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Perioperative pembrolizumab plus chemotherapy improves overall survival in patients with resectable gastric cancer.

Pembrolizumab Plus Chemo Improves Overall Survival in Resectable Gastric Cancer

Durable complete responses were observed in patients with TP52-mutated mantle cell lymphoma treated with ibrutinib plus venetoclax.

Ibrutinib-Venetoclax Combo Elicits Durable Complete Responses in TP53+ MCL

Adding brentuximab vedotin to lenalidomide/rituximab results in a stronger overall survival benefit compared with lenalidomide/rituximab alone in relapsed/refractory diffuse large B-cell lymphoma.

Brentuximab Vedotin Triplet Provides Stronger Survival Signal vs R2 in R/R DLBCL

The overall survival rate in patients with advanced biliary tract cancer treated with durvalumab plus chemotherapy was nearly double the rate of those treated with chemotherapy alone.

Durvalumab Plus Chemo Shows Sustained Survival Benefit in Advanced Biliary Tract Cancer

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Caroline Seymour joined MJH Life Sciences in 2018 and has expertise in video production and print/digital publication. Email: cseymour@onclive.com​

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Findings from the RATIONALE-306 trial support treatment of tislelizumab plus chemotherapy for PD-L1-positive ESCC.

Adding Tislelizumab to Chemo Enhances OS Benefit in PD-L1+ Esophageal Squamous Cell Carcinoma

Adding dostarlimab to chemotherapy improved survival vs chemo alone in primary advanced or recurrent endometrial cancer.

Dostarlimab Plus Chemo Exhibits Overall Survival Benefit in Endometrial Cancer Regardless of MMR Status

The monitoring period after CAR T-cell therapy may be safe if shortened due to the lower incidence of ICANS and CRS 2 weeks after treatment in patients with DLBCL.

Lower Rates of ICANS, CRS 2 Weeks After CAR T May Support Shorter Monitoring Period for DLBCL

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Archana Ajmera, RN, MSN, WHNP-BC, ANP-BC, nurse practitioner, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses the challenges of managing stomatitis.

Archana Ajmera Discusses the Challenges of Managing Stomatitis

Archana Ajmera, RN, MSN, WHNP-BC, ANP-BC, nurse practitioner, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses stomatitis prevention during everolimus/exemestane treatment for metastatic breast cancer.

Archana Ajmera on Stomatitis Prevention During Metastatic Breast Cancer Treatment

An oncology nurse practitioner highlights the benefits of attending conferences like the ASCO Annual Meeting. 

ASCO Offers an ‘Eye-Opening Experience’ for Nurse Practitioners 

The ASCO Annual Meeting can help oncology nurses network and see how clinicians around the globe are treating patients with cancer, explained Rosemarie Wellman, APN.

Wellman is a nurse practitioner manager at the John Theurer Cancer Center in Hackensack, NJ. She sat down with Oncology Nursing News at the conference to explain what she and her colleagues can take away from ASCO. She mentioned the networking potential with doctors, nurses, and drug representatives. The sessions have also allowed her to see the latest treatments and research, as well as how her cancer care colleagues treat the disease. Wellman mentioned that she hopes to attend a session for every disease type.

“It has been an eye-opening experience to talk to other people and see what they do [in cancer care],” Wellman said.

Additionally, Wellman mentioned that research being presented at the conference has potential to change the way that oncology nurses care for their patients.

“There's such a wide array of sessions and posters, and I think that nurses could come away with a lot of information that will be put to practice into their practice.”

This is actually the first time I am attending ASCO. And I have found it to be wonderful because of what's here. 

There's great networking potential because you get to meet doctors, nurses, drug [representatives]. So it has been an eye-opening experience to talk to other people and see what they do and where they're from. 

And then going to the sessions. I've only been to a few so far, but they have been amazing. And you get to learn so much and see what other people are doing.

