 takes a look back at our most popular stories. In January 2023, data presented at the 2022 

 continued to grab the attention of oncology nurses. Below, find links to poster presentations highlighting new innovations in tamoxifen-related symptom management, and an exclusive interview highlighting key nursing takeaways of interest from the meeting. Moreover, read up on the FDA’s approval of elestrant (Orserdu), which followed updated data presented at the meeting.

Other topics of interest included pain management, a core component of cancer care. However, use of agents to curb these effects, especially opioids, present challenges in practice. Fortunately, the American Society of Clinical Oncology (ASCO) has recently updated their opioid management guideline, providing clearer instruction on best practices with these critical pain management drugs.

Lastly, January is cervical cancer awareness month. 

 published a 4-part weekly series on what oncology nurses need to know to best advocate for their patients with cervical cancer, which included updates in prevention and treatment options.

5. CBD Oil Shows Modest Improvements in Tamoxifen-Related Adverse Effects

 demonstrated that cannabidiol (CBD) oil may be useful in managing tamoxifen-related adverse effect (AEs).

In a study population of 26 patients, the oil was associated with decreases across several AEs related to tamoxifen, including insomnia, hot flashes, arthralgia, mood alterations, and muscle cramps. In addition, median health-related quality-of-life scores increased after 4 weeks with CBD, and the treatment may have demonstrated improvements in endocrine symptoms as well.

Of note, study authors acknowledged that the study period was short and that longer study periods may reveal better insight on whether CBD may provide long-lasting improvements in these domains.

4. Emerging Data Showcases Promising Advancements for Patients With HER2-Low Breast Cancer

 Loyda Braithwaite, MSN, RN, AGPCNP-BC, AOCNP, highlighted promising advances in breast cancer treatments across multiple settings and disease types, including for patients with HER2-low and hormone receptor–positive disease.

In the conversation, Braithwaite, who is an oncology nurse practitioner at the University of Wisconsin Carbone Cancer Center, discussed fam-trastuzumab deruxtecan-nxki’s (Enhertu) performance across the 

 (NCT04553770) trials, as well as sacituzumab govitecan-hziy’s (Trodelvy) expanding use in the hormone receptor–positive setting in TROPiCS-02 (NCT03901339).

She also discussed whether oral SERDs hold the potential to change practice. “[Oral SERDs] are very exciting from the clinician perspective, but also from the patient perspective, to think about the accessibility [options] that we’re going to have to treat them,” she told 

3. ASCO Guidelines Provide Road Map for Cancer Pain Management With Opioids

Unfortunately, 55% of patients experience pain during active treatments, and 66% of patients with advanced disease will experience cancer-related pain. Although guidelines for managing cancer-related pain exist, there are few guidelines focused on exclusively on opioids.

ASCO has updated its guidelines providing recommendations for the management of cancer pain with opioids. A multidisciplinary expert panel consisting of patient representatives and an ASCO guidelines staff member with health research methodology expertise developed the guidelines that were informed by evidence including 16 randomized controlled trials and 31 systemic reviews from January 1, 2010, to February 17, 2022.

The supportive care guidelines addressed 7 key questions for patients with cancer pain under all of which fell under the umbrella of the leading question: “In what circumstances should opioids be used to manage cancer pain in adults, how should opioids be administered, and how should opioid AEs be prevented or managed?”

2. FDA Approves Oral SERD Elacestrant for 

-Mutant ER+, HER2– Metastatic Breast Cancer

On January 27, 2023, the FDA granted an accelerated approval to elacestrant (Orserdu) for the treatment of patients with 

-mutant,estrogen receptor–positive, HER2-negative advanced or metastatic breast cancer following at least 1 prior lines of endocrine therapy. The approval is supported by data from the phase 3 EMERALD study (NCT03778931).

The investigational oral selective estrogen receptor degrader (SERD) was evaluated among patients with 

-mutant disease (n = 115) vs standard-of-care (SOC) endocrine therapy (n = 113) of either fulvestrant or an aromatase inhibitor. The median progression-free survival was 3.8 months (95% CI, 2.2-7.3) vs 1.9 months (95% CI, 1.9-2.1) with the SERD and SOC, respectively (HR, 0.55; 95% CI, 0.39-0.77; 

 = .0005).The overall survival outcomes were not statically significant (HR, 0.90; 95% CI, 0.63-1.30).

