When pediatric cancer lasts into adulthood, one children’s hospital knows what to do

Childhood cancer sometimes persists well after a patient grows up. That’s when specialized treatment comes into play.

By WP BrandStudio

The summer Jesus Sanchez turned 18, he was helping his uncle with some landscaping when it suddenly became harder for him to push the lawnmower. He had been feeling tired and losing weight for a while, and noticed he was bruising more easily. So on the day he began to feel weak doing yard work, his father took him to a doctor. After a blood draw, he was sent to the emergency room where it was confirmed: he had leukemia.

“I was scared,” Jesus recalled. “I had no idea that at that age, I would get hit with something like that. I was still trying to figure out what life was like after high school.”

Despite being a legal adult at the time of his diagnosis, Jesus was still considered a pediatric patient, a classification given until the age of 20. These kinds of patients, who are not children but also not fully adults, have a specific set of needs and often deal with cancers that can be harder to handle.

I was scared. I had no idea that at that age, I would get hit with something like that. I was still trying to figure out what life was like after high school.

Jesus Sanchez

Teens and young adults like Jesus, who was diagnosed with B-cell acute lymphocytic leukemia, face a higher risk of relapse. They’re more likely to have genomic mutations in their cancer cells that can lead to a poor prognosis, said Kara Davis, pediatric oncologist at Stanford Children’s Health and Assistant Professor of Pediatrics at Stanford University School of Medicine. For them, groundbreaking, specialized care is often the key to success.

Jesus in the hospital after his second transplant.
Jesus in the hospital after his second transplant.

The care team at Stanford Children’s Bass Center for Childhood Cancer and Blood Diseases understands this need for innovation. For years, they’ve been pioneering new ways to treat persistent childhood cancer while addressing the physical, emotional and social needs that are unique to young adult patients.

“We have to help adolescents like Jesus transition to adulthood,” said Pam Simon, NP, director of Stanford’s Adolescent and Young Adult Cancer Program. “He’s an adult. He has an adult body. We have to figure out all these different things in trying to take care of that patient. Yes, with the cancer, but everything else that comes with the cancer, as well.”

Stuck in the middle

Young adult cancer patients are a mobile population with a multitude of long-term goals. They visit the hospital for treatments then go back to school or work. They’re often in the process of establishing their professional lives and some of them are beginning to think about starting a family. During his 10-year experience with leukemia, for instance, Jesus went to school, managed a farm, maintained a relationship and regularly played sports like volleyball and soccer.

But a lot of pediatric cancer centers aren’t built to accommodate this kind of evolving, goal-oriented existence. So in 2015, Simon spearheaded the creation of an Adolescent and Young Adult Cancer Program (AYA), a collaborative effort between Stanford Children’s Health and Stanford Health Care. Simon’s goal was to address some of the non-cancer needs of pediatric patients, like finding a career path that matches their circumstances and abilities, understanding health insurance as an adult, and navigating fertility and mental health care (both of which can be impacted by cancer and cancer treatment.)

Whenever I’m at the hospital, the nurses make me so comfortable. They always find the right person that I can talk to about whatever I need.

Jesus Sanchez

The AYA program also connects adolescent patients to one another, so they can forge relationships with people who are in similar places in their lives. And it keeps patients informed about any clinical trials happening at Stanford that may be beneficial to their treatment.

Arguably the most important facet of the AYA program is communication. Young adults don’t need the constant care that young children do and they’re often able to make their own informed decisions about treatment. Knowing this, the AYA program helps young adults process the physical and emotional stress of their diagnosis and care in a developmentally appropriate way.

Dr. Kara Davis explains treatment advances in pediatric leukemia.

For Jesus, the clear and honest dialogue he had with his doctors was one of the most memorable aspects of his time at Stanford Children’s Health.

“The communication was very helpful from day one, especially from Dr. Davis who explained complicated treatments—I had never gotten so much information,” he said. “Whenever I’m at the hospital, the nurses make me so comfortable. They always find the right person that I can talk to about whatever I need.”

Jesus at a follow-up appointment after his first transplant.
Jesus at a follow-up appointment after his first transplant.