Even the [presentations] that are geared towards doctors, as a nurse practitioner, I feel like I'm learning. And then I can always go to one of my physicians if I have any questions. But I think there's enough. There's such a wide array of sessions and posters. And I think that nurses could come away with a lot of information that will be put...into their practice.

ASCO Offers an ‘Eye-Opening Experience’ for Nurse Practitioners

Collecting data on a patient’s physical activity, sleep habits and other objective information has become easier with wearable technology, but an expert explained how it is important to determine what information can benefit the care of a patient with cancer.

Oncology Nursing News spoke with Eileen D. Hacker, Ph.D., APRN, AOCN, FAAN, professor and chair in the department of nursing in the division of the senior vice president and chief nursing officer at The University of Texas MD Anderson Cancer Center in Houston, on how wearable technology can be used in a clinical and research setting, while determining what tactics may be most helpful for patient care.

Can you discuss how wearable technology can be used in oncology nursing?

It actually can be used for a number of different reasons. It can be used to collect objective data, like physical activity data, sleep data, temperature data. There's a whole slew of biological parameters that it can be used for.

Wearable technology has really revolutionized the way we're able to collect objective data in real-world settings. Before, you needed to be in a clinical environment or in a laboratory to collect some of this data. Now, participants in research can wear these devices and go about their business. Many times, these devices are non-intrusive, so participants don't even remember that they're wearing it. It really gives us some real-world parameters for how these variables are impacted. When they're wearing these devices in the real world, we can see how participants in our research live their lives, get up, get dressed, are active, sit, stand, whatever they may be doing. We can capture that data and be able to make some real decisions to help them improve their physical activity, sleep, whatever it is we're trying to do, then we can monitor it over time.

In your research, are you using devices that anyone could access or are they medical grade?

We've used both. To collect the physical activity data, we've used research-grade accelerometers. Fitbits [and] Garmins are used in research to help people monitor their own physical activity and help them reach their preset physical activity goals. We have used them as part of the intervention, some people do use them for outcome variables as well. It's great if people choose to wear them.

Can you discuss the digital vital sign monitoring aspect of wearable technology?

One of the most important pieces of any type of wearable technology is determining the burden to the participant. Wearable technology that is overly burdensome to the participants will not be effective, people won’t like to wear the devices.

One of the challenges with wearable technology is really making distinctions between research grade and everyday grade. Now they're great for everyday purposes, for people that aren’t doing research, but for research-grade, we really need to be careful because we don't want to introduce measurement error.

How can oncology nurses use physical activity and sleep data from wearables while avoiding data fatigue?

It's a real issue. And it's not only data fatigue, it's device fatigue. A lot of participants for research—and just regular everyday people like us that want to wear these devices—can get sick of wearing it. And I have found, at least in some cases, it's wonderful for many participants, but some participants can become overly concerned about their health. For instance, if they set a goal for physical activity and they continue to not reach it, or they look at their sleep, see a cycle of bad sleep or poor sleep, then they may start worrying about their sleep. This actually happened to me, I stopped wearing my Fitbit for probably a month because I was getting overly concerned about my sleep.

Typically, the raw data from these types of devices are extensive. There are 1040 minutes in every single day, if you're wearing a device and collecting data or are a research participant, that's 1040 pieces of data for every single day, times 7 days or 14 days. Multiplied that by 30, or 50, or 100, and it’s an incredible amount of data. It can be wonderful data, but to analyze it to ensure the data are clean is very time and labor intensive. Then you have to make decision rules, like do you include them in your study if they only wore the device for 4 hours a day? You have to make these decisions up front. And then you have to hope that the participants agree to wear the device. At least in our research, most of them have been very willing to wear the devices and really provided us with great data.

With nearly 40 years of oncology nursing experience, did you think we'd reach a time like this where wearable technology is being integrated into the care of patients with cancer?

Well, I started using wearable technology before Fitbits, before any of these other devices, when it was super novel. We thought, “My gosh, you could wear this device, it will measure physical activity or measure sleep. It's non-intrusive, it's like wearing a watch, people won't even remember they have it on. It looks like a watch because it shows the time.” And I remember thinking how incredible it felt to collect important information from patients while minimizing the burden on them. And it maximizes compliance because they don't have to do anything. They don't have to keep these extensive diaries, etc.”