Cervical Cancer Prevention Comes Into Focus for Awareness Month

January is cervical cancer awareness month. In this first installment of a weekly series on the oncology nurse’s role in patient advocacy efforts, Debi Fischer, MSW, BSN, BA, LCSW, RN, highlights current educational efforts of disease progression and the Quilt Project.

In 2022, there were 4280 deaths caused by cervical cancer. The FDA has given the greenlight to 3 human papillomavirus (HPV) vaccines: Gardasil, Gardasil 9, and Cervarix. These vaccines are believed to be able to prevent 90% of HPV-attributable cancers. Moreover, Papanicolaou tests is a highly effective screening tool which can help providers combat cervical cancer before it even occurs. If a woman follows screening recommendations, cervical cancer can be found before it becomes invasive and spread. Treatment options are more extensive at this level and in fact precancerous cell changes can also be discovered.

According to Fischer, the advances that have been made in cervical cancer have been significant. Oncology nurses play a significant role about raising awareness, and ensuring that these advances have the opportunity to positively affect their patients.

Articles

Each month, Oncology Nursing News® takes a look back at our most popular stories.

Oncology Nursing News Top Stories: January 2023

The FDA has approved zanubrutinib (Brukinsa) for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

The recommended dose for the oral BTK inhibitor is 160 mg twice daily or 320 mg once daily; the prescribing label comes with warnings for hemorrhage, infections, cytopenias, second primary malignancies, and cardiac arrythmias.

The regulatory decision is supported by efficacy data from the phase 3 SEQUOIA (NCT03336333), and ALPINE (NCT03734016) trials. Across clinical trials, the most common adverse events (AEs) were decreased neutrophil counts (42%), upper respiratory tract infections (39%), decreased platelet counts (34%) hemorrhage (30%), and musculoskeletal pain (30%). Second primary malignancies were observed in 13% of patients. Atrial fibrillation or flutter were reported in 3.7% and 0.2% of patients experienced grade 3 or higher ventricular arrhythmias.

Zanubrutinib should be swallowed whole with water. It can be taken with or without food. Coadministration with strong or moderate CYP3A inducers should be avoided and the dosage for zanubrutinib should be modified if it is being taken with a CYP3A inhibitor.

In SEQUOIA, 479 treatment-naïve patients with CLL/SLL who did not have a 17p deletion were randomly assigned 1:1 to receive either zanubrutinib (n = 241) or bendamustine (Treanda) plus rituximab (Rituxan; BR) for 6 cycles (n = 238). The median progression-free survival (PFS) was not estimable (NE) with zanubrutinib (95% CI, NE-NE) vs 33.7 months with BR (95% CI, 28.1-NE). The estimated median follow-up time was 25.0 months, and the HR was 0.42 (95% CI, 0.28-0.63; 

< .001). The overall response rate (ORR) for patients receiving zanubrutinib was 93% (95% CI, 89%-96%) vs 85% (95% CI, 80%-90%) for those receiving BR. The complete response (CR) rates were 7% vs 15%, respectively.

Moreover, in a separate nonrandomized cohort in which zanubrutinib was assessed in patients with a 17p deletion (n = 110), the ORR was 88% (95% CI, 81%-94%) and the median duration of response was not reached after a median 25.1 months of follow-up. The CR rate was 6%.

Data from the ALPINE trial also supported this approval, in which zanubrutinib demonstrated superior efficacy and safety when compared with ibrutinib (Imbruvica) in a population of patients with relapsed or refractory CLL/SLL. The ORR in the zanubrutinib arm (n = 327) was 80% (95% CI, 76%-85%) with 13 patients having a CR. In the ibrutinib arm (n = 325) the ORR was 73% (95% CI, 68%-78%) with 8 patients experiencing a CR. The response rate ratio was 1.10 (95% CI, 1.01-1.20; 

 = .0264). Median duration of response was not estimable in either arm and the median follow-up time was 14.1 months.

For patients without a 17p deletion in SEQUOIA, 36% of patients had a serious AE, the most common of which (≥ 5%) were COVID-19, pneumonia, and secondary primary malignancy. Permanent discontinuation and doe reduction were observed in 8% of patients, respectively, and dose interruptions were observed in 46%. The most common any-grade AEs with zanubrutinib were musculoskeletal pain (33%), upper respiratory tract infection (28%), and hemorrhage (27%).

