Treating blood cancers in prisons is possible and increasingly effective, but it requires careful planning, a doctor at UConn Health said this week.
Prison clinics face unique challenges
Swarup Kumar, an assistant professor of medicine in the Division of Hematology and Medical Oncology at UConn Health, spent three years running an oncology clinic inside a Department of Corrections facility. The work provided opportunities to mentor fellows while managing a patient population with distinct logistical and medical needs.
One incarcerated patient received bispecific antibody therapy, a treatment that targets cancer cells while sparing healthy tissue. Kumar noted that such treatment is achievable with sufficient planning, coordination with authorities, and hospital-based administration for early doses. Once patients respond well, treatment intervals can often be extended safely from every two weeks to monthly or even every eight weeks, reducing infection risk and hypogammaglobulinemia while preserving response.
The experience demonstrated the need for adaptable treatment planning.
New therapies change treatment approaches
Kumar also addressed the broader effects of emerging therapies for relapsed or refractory multiple myeloma, a cancer of plasma cells. The increasing availability of bispecific antibodies, CAR T-cell therapy, and antibody-drug conjugates (ADCs) has expanded options for patients who have exhausted other treatments. These advances require doctors to adjust their approach—moving from managing the disease as a chronic condition to pursuing therapies that could lead to deep remission or even a cure.
His method for selecting among these options considers age, comorbidities, and functional status. Older patients with significant health issues may not benefit from aggressive, potentially curative therapies if the risks outweigh the benefits. Younger, healthier patients might be directed toward more intensive, fixed-duration treatments aimed at long-term remission.
Related: User Blocked After Repeated Policy Violations
Clinical trials remain a priority when a patient’s profile matches an available study. For approved therapies, Kumar typically favors bispecific antibodies over ADCs, pointing to more robust data and industry momentum toward fixed-duration regimens with high minimal residual disease–negativity rates, particularly for older patients with aggressive disease needing rapid control.
UConn Health does not yet offer CAR T-cell therapy on site but partners with nearby centers to provide it, with in-house capability expected soon. ADCs, such as belantamab mafodotin, are largely reserved for patients who have not responded to CAR T-cell therapy or bispecific antibodies, citing manageable but notable ocular toxicity monitored with ophthalmology support.
Kumar’s approach aligns with a broader trend in oncology: the growing personalization of cancer care. As new therapies emerge, doctors must consider not only the biological characteristics of the disease but also the practical aspects of the patient’s life. This includes coordinating with authorities or balancing treatment intensity with quality of life.
The move toward fixed-duration therapies, where treatment is given for a set period rather than indefinitely, alters how doctors and patients view cancer. Some see it as a path to a treatment-free future. Others must weigh a range of options, each with its own risks and benefits.
Kumar’s clinic showed that even in constrained environments, effective care is possible with the right adjustments.