Over time, as I've watched the number of wearable devices proliferate, trying to keep your finger on all the different devices can be challenging. I think the key though is really making sure that we can minimize the burden on the participants so that we can maximize compliance because anytime wearing something, doing something becomes overly burdensome, people start dropping out of your study.

What advice would you give oncology nurses on the use of wearable technology and the data they can produce in patient care?

The advice I would give is: do your homework up front. Personally, I think it's important to try out the device yourself in a number of different situations before you start using it in your own research. That's something I've done with almost all my studies, any intervention study, I do the intervention myself for a number of weeks. I try to find the pitfalls or any potential unintended consequences or little roadblocks. It's helpful to smooth some of those things out up front. Pilot studies are always incredibly important before embarking on large studies.

This transcript has been edited for clarity and conciseness.

One expert explains the importance of deciphering the data obtained through wearable technology while aiming to avoid data fatigue in oncology nurses.

Navigating Wearable Technology in Oncology Nursing While Avoiding Data Fatigue

Experts share insights on standard work-up and staging practices for a patient with newly diagnosed bladder cancer.

Unlocking Bladder Cancer: A Guide to Effective Diagnosis and Staging

 Talking about the diagnostic work-up, which again, is mostly done by an urologist, Nerina, if you can give us your thoughts. When we see these patients in the clinic, what testing do we do, assuming the cystoscopy and maybe a TURBT [transurethral resection of bladder tumor] was done? What other tests do we do in terms of imaging, maybe biomarkers? [Do you have] any comments on that?

: I think with biomarkers, the NCCN [National Comprehensive Cancer Network] guideline recommends germline testing and genetic counselor referrals, especially if patients are presenting at a younger age, or have a family history of colon or endometrial malignancy. You’re assessing for Lynch syndrome, DNA mismatch repair deficiency mutations, and other hereditary conditions. In terms of imaging, if there is evidence of muscle-invasive disease, we would get complete staging, including a CT of the chest, abdomen, and pelvis, to assess for other sites that could potentially be there.

: I totally agree, Nerina. I think that’s exactly the standard practice, imaging with a CT [of the] chest, abdomen, and pelvis, as you pointed out. And ideally, we use IV [intravenous] contrast for better-quality images. Sometimes, we have this challenge of patients having kidney failure, and IV contrast may be a challenge. Lisa, do you do an MRI in those cases with gadolinium, where you can use lower GFR [glomerular filtration rate] thresholds? How do you deal with that kidney impairment, or rarely, allergies to IV contrast?

: Often, if that is an issue, we will get a noncontrast CT [of the] chest, and then MRI imaging of the abdomen and pelvis to get a better sense of staging.

 Thank you. I think we do the same thing here. To add to this great discussion, we always think about, especially for metastatic disease, what else the patient may need. I totally agree, Nerina, germline testing is something we are learning about more and more because germline mutations are much more common than we thought. And we frequently send patients to genetic counseling, to your point, so I totally agree with that. A good family history assessment is key, and now we use nurse navigators more and more to try to ask the patients ahead of time about their broader family history and different degrees of relatives.

The other thing that comes to mind is genomic testing for tumor somatic mutations. We send tumor tissue to look for different genomic biomarkers. Traditionally PD-L1 has been something we looked at, but I think it’s not that useful anymore in urothelial cancer, mainly because we usually tend to start with chemotherapy in most patients. But we send genomic sequencing for all patients with metastatic disease because we look at different mutations, genomic alterations. We’ll talk a bit about erdafitinib in a second, and that’s for only select patients based on 

 mutations or fusions. It’s definitely an important message for the audience that if you have a patient with metastatic urothelial cancer, make sure to send at least tumor tissue for genomic testing. And in some cases, many of us may also send circulating tumor DNA to complement that and capture the heterogeneity of the disease. That’s a great discussion.

