Dr Bob Underwood (Host): Welcome to Pedscast, a podcast brought to you by Children's of Alabama. I'm your host, Dr. Bob Underwood. Clinical trials are the one of the key steps in developing the most modern and best medical therapies and to learn more about this We're speaking with the director of the pediatric clinical trials office at Children's of Alabama and the University of Alabama at Birmingham Dr. Matthew Cudney.

Dr Matthew Kutney: It's great to be here and I welcome this opportunity

Dr Bob Underwood (Host): It's wonderful to have you on.

So, tell us about your role as the Director of the Pediatric Clinical Trials Office. What do you do and what do you help arrange?

Dr Matthew Kutney: So, we see children here at Children's of Alabama in our division who are facing life threatening illnesses with cancer or serious blood disorders. So, the goal of our Pediatric Clinical Trials Office is to understand what improvements can we make upon the care that we're providing to these patients.

And as the director of that office, I'm really privileged to work with an amazing group of compassionate and dedicated researchers who make those trials possible.

Dr Bob Underwood (Host): So can you talk about some of the clinical trials that your team is or has been involved with?

Dr Matthew Kutney: Yeah, so we talk about our cancer patients, but we also have a large group of patients who are facing serious blood disorders or hematology patients.

So our group is quite a large clinical trials organization that's broken down into teams where we focus on certain diseases. We have our leukemia, lymphoma team, we have our solid tumor team. So they deal with cancers of the kidneys. liver, et cetera. We have a whole group focused on neuro oncology brain tumors.

We have a group that focuses on how we give stem cell transplants, and then also our hematology group dealing with sickle cell patients with people who have bleeding disorders or clotting disorders. So you can imagine kind of the breadth of the type of trials that are involved, but to focus in on just a few of those that I think are key illustrations of what we're trying to do.

One of the exciting things that has happened recently in oncology and particularly in pediatric oncology. is the movement from chemotherapy into immunotherapy and targeted therapies. So let me explain that for a moment. What we traditionally think of cancer treatments of chemotherapy are medicines that are damaging the cancer cells and killing them, but as a side effect, they're also damaging other healthy cells.

So certainly we want to move away from that. We now have targeted therapies that really look at or target into the changes that occurred in the cancer cells to turn them into the cancer cells. And those are unique processes that are different than the other healthy cells. So we've been fortunate to offer to our children here in Alabama, some amazing studies using these.

Targeted treatments, both in the solid tumor and the leukemia world, and those have been very successful. And then on that immunotherapy side, there's some exciting research that we've been able to participate in and lead here in Alabama, where we're actually engaging the child's immune system to fight off their cancer as if it were an infection.

Dr Bob Underwood (Host): I've been doing this for a while now as a physician and that is such a great change from when I started to really use your own immune system and monoclonal antibody therapy being able to target these specific cancers. It's really phenomenal and you've got a background also in bone marrow transplant, right?

Dr Matthew Kutney: That's right. That's right. And so for some of our patients, that's such an important treatment and we're privileged to be able to offer that very specialized treatment and service here at Children's of Alabama and our stem cell transplant or bone marrow transplant program is involved in providing that life saving treatment to many patients.

They're also very active and engaged now in this new area of cellular immunotherapy. So with some of my patients who have leukemia, we have excellent chemotherapy treatments and that cures most patients. But for those patients who don't respond to that initial therapy, one of the traditional approaches was to give them even more intensive chemotherapy and then go through a bone marrow transplant, which can have a lot of long term side effects.

And now we've engaged with our stem cell transplant team to offer some of those patients a chemotherapy. type of cellular therapy called CAR T cell therapy, where their own immune cells are taken into a lab and made such that they are programmed to fight against their cancer. And we've been able to offer that to some of the children of Alabama here, who otherwise would have had to go through those very intensive treatments with chemotherapy, stem cell transplant, and they've been able to respond to these new cellular therapies.

And that's really amazing to see these patients, how well they do. They tolerate the treatments and it's been a great success in our era of oncology.

Dr Bob Underwood (Host): Yeah, I think the progress and the modernization has just really been terrific and it's wonderful for the kids, really. So what about some work around genomics and precision medicine?

Dr Matthew Kutney: We diagnose a patient with cancer by saying, Not just that they have leukemia But that they have acute lymphoblastic leukemia and it's a b cell and not only that but that it is a philadelphia chromosome positive So there's all these layers to our diagnosis where we do very detailed investigations to understand the patient's individual cancer and what changes occurred in those cells to turn it into a cancer cell.

And so across the whole spectrum of our cancers, we are doing very detailed investigations so that we can offer the best and most targeted types of treatments and we call this an era of precision medicine and that's so important in children that we want to Give the most effective treatment that is tailored to that individual patient and also to understand the mechanisms that led to their cancer and really target those instead of all the other healthy cells that are in the body, as we mentioned.

Dr Bob Underwood (Host): It's just amazing. And we've already hinted at this, but in what ways do you feel your office at Children's of Alabama is really making a difference in the lives of children through these clinical trials?

Dr Matthew Kutney: We are one of the nation's largest clinical trial groups in pediatric oncology and in hematology.

We've been a leader in this area for a while now. I've been really blessed to be a part of this team that has seen extreme growth over the last five years. We've actually more than doubled the number of consortia that we're involved with so that we can offer across a wide spectrum, the best clinical trials that are out there right here for patients in Alabama, regardless of the type of disease that the patient is facing in oncology or hematology.

And that's been great for the families of these patients to know that they come to Children's of Alabama and they're receiving the very best care that can be offered.

Dr Bob Underwood (Host): Yeah. And it sounds like it's really setting yourselves up for future progress too. What are your goals for the future of the program?

Dr Matthew Kutney: I think that this expansion into the other consortia, what those means is these are groups of the best hospitals across the country coming together, understanding what progress needs to be made in the treatment of childhood cancers and blood disorders, and working together to find those best cures, so we are actively working together.

Expanding the number of consortia and partnerships that we have with other hospitals so that we can bring the best treatments here and at the same time getting into those much more complicated types of trials, as I mentioned, the cellular therapy, some of these immunotherapy that are really at the cutting edge, and we're now able to offer those across a number of different diseases.

And so I think the future is very bright for the clinical trials that we're able to offer for our patients here.

Dr Bob Underwood (Host): It's really just great work that you're doing. Anything else that you'd like to add for the audience while you're on?

Dr Matthew Kutney: Again, I'm privileged to work with a dedicated team here, but it takes a lot of resources and a lot of team members to put this complex clinical trials office together and to really to offer the best treatments to our patients.

So we are really indebted to the community, to the people of Alabama who have supported Children's of Alabama and the research that we do, and we really appreciate that support that they offer us.

Host: Once again, that was Dr. Matthew Kutny, Director of the Pediatric Clinical Trials Office here at Children's of Alabama. For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please subscribe and review it and share this podcast on your social channels, and be sure to check out the entire Peds Cast library for other topics that might be of interest to you. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Bob Underwood.