OMPRN is excited to welcome Dr. Natasha Kekre, a distinguished hematologist at The Ottawa Hospital and a pioneer in the field of CAR-T cell therapy and stem cell transplantation.
Dr. Kekre has dedicated her career to advancing treatment options for patients with blood cancers, blending clinical expertise with a profound commitment to research. Her work is particularly notable for its focus on bringing novel, made-in-Canada therapies to clinical trials, ensuring Canadian patients have access to cutting-edge treatments.
Beyond her clinical and research roles, Dr. Kekre also serves as the physician co-chair for the equity, diversity, and inclusion committee at The Ottawa Hospital, highlighting her dedication to creating a more inclusive and equitable healthcare environment.
In this interview, we delve into her journey in medicine, her groundbreaking research, and her vision for the future of cancer treatment. Join us as we explore the challenges and triumphs of hematology through the insights of a true innovator.
Interview conducted by Terry Hawrysh via email on July 22, 2024.
Dr Kekre, please tell us a bit more about your medical training and where you completed your clinical fellowship.
I did my medical school at the University of Ottawa after finishing a bachelor’s degree from University of Windsor, Ontario. I then went on to do my internal medicine and hematology residency training here in Ottawa at The Ottawa Hospital. After that I went to Boston, Massachusetts to pursue a fellowship in stem cell transplantation as well as a master’s in public health from Harvard University. I took a few months off and then started my job in October 2015 as a hematologist. I have been treating patients with blood cancers since that time.
Can you tell us a bit more about your role at the Ottawa Hospital?
At The Ottawa Hospital, my role is mostly focused on research. 75% of my time is dedicated to research related to stem cell transplantation and a new immunotherapy called CAR-T cell therapy. My role is mostly focused on bringing these novel therapeutics specially made in Canada therapies, to clinical trials for Canadian patients.
In addition to that, I currently hold a role as the physician co-chair for the equity, diversity and inclusion committee for The Ottawa Hospital. In addition to that, as with all physicians at our site, I take a role in education, teaching our medical students, residents and clinical fellows. I also co-supervise students working on a masters or PhD thesis.
What does your typical day look like?
Right now my day mostly consists of meetings with research collaborators and scientists, writing grants, writing papers for publication and monitoring the data for patients treated on my clinical trials. I do clinics as well where I see patients who are undergoing stem cell transplant or CAR-T therapy, as well as patients being considered for these treatments. On clinic days, part of my time is dedicated to follow-up of patient care which includes blood work and test results.
Who are you most thankful for on the care team you work with and why?
Currently my care team includes nurses, social workers, nurse practitioners, physician assistants and general practitioners specialized in oncology. All of these people play a very important role in my clinical work.
The most important person currently for me is the nurse practitioner who is dedicated to CAR-T cell therapy. She runs the CAR-T cell program and ensures that all of our patients receive adequate follow-up and are booked and planned appropriately for their therapies. Without her, I could not dedicate so much of my time to research because I would need to see more patients.
If you would like to read up on the different roles of other cancer support professionals, view the ‘support professionals in cancer care’ page for a breakdown here.
What do you find most challenging about your role?
The most challenging part of my job is probably that I have to maintain a balance between research and clinical work. Sometimes when there are large grants due for example, I would like to spend the time dedicated just to research and grant writing, but my clinical roles are always there, and clinics and patient care have to be a priority. This can be a tough balance, but I am lucky to be heavily supported by strong physician colleagues as well as nurses and physician assistants and practitioners who can help to ensure that my research program continues to run smoothly.
“Currently as a CAR-T research clinician in Canada, my role is primarily focused on bringing these novel therapies to Canadian patients who otherwise would have no access to these therapies and often have no other treatment options”.
What about your role gives you the greatest satisfaction and motivates you the most?
Currently as a CAR-T research clinician in Canada, my role is primarily focused on bringing these novel therapies to Canadian patients who otherwise would have no access to these therapies and often have no other treatment options. This means that I often see very sick patients who have really run out of options and are looking for clinical trials. It is the most satisfying when the work we have put into the clinical trials benefits a patient like this.
Can you tell us a bit about your research and it potential benefits to cancer patients?
I currently work on a relatively new immune therapy called CAR-T cell therapy. This involves using the patient’s own immune cells to re-engineer them to fight their cancer cells. This therapy has now been around for about 10 years but has been very slow to enter practice in Canada. For these reasons I have always been motivated to bring these new therapies to our cancer patients in Canada.
Myself along with a group of physicians and scientists across Canada worked together to build a made-in-Canada CAR-T therapy program. Our first clinical trial was built for certain types of relapsed or refractory leukemias and lymphomas. We were able to show that for the first time in Canada we could make this therapy and provide it to patients. We have now seen success with this program and are building further clinical trials for other cancers and other diseases that could benefit from this therapy.
Why should patients consider participating in clinical trials vs following regular standard of care options?