 CAR-T turnaround

Meeting patients’ developmental and emotional needs is just one part of the treatment puzzle at Stanford Children’s Health. The hospital’s staff and leadership also work tirelessly behind the scenes to give patients access to cutting-edge research and treatments that they couldn’t receive elsewhere.

Jesus, whose cancer has at times been aggressive and unresponsive to treatment, knows this well. Between 2012 and 2017, he underwent two bone marrow transplants and faced two relapses. By 2017, right after Jesus’s second bone marrow transplant, Stanford Children’s Health was continuing to innovate with a form of immunotherapy known as CAR-T therapy, which utilizes a patient’s own T cells to detect and combat cancer. T cells already exist in every human body. They’re designed to combat unhealthy or invading cells, even those found in cancer. But in some instances, T cells aren’t strong enough to fight illness. CAR-T treatment genetically modifies a patient’s T cells so they’re equipped to destroy cancer.

“The cells basically become snipers,” said Davis. “If we think about chemotherapy as a bomb that you could drop and it kills everything, these cellular therapies are much more targeted than that.”

Researchers and clinicians are still learning exactly how CAR-T works, but one thing is clear: it can reduce relapse by as much as 70%. Before CAR-T, it was common for some patients to continually relapse, despite trying new therapy after new therapy, said Tanja Gruber, MD, PhD, chief of pediatric hematology, oncology and stem cell transplantation at the Bass Childhood Cancer Center and a Professor of Pediatrics at the Stanford University School of Medicine.

“What we’re realizing now is that CAR-T is very, very effective at putting patients into remission, and a subset is maintaining those remissions,” said Gruber.

In 2018, the FDA approved Tisagenlecleucel, a CAR-T therapy designed to treat relapsed childhood B-cell ALL—the type of cancer that Jesus had been battling for years. Together with Dr. Davis, Jesus decided to move forward with trying it. Today, two years after receiving the treatment, his cancer is still in remission.

Many of our patients have been told they can’t be cured, so when you provide them with another therapy to try, and the hope, there’s nothing like it.

Dr. Tanja Gruber, MD, PhD, director of Stanford Children’s Bass Center for Childhood Cancer and Blood Disorders

CAR-T is relatively new, which means there’s still a lot to learn about it. While it’s more effective than other treatments at preventing relapse in patients who have exhausted other options, there is still a chance of cancer reappearing after receiving CAR-T treatment, according to Davis. Going forward, Stanford researchers and physicians are working to understand why relapses happen, and trying to prevent them. Stanford doctors are also leading the development of new types of CAR-T therapy that attack different kinds of cancer, including solid tumors.

Jesus with Pam Simon.
Jesus with Pam Simon.

The ultimate goal, said Gruber, is for Stanford to provide the most innovative and effective care based on treatments developed across the university.

“Many of our patients have been told they can’t be cured, so when you provide them with another therapy to try, and the hope, there’s nothing like it,” said Gruber.

A new lease on life—even with COVID

These days, with CAR-T cells still present and signs of ALL absent, Jesus likes to spend time with his girlfriend and his dog, working in the garden or playing sports with friends. He had to take a break from some of his regular activities recently when he contracted COVID-19 in the spring. But even while dealing with complications from the virus, likely due to his compromised immune system, Davis said he came to the hospital with his usual laid-back style.

“He says, ‘It’s fine. I know I’m in good hands. Let’s figure this out,’” she said. “He always makes us think.”

Jesus and his girlfriend.
Jesus and his girlfriend.

For his part, Jesus tries not to spend too much time worrying—about his health or anything else. His years spent in a hospital room made him realize what he’d taken for granted. And while it was hard to see others his age reach different points in life as he struggled to stand still, it’s also hard for him to imagine how his life might have been if he hadn’t been treated at Stanford Children’s Health.

“Dr. Davis is somebody that I don’t feel like I can be separated from at this point,” Jesus said. “During treatment, I always had somebody nearby when I really needed them, 24 hours a day, taking care of me.”

Learn more about Stanford Children’s Health Bass Childhood Cancer Center.

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