Matthew Burke, MBA, RN, MSN, APRN-BC, Oncology Nurse Practitioner/Melanoma and Renal Cell Carcinoma, Yale New Haven Hospital, discusses potential challenges nurses might face with the new advent on immunotherapy.

Burke says immunotherapy is the beginning of a new paradigm in the treatment of cancer. In addition to learning about side effects associated with these agents, nurses are going to understand how to deal with combinations of immunotherapy agents.

Nurses will also be challenged to learn more about sequencing therapy, Burke says, which brings in a whole new class, and possible severity, of toxicity.

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Matthew Burke on Potential Challenges Facing Nurses in the Field of Immunotherapy

Matthew Burke, MBA, RN, MSN, APRN-BC, Oncology Nurse Practitioner/Melanoma and Renal Cell Carcinoma, Yale New Haven Hospital, discusses managing immune-mediated adverse events (IMAEs).

Burke says there are not great guidelines for managing IMAEs. The most common IMAEs are colitis, dermatitis, endocrinopathies and hepatotoxicity. Burke says the key to managing these side effects is early intervention, close monitoring and supportive treatment or steroids when necessary.

Using steroids to treat these side effects are "more of an art than science," Burke says. In some cases, steroids will not work, especially in autoimmune colitis or autoimmune hepatitis. In this instance, nurses can use adjunct therapies such as infliximab or mycophenolate, Burke says.

Burke says it is important for nurses to know and understand the principles behind IMAEs.

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Matthew Burke, MBA, RN, MSN, APRN-BC, Oncology Nurse Practitioner/Melanoma and Renal Cell Carcinoma, Yale New Haven Hospital, discusses managing immune-mediated adverse events (IMAEs)

Matthew Burke on Immune-Mediated Adverse Events

Matthew Burke, MBA, RN, MSN, APRN-BC, Oncology Nurse Practitioner/Melanoma and Renal Cell Carcinoma, Yale New Haven Hospital, discusses the difference between adverse events caused by chemotherapy and immunotherapy.

Burke says chemotherapy-related adverse events are usually limited to the time that the drug is in the patient’s body while immunotherapy agents cause modifications in the checkpoints of the immune system that may be permanent.

Because the immune system is altered during treatment with immunotherapy agents, Burke says the severity of immunotherapy-related adverse events can be much worse than chemotherapy-related adverse events. Also, it is difficult to predict which patients will experience severe adverse events from immunotherapy treatment.

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Matthew Burke Discusses Adverse Events 

Matthew Burke, MBA, RN, MSN, APRN-BC, Oncology Nurse Practitioner/Melanoma and Renal Cell Carincoma, Yale-New Haven Hospital, discusses the prevalence of immunotherapy-related adverse events.

Burke says that approximately one-third of patients will develop a clinically-significant adverse drug reaction. Occasionally, these can develop into moderate or severe side effects. The three side effects that concern Burke most are dermatitis, enterocolitis, and endocrinopathy.

The prevalence of immunotherapy-related side effects is consistent across all studies, versions, and combinations of drugs, Burke says.

Matthew Burke, MBA, RN, MSN, APRN-BC

Articles

Matthew Burke on Potential Challenges Facing Nurses in the Field of Immunotherapy

Matthew Burke on Immune-Mediated Adverse Events

Matthew Burke Discusses Adverse Events

Matthew Burke on the Prevalence of Immunotherapy AEs