Emily, you are focusing on urinary cancer and have great experience. Can you tell us a bit more about the staging of bladder cancer? We do the multidisciplinary clinic together, and this comes up frequently. Can you drive us through, the diagnosis is [made with] usually cystoscopy, TURBT, sometimes urine cytology. Tell us a bit about the staging and the work-up of those people.

: T [tumor] stage is usually something we want to get pathologically, so we’re looking for muscularis propria to be present in the specimen from the TURBT so that we can assess whether this is muscle-invasive disease or not. So typically, we want to establish that this is muscle invasive on the TURBT specimen. Then we always look at the scans with our radiologist and our bladder cancer multidisciplinary clinic to also have them weigh in on whether they think there’s some suspicion of extravesicle, or extension beyond the bladder, on the CT scan. Obviously, MRI is much more sensitive for detecting T3 or T4 disease, but sometimes we can even see it on a CT scan. Then the nodal status is something that obviously we would just see on a baseline-staging scan. It’s also always helpful to be able to discuss those scans in real time with the radiologist and point out all of the more or less suspicious nodes, and get an expert interpretation of the degree of suspicion for lymph node involvement.

We often end up, by the time we see patients, they also have had multiple scans over the last several months. Usually by the time they get sent to our multidisciplinary clinic, this has been worked up with maybe an initial scan at the time of presentation, and then the CT IVP [intravenous pyelogram], or a CT [of the] abdomen and pelvis with contrast once we realize what is going on, maybe after the cystoscopy before the TUR [transurethral resection]. So it’s always helpful to have multiple time points where you can look for growth or stability in any indeterminate lymph nodes.

 Thank you, Emily. Great points, absolutely. Speaking about all those factors and the need for a multidisciplinary approach, obviously, as you mentioned, tissue is the issue. You need to have tissue confirmation and also adequate staging. And this can be nuanced sometimes, to your point, sometimes muscularis propria may not be represented in the tissue sampling of a TURBT, the transurethral bladder tumor resection. If it is a T1, we always repeat the TURBT to ensure muscularis propria presence, and even if it is present, there’s the risk of understaging. I think it’s an important point that the urologists do that, repeat the TURBT to minimize the chance of understaging.

And the clinical staging, to your point, Emily, takes into account the pathology information from the TURBT, but also the exam under anesthesia and imaging. Because I know you and I have done this before, you may have a case that looks like a clinical T3 with extravesical extension, as you mentioned, and hydronephrosis, but in tissue, you cannot prove the muscularis propria invasion. But if everything looks like T3, we treat this patient as a T3 stage. Right?

Experts share insights on standard work-up and staging practices for a patient with newly diagnosed bladder cancer. 

Expert panelists unpack a patient's bladder cancer presentation, evaluating the presence of typical signs and symptoms that could lead to a diagnosis.

Case Study: Recognizing the Typical Signs of Bladder Cancer

 presentation entitled, “Morning Rounds: The Bladder Cancer Treatment Paradigm.” I’m Dr Petros Grivas, your host for today. I’m a medical oncologist in Seattle, a professor in oncology, and the clinical director of the genitourinary [GU] cancers program at the Fred Hutchinson Cancer Center and the University of Washington [in Seattle]. I’m very excited and thrilled to be joined today by 3 amazing providers and members of our team. I will let each of them introduce themselves. Let’s start with Dr Emily Weg. Emily?

: Good morning, it’s a pleasure to be with you today. I’m Emily Weg, I’m an assistant professor in the department of radiation oncology at the University of Washington and the Fred Hutchinson Cancer Center, and I specialize in genitourinary malignancies.

 Great, Emily. And it’s great to work with you on our team. Then we have Lisa Adams, who’s a fantastic physician assistant in Colorado. Lisa?

: Hi, I am Lisa Adams. I’m a physician assistant in a medical oncology practice with the University of Colorado Health System [in Colorado Springs]. I’m very excited to be here this morning.