In the cohort of patients with a 17p deletion the rate of serious AEs was 41% with pneumonia (8%) and second primary malignancy (7%) having the highest incidence. Permanent discontinuation and doe reduction were observed in 5% of patients, respectively, and dose interruptions were observed in 51%. Musculoskeletal pain (38%), upper respiratory tract infection 328%), and rash (28%) were the most common any-grade AEs.

In ALPINE, serious AEs occurred in 42.0% of patients receiving zanubrutinib compared with 50.0% of patients receiving ibrutinib. Treatment discontinuation due to AEs was 15.4% and 22.2%, respectively, and events leading to death was 10.2% compared with 11.1%. The most common AEs were neutropenia (16.0% vs 13.9%), hypertension (14.8% vs 11.1%), pneumonia (5.9% vs 8.0%), and COVID-19–related pneumonia (7.1% vs 4.0%), respectively.

Patients taking zanubrutinib should be taught to report and signs or symptoms of sever bleeding or infection. They should be informed that they will need periodic blood tests to monitor for cytopenia. They should be made aware that other malignancies have been reported with zanubrutinib, and advised to wear sun protection and monitor for other malignancies. They should also report any signs of palpitations, lightheadedness, dizziness, fainting, shortness of breath, and chest discomfort.

Zanubrutinib can cause embryo-toxicity. Patients should use effective contraception during treatment and for 1 week after the last treatment dose.

FDA approves zanubrutinib for chronic lymphocytic leukemia or small lymphocytic lymphoma. News release. FDA. January 19, 2023. Accessed January 19, 2023. 

Brukinsa. Prescribing information. BeiGene USA, Inc; 2023. Accessed January 19, 2023. 

The FDA has approved zanubrutinib for patients with chronic lymphocytic leukemia or small lymphocytic lymphoma. The prescribing label comes with warnings for hemorrhage, infections, cytopenias, second primary malignancies, and cardiac arrythmias.


FDA Approves Zanubrutinib for CLL/SLL

, we ring in the New Year 2023 by combing through 2022 FDA approvals. Listen as associate editor, Lindsay Fischer, recounts key approvals on a month-by-month basis, with input from some of the investigators from behind the research. To read the full information surrounding the approvals, be sure to check out our news coverage below. Other resources can also be found below.

, and for all the engagement in 2022. We look forward to bringing you more oncology news in 2023.

We want to hear from you! Which drugs approved in 2022 have been practice changing? Have you had any difficulty or success in incorporating these novel agents into clinical use? Any challenges with supporting patients on these regimens? Email 

FDA Approves Tebentafusp to Treat HLA-A*02:01 Positive Uveal Melanoma

Cilta-Cel Snags FDA Approval for Relapsed/Refractory Multiple Myeloma

Neoadjuvant Nivolumab Plus Platinum-Doublet Chemotherapy Is Now Approved for Resectable NSCLC

FDA Greenlights Olaparib for BRCA-Mutated, HER2-Negative Breast Cancer

FDA OKs Relatlimab/Nivolumab for Unresectable or Metastatic Melanoma

FDA Approves Pembrolizumab in MSI H/dMMR Advanced Endometrial Carcinoma

FDA Approves 177Lu-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer

Axi-Cel Snags FDA Approval for Second-Line LBCL

FDA Approves Trastuzumab Deruxtecan for Unresectable or Metastatic HER2+ Breast Cancer

FDA Grants Ivosidenib Plus Azacitidine Approval for Newly Diagnosed AML With IDH1 Mutations

FDA Grants Azacitidine Approval For Pediatric Patients With Myelomonocytic Leukemia

FDA Grants 2 Frontline Nivolumab-Based Regimens Approval for Unresectable Advanced or Metastatic ESCC

Tisagenlecleucel Receives FDA Approval for Relapsed or Refractory Follicular Lymphoma

FDA Grants Accelerated Approval to Dabrafenib Plus Trametinib for BRAF V600E–Mutated Solid Tumors

