Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're talking with Dr. Katie Metrock, Director of the Pediatric Neuro-Oncology Program here at Children's of Alabama. Dr. Metrock, thanks so much for your time.

Katie Metrock: Thank you for having me.

Host: So, I want to talk first about Pediatric Neuro-Oncology in general. Can you tell me a little bit about this field and kind of what it's all about?

Katie Metrock: Sure. Pediatric Neuro-Oncology is a field of Medicine within Oncology that focuses on treating children and young adults with brain and spinal cord tumors.

Host: So, tell me a little bit about what led you to pursue a career in this field. What made this appealing to you?

Katie Metrock: So, when I was a young girl, my aunt had a brain tumor. And I went to visit her in the hospital and was very fascinated by all that was happening. Fortunately, my aunt did quite well, but that really sparked my interest. And from there, as I grew older, I started shadowing doctors in various fields of Medicine. And eventually, I worked at a camp during college for children with cancer. And I got to meet and spend a lot of time with a young patient with a brain tumor. So when I went to Medical school and residency, I tried to keep an open mind and looked at all the different types of fields. But I think, ultimately, I knew this is the space I wanted to be in to help these children to get them better treatments. So, it's been a very lifelong journey for me, but I absolutely love this field.

Host: A couple personal experiences, I guess, that really kind of led you in this specific direction.

Katie Metrock: Absolutely.

Host: And all these years later, you are now the Director of Pediatric Neuro-Oncology Program here at Children's of Alabama. You were named the director last year. So, I want to talk about that program in particular. About how many patients do you serve each year and what different types of conditions go into this?

Katie Metrock: Well, here at Children's, we see over 70 new patients a year with brain and spinal tumors. These may be low-grade tumors. So by that, I mean slow-growing, less aggressive tumors. Then, we also see tumors that are much more aggressive, such as high-grade gliomas, medulloblastomas, patients that have ATRT, those are aggressive cancerous tumors. We also see patients that have neurofibromatosis, which is a genetic condition that predisposes patients to get different types of tumors, including brain and spinal tumors. We are very dedicated to providing the very specialized care that those particular patients need as well.

Host: I imagine these can be very challenging conditions to deal with for both the patient and the family.

Katie Metrock: Absolutely, yes.

Host: Is it rewarding for you to be a part of these patients' lives and see the way that you're able to help them progress and deal with, you know, what they're going through?

Katie Metrock: Absolutely. I am amazed at our patients day in and day out of how they are handling what they're going through, the patients, their families. And I'm very grateful for the team that we have here to be committed to helping them through that journey for whatever that means to each patient, right? Because they're each their own little person or young adult. And so, they're getting hit with these diagnoses at different stages of life, and it takes a specialized team to help them navigate that. And again, yeah, I'm every day, just amazed at what these kids are capable of.

Host: And you mentioned the team, and I know that's something you've talked about a little bit, is how big teamwork is in terms of the approach to caring for these children. Can you talk about how much of a difference that makes all the members of the team coming together to help each of these kids?

Katie Metrock: I think having what we call a multidisciplinary approach to their care is essential. Patients that come here, they should expect specialized, comprehensive care and, like you were saying, being diagnosed with this is one of the scariest things that can happen to a family. And the team that we have here is dedicated and committed to helping families navigate that water. And, as a part of our team, we have four neuro-oncologists, pediatric neuro-oncologists. We have three pediatric nurse practitioners. We have a Child-Life specialist, chaplains, social work, neuropsychology. We have a team of researchers that are in the background, trying to make better treatment programs for these children. So, it takes all of us working together to help them through this entire process.

And on top of that, we have a fantastic team here of neurosurgeons and neurologists that are just as committed to these patients. Like I was saying, for a patient with a brain tumor, they come in, they often need surgery, so that we know what type of tumor it is. And that we can learn more about that tumor and if there's targeted specialized approaches for that particular tumor. And then, they need the team of people around them to help them through whatever side effects that they're going through from their tumor.