 Welcome, Lisa. [It’s] great to have you. Talking about fantastic physician assistants, I’m also thrilled to be joined by Nerina McDonald. She’s also a physician assistant, and she’s working with us here at the University of Washington and Fred Hutch. Nerina?

: Hi, I’m Nerina McDonald, I’ve been practicing in GU oncology at Fred Hutchinson Cancer Center for about 4 years now, and I have the pleasure of working with Dr Grivas on a regular basis in our clinic.

 Thanks, Nerina. It’s a pleasure to do this together today. We’re going to discuss the testing and treatment of patients with metastatic bladder cancer and urothelial cancer in general. Of course, the field is evolving so rapidly, and it’s really exciting to see the advances in the field. We’re going to look at some clinical scenarios and review best practices, and I want to hear and learn from my colleagues here today. Let’s begin, starting with a case, to put things in context. Again, as I mentioned before, it’s a great opportunity to do this program because so much has been changing in the field of urothelial cancer.

This particular case we have today is an 80-year-old gentleman who presents to the emergency department reporting severe lower abdominal pain in the suprapubic area, fatigue, tiredness, as well as increased urinary frequency and urgency. [He has] also noticed hematuria, blood in the urine, over the past few days. This gentleman has a history of smoking, he’s a former smoker with a 20 pack-year history. He quit about 10 years ago. His medical history is also significant for mild COPD [chronic obstructive pulmonary disease] and diabetes mellitus, which is controlled by medications. I know this is not the most common scenario of presentation of bladder cancer. Most of the patients come to us through urology, hematuria and other urinary tract symptoms, is the main entrance point for patients. Emily, I’ll start with you, you’re a very accomplished radiation oncologist. Do you get calls sometimes from the emergency department for newly diagnosed, newly presented patients? It’s probably less common, right?

: Yes, it’s pretty unusual that the emergency department would call the radiation oncologist. But I think a lot of this patient’s presentation is fairly typical. About 75% of patients with bladder cancer present with hematuria, and about a quarter of them present with lower urinary tract symptoms, like frequency, urgency, and discomfort with voiding. The suprapubic pain you described and the dramatic nature of this presentation is a bit unusual. The way radiation oncology is usually roped into the picture is, traditionally, once there’s already a proven tissue diagnosis.

 Thank you, Emily, I totally agree with you. And I think even in our practice, Nerina, you probably would agree that the vast majority of our patients come through the urology practice. It’s not that common to get this presentation, but it can happen. Sometimes we have a de novo metastatic urothelial cancer. Just for context for the audience, if you have 100 patients diagnosed with bladder cancer de novo, only about 4% or 5%, as Dr Weg mentioned, present de novo with metastatic disease. Usually, it’s already been diagnosed in early stage disease. I will ask you, Nerina, when we meet those patients in the clinic, could you comment a bit about the symptoms they have, especially with metastatic disease? What are they complaining about? What are their symptoms?

: I think patients may often present with urinary obstruction, irritated voiding, and pain. If they are in a metastatic setting, I have seen a handful of patients who are having bone pain due to bone metastases. Sometimes we can see constitutional symptoms, such as fatigue, weight loss, anorexia, failure to thrive, etc.

 [I] totally agree with you, and it depends on the [type of] disease and the extent of the disease. Lisa, I know sometimes there might be some differences between community practices and academic practices, mostly because the patients may start in a community practice, which may be closer to home for them. I talk frequently with my colleagues in community practices, and the patients we see sometimes in the tertiary academic center may be a bit filtered, selective populations who travel to see us. [Do you have] any comments on your end about the initial presentation of patients through the clinic, or the emergency department?

: Absolutely. Where we are in southern Colorado, we do serve a larger rural population, where maybe access to primary care, screening, and early referrals to specialists may be a bit less. So we do see maybe a bit more of this similar presentation of patients diagnosed in the advanced setting, or maybe going to the emergency department rather than through the traditional routes.

