The oncology and palliative care nurses at Royal Jubilee Hospital (RJH) can’t help but smile. While these nurses care for very sick patients and those at the end of life, they are thrilled to be one of the first medical teams in the province to offer a potentially revolutionary new approach to cancer treatment.
Mackenzie Gavidia-Alas and Erica Kroeger — two nurses who have each spent more than a decade working in oncology for Island Health — know they’re part of something special. “I love oncology,” said Kroeger, a clinical nurse educator whose career started in Saskatoon before she joined Island Health in 2012. “I find it absolutely fascinating.”
Gavidia-Alas, who started in oncology right out of nursing school in 2012 and now manages the cancer care program at RJH, “has seen a ton of change in cancer treatment in the last decade. It’s pretty incredible,” she said, “to see where we were 10 years ago and where we’re at now.”
One of those huge leaps in cancer care is happening right now. While many have likely never heard of bispecific T cell engagers, these new drugs are showing great promise for treating a range of cancers, including blood cancers like lymphoma and multiple myeloma and certain melanomas. The oncology department at RJH was one of the first hospitals in the province to bring these medications into circulation, thanks to a partnership with BC Cancer – Victoria that started in June 2022. There are no financial costs for patients who qualify for bispecific T cell engagers.
Dr. Ashley Freeman, a medical oncologist and malignant hematology lead at BC Cancer – Victoria, was instrumental in bringing bispecifics to RJH. In Dr. Freeman’s words, BC Cancer “partnered with the Royal Jubilee Hospital to do this because it is our main cancer treatment hospital on the Island, and they have an excellent record of supporting cancer therapy.”
“It was great working with RJH because they recognized the value in this exciting new class of cancer therapy and worked quickly to implement it. As a result, we were the first centre outside of Vancouver to be using these medications in the province. Their support and partnership were the most important thing in getting this up and running,” Dr. Freeman said.
So, what are bispecific T cell engagers? “It's an antibody treatment that simultaneously binds to a cancer cell and a T-cell,” Dr. Freeman explained. “And the idea is that the T-cell kills the cancer cell.”
A type of immunotherapy, bispecific T cell engagers use the body's own immune system to fight cancer. When the drugs bind to the cancer cell and the T cell, Kroeger explained that “the T cell recognizes the cancer cell as foreign and not okay and then activates an immune response to then have the immune system kill off all of these cancer cells that have that specific marker on the surface.”
While traditional chemotherapy takes what Kroeger called “a shotgun approach” to cancer treatment and kills all rapidly dividing cells, both the good and the bad, bispecific immunotherapy is much more targeted on the cancerous cells only. “What it’s doing is harnessing your immune system’s ability to target those bad cells — those cancer cells — and kill them off,” Kroeger said.
While Kroeger and Gavidia-Alas are both motivated by the ever-evolving science, ultimately, they draw deep inspiration from being part of something much bigger than themselves. “You get to be a part of someone's journey through the hardest time of their life and support them through that, and then either have them be successful in their treatment or support them with end of life,” Gavidia-Alas said. “It's just such an honor to be able to do that, to be a part of their care journey.”
Both nurses recognize that it is still early days for bispecific medication, but they have high hopes for the future. “Even 10 years ago when I started it was mostly just chemotherapy. Immunotherapy was this thing that was coming out, and now we have these bispecifics and it's just going to snowball,” said Gavidia-Alas.
As Dr. Freeman reflected on how the partnership came together and where it could lead, she emphasized the importance of health authorities finding ways to bridge gaps and work together. “When it [bispecific antibodies] works, it has the potential to work really well for people. It's just so important that…the different health authorities come together to facilitate our ability to give these treatments because as cancer care evolves, it's becoming more complex,” she said. “We really do need the support of our broader system to deliver the care. This is a good example of two different health authorities coming together to make that happen.”
To find out more about bispecific antibodies, visit BC Cancer. Bispecific T cell engagers, also known as bispecific antibodies, are one type of therapy that may be used in the treatment of certain cancers. Patients are encouraged to talk to their oncologist about what treatments are best for their particular cancer.