And so, ever since coming here to Children's, I have been blown away with the teamwork approach. That's from all angles within our own team, but then also including, for example, those neurosurgeons. Our Neurosurgery team here, they're absolutely top of the line and they are committed. They have open lines of communication. It is a special, special place to be to help these patients get what they need quickly and to know it's going to be the best care possible. We also have a very great relationship with Radiation-Oncology. So, these providers are the team that when radiation is necessary, they work with us to help develop a plan for these patients that may involve what's called photon radiation versus proton radiation, and what's the best, safest plan that is tailored to each individual patient. And like I said, it's great to work with a group of people that just have such open communication, and are able to provide each other feedbacks with the patient at the center.

Host: And you mentioned all the different disciplines, all the different types of medical professionals that are involved in this. And I guess that just ensures that when a patient comes to Children's with one of these conditions, that everything they need, everything their family needs is going to be thought of and taken care of in one way or another by a member of this team.

Katie Metrock: Yes. When they come in, the first, you know, item that we need to know is what type of tumor and how do we treat it. But I think you can get tunnel vision with that. And you really have to see that this is a child and they have their whole life leading up to this, their whole life around them, and then the life that they're going to move forward with after this. And so, how do we meet them where they're at and how do we help them move forward with the best success possible? And that's where that whole team comes in, where we have everybody around thinking about all aspects of what that journey is going to mean for them. And again, having that communication where everybody's available, everybody is ready to step up and be there for that family is incredibly important.

Host: The team certainly works hard and communicates well to make sure that the family and the patient's needs are met throughout the process that they're going through. You mentioned the researchers a minute ago as a part of this team, and I know that's a big part of this. Can you talk about some of the research that you and the team are involved in?

Katie Metrock: Yeah. Research is vital to moving this field forward. And there's different types of research when you think about it. So, there's the bench research, which is the laboratory-based research, where we're really at the front line trying to figure out what's driving these tumors, what's making them resistant to the tumors, the treatment regimens we have, and what are better treatment options available.

And then, we have the translational, moving that from the bench to the bedside to make it available for patients in a way that is safe. And so, you know, when we talk about research, we're talking about all of that. And right now, in childhood cancer, brain and spinal tumors are the leading cause of childhood cancer death. And so, we have a long way to go. And so to me, Making research at the forefront of our mission is huge. We have to do better for these kids.

We have researchers here. For example, Dr. Rintaro Hashizumi, he's doing research on how to deliver medicines more effectively. So, you think about the brain and spine, it's very well-protected from the rest of your body, and it's designed to be that way, right? It's supposed to be protected. But when there's a tumor in there that causes problems, when we're trying to get treatment regimens into the tumor, that protective barrier can be a problem. That's called the blood-brain barrier. So, Dr. Hashizumi's research is looking at ways to deliver therapies, actually, intranasally or through the nose. So, thinking outside of the box.

Host: Really innovative stuff.

Katie Metrock: Absolutely. And then, like I was saying before, how do we do that safely and efficiently? And that's where these clinical trials come into play. So, we are a part of multiple clinical trial research consortia here. And a consortium is a group of hospitals that have teamed together to try to move research more efficiently for patients. It can take years to run a clinical trial. And fortunately, pediatric cancer is rare, but it obviously does happen. And if we all tried to work within our own bubble, we would never move the needle. So by pairing up, by teaming up, we can enroll patients on clinical trials more quickly, and then learn what the research question is, learn from that. And hopefully, if there's a treatment that's better than what we have, we can move it forward faster and make that more available for patients.

So here at Children's, we're a part of multiple consortia. We're a part of the Children's Oncology Group, including their phase I consortia, which is CTEP. We're a part of the Pediatric Neuro-Oncology Consortium, which is also called PNOC. We're a part of Sunshine. And we have partnerships with multiple other consortias. So having that partnership allows us to offer those trials to our own patients, but then also allows us to be part of moving this field forward in a way that, like I said, we have to do it safely and we have to do it efficiently.

Host: It's working on it yourselves, but also working hand in hand with other hospitals around the country and around the world, really.

Katie Metrock: Yes. Yes.

Host: And you can certainly make a lot of progress that way. Yeah, I can tell you're passionate about the research side of this for sure, and also the patient care side. With those things in mind, what are your goals for the future of this program here at Children's?