The reason to participate in clinical trials is that it allows us to find new and better therapies for patients. Sometimes trials are needed to find therapies that have less side effects and sometimes it means finding therapies that have a higher rate of cure. Usually in a clinical trial where we compare a standard of care option to a new therapy, we have to have some sort of clinical equipoise. This means that we do not believe that the new therapy is more harmful than the current therapy, but we do not yet have proof that it could be better.
Therefore, when we weigh the risks and benefits of the new therapy against our standard of care options, we believe that there is no right answer about which might be better. The only way to do this is for clinical trials to directly compare standard of care options versus the new experimental option. Often, we can learn a lot about patient reported outcomes, clinical outcomes and unexpected or expected side effects of the experimental therapy from doing clinical trials like this. All of this is required for us to advance new therapies into standard of care for our patients.
View our ‘clinical trials’ video for more information on how clinical trials work.
Your research team has collaborated with patient partners in the earliest stages of your clinical research – how did that work out?
We have been very fortunate to have a large group of patient partners that we have collaborated with right from the beginning. These patient partners have helped with our consenting documents, clinical trial protocol design, and ensuring that we are considering the patients’ and their caregivers’ needs throughout the clinical trial. This even led us to build a visual consent form that provided a 1-page graphic document that would easily illustrate to patients what they would undergo during the clinical trial.
We continue to partner with patients as we build the next set of clinical trials as well as to help support our vision of affordable and equitable access to care for these new therapies. This means that we are continuing to involve patient partners in our economic analyses and our quality-of-life assessment for these therapies.
Consult the video ‘being an active participant in cancer care’ for more information on the benefits of becoming an active participant in your cancer care.
The early detection and early intervention of cancer is important to improving the outcomes of patients by hopefully avoiding more toxic late-stage treatments – how do envision this being done in a clinical environment? Are you there yet?
This is outside of my scope of practice, but in general the better we get at detecting cancer early and intervening early, the more likely we are to avoid significant side effects and have long-term responses. This has been true for all cancers in general, illustrating that early detection leads to better overall outcomes. For this reason, we need to do better at early detection strategies. While this is outside of my scope right now as I am mostly treating patients beyond second and third line of care, I do think that our clinical environment needs to be built to accommodate the growing need for early detection. This means early detection by imaging, genetic studies and probably many other tests.
Based on your clinical experience, what are the top three most important questions patients should have answered by the clinician during diagnosis and treatment?
I think that is a really tough question because different patients will have different priorities at their diagnosis and treatment discussion with their physician. I think one of the most important things is for patients to ask their physicians what their prognosis is with frontline therapy. This sets the patient and their caregiver’s expectations for the beginning of treatment. In addition, although these conversations are difficult, it is important for patients to express their wishes about what level of care they would want if they were to get very sick and have a terrible quality of life secondary to their cancer or other treatments. Lastly, I would always encourage patients to ask when they are presented with a treatment, what are the alternatives and why did the physician specifically choose one treatment pathway over another.
To view more on the typical questions to ask a certain healthcare professional, please consult our ‘support professionals in cancer care’ infographic.
Can you describe how molecular pathology contributes to your clinical research and activity as a clinical hematologist?
As a hematologist, molecular pathology helps to risk stratify patients with certain leukemias and lymphomas. The pathology results therefore tell us if the patient is at risk of relapse or progression of their cancer from their first line or treatment. This helps us to either be more aggressive in our approach for treatment or can set up the expectation that we might need second or third line therapies. As these genetic and other molecular signatures develop, the further we can risk stratify patients based on these results, the more detailed we can be in our discussions of prognosis and treatment options. In addition, the development of molecular pathology is growing an entire field of more targeted therapies in cancer, which can specifically target a cancer-related mutation if a tumour has that mutation.
Consult our infographic on ‘what is molecular pathology’ for more information.
What do you envision as is the “next big thing” in the treatment of cancer patients?
I think that immune therapies for cancer such as CAR-T therapy are already evolving. I think the next big thing that we are going to see is further advancing this technology so that we can turn on or off the CAR-T therapy, create combination CAR-T therapies, and further manipulate the technology in ways we have not yet seen invented. This will make CAR-T therapy more accessible for more tumour and possibly other disease types.
Conclusion
We are grateful for Dr. Natasha Kekre’s insights, which illuminate the multifaceted care provided to patients with blood cancers. Her dedication to advancing treatment through both clinical practice and pioneering research exemplifies the commitment of professionals at The Ottawa Hospital. This interview highlights the critical role of innovative therapies, such as CAR-T cell therapy, and the importance of a collaborative, comprehensive approach to cancer treatment. Dr. Kekre’s work not only brings hope to patients in Canada but also underscores the importance of collaborative efforts for successful cancer treatment. We hope this conversation with Dr. Kekre offers valuable information and reassurance to patients and families navigating the complexities of cancer treatment.
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