FDA Approves Liso-Cel for Second-Line Large B-Cell Lymphoma

Crizotinib Approved For ALK+ Inflammatory Myofibroblastic Tumors

HER2-Directed Therapy, Trastuzumab Deruxtecan, Approved for Metastatic NSCLC

Trastuzumab Deruxtecan Is Approved for Patients With Metastatic HER2-Low Breast Cancer

FDA Approves Darolutamide Tablets for Select Patients With Prostate Cancer

Capmatinib Snags Full FDA Approval for MET Exon 14 Skipping NSCLC

FDA Grants Ibrutinib Approval for Pediatric Graft-Versus-Host-Disease

FDA Gives Pemigatinib Greenlight for FGFR1 Rearranged Myeloid/Lymphoid Neoplasms

Durvalumab Plus Gemcitabine/Cisplatin Approved by the FDA for Advanced or Metastatic Biliary Tract Cancers

Sodium Thiosulfate Gets Green Light for Chemotherapy-Induced Hearing Loss in Pediatric Patients

Selpercatinib Is Approved for 2 RET Fusion–Positive Solid Tumors, Non–Small Cell Lung Cancer

FDA Approves Futibatinib for Pretreated, Advanced or Metastatic Intrahepatic Cholangiocarcinoma with FGFR2 Rearrangements

FDA Approves Durvalumab in Combination with Tremelimumab for Unresectable HCC

Teclistamab-cqyv Snags Accelerated Approval for Relapsed or Refractory Multiple Myeloma

Cemiplimab Gets Go Ahead In Combination With Chemotherapy For Advanced NSCLC

Brentuximab Vedotin Gets Green Light for High-Risk Hodgkin Lymphoma in Pediatric Patients

Durvalumab/Tremelimumab/Chemotherapy Combination Approved for NSCLC Indication

Mirvetuximab Soravtansine-gynx Gets Go Ahead in Platinum-Resistant Ovarian Cancer

Olutasidenib Approved for IDH1-Mutated Acute Myeloid Leukemia

Adagrasib Receives Accelerated Approval for KRAS G12C Mutated NSCLC

Watch: Newly Approved Tebentafusp Requires Up-Front Active Toxicity Management in Melanoma

Dr. Geyer Highlights Optimal Dosing Strategies for New Olaparib Indication in Breast Cancer

Nurse Takeaways: Latest Pembrolizumab Indication in Endometrial Cancer

Podsada Discusses Biomarker Testing and ADC Therapies in Breast Cancer

Goodwin Provides Nursing Perspective on Recent FDA Approvals in NSCLC

Futibatinib Approval Ushers in Targeted Therapy Option for Patients With Unresectable, Intrahepatic FGFR2-Positive Cholangiocarcinoma

Barber Discusses the Integration of Durvalumab/Chemotherapy Combination as New Standard of Care in Biliary Tract Cancers

Podcasts

In this episode of The Vitals, we recount the oncology drugs that received FDA approvals in 2022.  

A Look Back at 2022 FDA Approvals in Oncology

In 2022, various emerging topics grabbed the attention of our readers, from the feasibility of using neoadjuvant chemotherapy to make organ-sparing surgery more accessible for patients with rectal cancer, to using bioimpedance spectroscopy to proactively preventing chronic lymphedema, to the use of oral Minoxidil to treat later-stage alopecia in survivors, nurses showed an interest in innovative ways to improve the patient experience and their quality of life throughout the cancer continuum. 

Our contributors highlighted new strategies to help patients visualize and conserve their energy, and addressed whether social media can help young patients with cancer connect with one another. Nurse experts provided 

summaries of emerging therapies approved across multiple indications for our 

Finally, experts in the field provided perspective on whether bunephrophine can replace traditional opioids, and if off the-shield CAR T-cell therapy can improve accessibility for patients requiring this treatment option.

® in 2022. We look forward to bringing you more news in 2023.

Neoadjuvant Chemotherapy Makes Organ-Sparing Surgery More Accessible for Patients With Rectal Cancer

Three months of neoadjuvant chemotherapy may allow patients with early-stage rectal cancer to significantly downstage their tumors and undergo organ-preserving surgery without the toxicities associated with preoperative chemoradiation, according to findings from the NEO trial (NCT03259035) published in the 

“Three months of induction chemotherapy with mFOLFOX6/CAPOX may successfully downstage a significant proportion of patients with favorable-risk, early-stage rectal cancer, allowing well-tolerated organ-preserving surgical therapy with minimal effect on organ function,” wrote Hagen F. Kennecke, MD, medical oncologist with the Providence Cancer Institute and Earle A. Chiles Research Institute, and coinvestigators. “The approach offers a much-desired organ-sparing option and warrants further investigation.”