Katie Metrock: I have several. But I think to kind of break them down, first, you know, I think about them as clinical goals and then those research goals, and then there's absolutely, as I just talked about with clinical trial research, there's overlap there as well. But from a clinical standpoint, it is my goal that every single patient that comes through this door feels like they have a team of people that are fighting for them, that are on their team, that are helping them through this. I don't want any patient to ever feel like they're alone or any family to feel like they needed more. And so, as a team, that is our mission and that is our goal to make sure year after year, we are delivering the highest standard of care to every single patient that comes through Children's door.

 From a research perspective, I mentioned the clinical trial consortiums we're a part of. I think we can continue to be a part of those, and we can continue to be a leader within those consortiums. We have the basic science here that we can bring forward to move those available to patients at these other institutions as well through this consortia. So, I think we have the ability to be a leader in research in Pediatric Neuro-Oncology.

Host: And a lot of people on your team, I think have important leadership roles within the world of Pediatric Neuro-Oncology, correct?

Katie Metrock: Yes, that's true. We have several of us that are involved in leading clinical trials. Dr. Girish Dhall, who is the Division Director here of all of Pediatric Hematology Oncology. He has a Neuro-Oncology background. So, he leads several different trials with various consortia involving medulloblastoma, involving germ cell tumors. So, he is at the forefront of that research and has been for years, and is continuing to lead the way to make better treatments available.

I'm working with Dr. Cassie Kline at Children's Hospital of Philadelphia to lead a clinical trial through PNOC, that is for patients with craniopharyngioma. In the past, the specific tumor type, there were really only surgical options or radiation, but we are trying to figure out if there are other medical options that we can provide for these patients. And that's just to mention a few. We have several, several different trials that we're actively involved in helping lead right now.

Host: A lot of people in leadership roles here, and you're also laying the groundwork for future leaders as well with the fellowship program, correct?

Katie Metrock: Yes. So, what that means is we have physicians that have gone through medical school and their residency. It might be a Hematology-Oncology. They go through their pediatric residency and then through their fellowship. So, they may do a residency in Pediatrics or they may do a residency in Neurology. And then often, they complete the Hematology-Oncology fellowship, which is a three-year fellowship focused on general blood and cancers. But the Neuro-Oncology fellowship is a one-year additional fellowship where a physician that is interested in this field can spend extra time becoming intricately involved in every aspect of the field. So, they have rotations with Neurosurgery where they're actually accompanying the neurosurgeons and watching what do these tumors look like in the operating room, what does that look like for the patient. They're following that tissue from the operating room down to pathology, which means they're getting to look at the tumor under the microscope in real time with the pathologist as they're learning what type of tumor this is, making decisions on exactly what needs to be done with that tissue that we have to learn more about the tumor.

And then, they are seeing every patient that walks through the door, as early on in that diagnosis as possible and walking them through it. So, that year becomes a year where they're so involved at the deepest level that they come, out with a deeper, deeper understanding of what it means to be a pediatric neuro-oncologist and how to help these patients. So, we've started that program a few years ago. We have trained Dr. Beth Littrell, who, when she completed her fellowship, we hired her here to become one of our pediatric neuro-oncologists. She is actually from Alabama and has a very strong passion for treating children from Alabama with these types of tumors. And we will continue doing that. That will help move this field forward to provide specialized care for patients with brain and spinal tumors.

In addition, we are starting a global Neuro-Oncology fellowship to help bring what we're doing here in the United States to children in areas of need outside the world. How can we do that to help them, especially in areas that aren't as fortunate as us? How can they deliver good care to, to kids in those places that are in need?

And lastly, we have recently developed a partnership with St. Jude, specifically to develop an educational program in the realm of neurofibromatosis for again places in need that don't have as much expertise in treating neurofibromatosis and neurofibromatosis-related tumors. How can we bring care to them? What kind of models of healthcare can we provide that will be effective in those areas? So, we have some very exciting educational opportunities that we're moving forward right now,, and I'm very proud of those. I think it it's the way that we can keep our field moving so that we can do better for all of the patients.

Host: A lot of great things going on in this program now and certainly laying a great foundation for the future as well. Once again, Dr. Katie Metrock, Director of the Pediatric Neuro-Oncology Program here at Children's of Alabama. Thanks so much for your time.

Katie Metrock: Thank you. I appreciate you having me.

Host: Thanks so much for listening to Inside Pediatrics. For more podcasts like this one, go to any platform where you can find podcasts or childrensal.org.