 [I] totally agree. Access to primary care, of course, and access to care in general I think is key and is not always given. That brings up an important point, Lisa, about disparities in health care, and how can we go work altogether, different stakeholders, to eliminate those disparities and provide access to care, diagnostic work-up. There are many initiatives, especially with the Bladder Cancer Advocacy Network, BCAN, that try to spread the word to people who have symptoms like blood in the urine, or other urinary tract symptoms, to seek medical attention early, and be referred to a urologist for work-up. It’s a very important need. And of course, as a medical oncologist or radiation oncologist in this group today, we usually see the patients after the diagnosis is made. The urologist is usually the first point of contact. Less commonly, in a situation like this when a patient goes to the emergency department, depending on the setting, maybe a biopsy of a metastatic site may be needed, or cystoscopy, and tumor tissue acquisition through a cystoscopy through a urologist.

The FDA approved blinatumomab (Blincyto) for adults and pediatric patients aged 1 month or older with CD19-positive, Philadelphia chromosome–negative, B-cell precursor acute lymphoblastic leukemia in the consolidation phase, irrespective of measurable residual disease status.

The decision is supported by data from the phase 3 E1910 study, in which the addition of blinatumomab to multiphase consolidation chemotherapy (n = 112) resulted in a superior overall survival (OS) benefit vs chemotherapy alone (n = 112), with 3-year OS rates of 84.8% and 69%, respectively. At a median follow-up of 4.5 years, the respective 5-year OS rates were 82.4% and 62.5%, respectively.

"In the E1910 study, blinatumomab reduced risk of death and showed a remarkable improvement in overall survival," Selina M. Luger, MD, professor of hematology-oncology at the University of Pennsylvania's Perelman School of Medicine and Abramson Cancer Center, chair of the ECOG-ACRIN Leukemia Committee, and study investigator, stated in a press release. "This approval redefines the standard of care for patients with B-ALL and provides them with a more effective treatment option than standard chemotherapy alone."

The FDA approved blinatumomab for patients 1 month or older with CD19-positive, Philadelphia chromosome–negative, B-cell precursor acute lymphoblastic leukemia.  

FDA OKs Blinatumomab for Children, Adults with CD-19 B-ALL in Consolidation Phase  

Carlie Stott, NP, in an interview with Oncology Nursing News about increasing clinical trial participation

With APP Help, Cancer Clinical Trials No Longer a 'Last-Ditch' Option

Advanced practice providers can be instrumental in leading a clinical team for patient clinical trial enrollment, according to Carlie Stott, NP.

Stott, who is a nurse practitioner specializing in medical oncology at Ochsner Health MD Anderson Cancer Center, presented an abstract at the 49th 

on how advanced practice providers could be leaders in the clinical trial space and develop tools to help boost patient involvement.

Her intervention put advanced practice providers in the navigation role. They educated patients that clinical trials are an option from the very beginning of treatment and are not a last resort—a misconception she said was common before the launch of the tool.

In addition to patient education, Stott emphasized the importance of involving other clinicians in the process as well.

“We have a social worker who can assist us we have different doctors with different sub-specialties that can help provide if we didn't have a clinical trial for them, we could help provide that standard-of-care recommendations if it was a difficult case,” Stott said in an interview with Oncology Nursing News®. “Then we have other APRNs, we have our clinical research nurses, and assistants that they could provide their input from the standpoint of eligibility criteria and how that patient could be enrolled.”

After the implementation of these programs, Stott mentioned that more patients tend to be aware that clinical trials may be a viable option. Additionally, she said that clinicians outside of the tumor board are also starting conversations about trials earlier in the process.

“They can have those conversations with their patients earlier so that it doesn't seem like a last-ditch effort when it comes up in a conversation maybe later down the line,” Stott said. “We're always bringing it up and making it seem like a good option because the [National Comprehensive Cancer Network] guidelines, they do want us to consider clinical trials for patients.”

Advanced practice providers can lead clinical teams and patients to boost oncology clinical trial enrollment, a nurse practitioner explained. 

Archana Ajmera, RN, MSN, WHNP-BC, ANP-BC

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