Opinion: Understanding Spoon Theory Is Essential for Oncology Nurses

In this contributor piece, Debi Fischer, MSW, BSN, BA, LCSW, RN, discusses “spoon theory,” which helps patients with chronic illness visualize, and therefore better conserve, their energy. She argues that this tactic can be useful for patients with cancer as well, and that oncology nurses should be familiar with the theory.

“Both spoon theory and the related fork theory are key concepts that surgical oncology nurses and licensed clinical social workers can add to their arsenal of weapons,” writes Fischer. “Understanding these concepts is helping, not only when working with this patient population, but in assessing one’s own levels of energy.”

Pembrolizumab Plus Bevacizumab and Cyclophosphamide Shows Promising Efficacy, Tolerability in Recurrent Ovarian Cancer

Real-world data from a retrospective study showed that pembrolizumab (Keytruda) combined with the anti-VEGF agent bevacizumab (Avastin) plus oral metronomic cyclophosphamide displayed minimal toxicity with long-term clinical responses in a significant number of patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. Data were presented in a poster at the 

The median overall survival (OS) was 14 months (95% CI, 11-not reached) with a 6-month OS rate of 93.7% and a 12-month rate of 65%. The objective response rate (ORR) was 42%, including 3 patients with a complete response (CR). Slightly less than half (49%) of patients achieved stable disease and the total clinical benefit rate was 91%. The median progression-free survival (PFS) was 7.8 months (95% CI, 4.5-10.3) and the 6-month and 12-month PFS rates of were 61.1% and 24.5%, respectively.

Experts Make the Case for Buprenorphine Use in Cancer-Related Pain Management

Buprenorphine may be an effective pain management strategy for various populations of patients with cancer, according to palliative care experts Mary Lynn McPherson, PharmD, BCPS, FAAHPM; and Amy A. Case, MD, FAAHPM. The agent’s unique pharmacology, and clinical utility and safety data, make it a preferable choice over traditionally used opioids.

McPherson, who is a professor at the University of Maryland, Baltimore, and executive director of the Advanced Post-Graduate Education in Palliative Care, Graduate Studies in Palliative Care, and Online Graduate Studies in Palliative Care programs, and Case, who is the chair of Supportive and Palliative Care at Roswell Park Comprehensive Cancer Center, recently participated in an invited speaker session titled “Why Consider Buprenorphine for Cancer-Related Pain?” at the 2022 Supportive Care in Cancer Annual Meeting.

Oncology Drug Crash Course: Fam-Trastuzumab Deruxtecan-Nxki (Enhertu)

Alyssa Hall, FNP-BC, AOCNP, Donna Thomas, BSN, RN, OCN, Kellie Zeichner, BSN, RN, OCN, provide an in-depth look at trastuzumab deruxtecan, including the approved indications and safety considerations, in a downloadable fact sheet.

Trastuzumab deruxtecan is a HER2-directed antibody and topoisomerase inhibitor conjugate composed of 3 components: a humanized anti-HER2 IgG1 monoclonal antibody, a topoisomerase inhibitor, and a tetrapeptide-based cleaver. After it binds to HER2 on the tumor cells, trastuzumab deruxtecan undergoes internalization and intracellular linker cleavage by lysosomal enzymes. Once released, the membrane-permeable deruxtecan causes DNA damage and apoptotic cell death.

After demonstrating significant efficacy as a third-line treatment for patients with metastatic HER2-positive breast cancer, trastuzumab deruxtecan has gained approval from the FDA for 5 indications and is under investigation across solid tumors.

For a downloadable version that you can print at home, check out our 

The Future of CAR T-Cell Therapy: Will Off-the-Shelf Options Soon Enter the Playing Field?

In this feature piece, Ellen Tichich, MFA, MSN, RN-BC talks with Brittney Baer, BSN, RN, a patient nurse care coordinator for patients undergoing immune effector cell therapies, at Vanderbilt University Medical Center in Nashville, Tennessee; and Kelly Garvin, BSN, RN, OCN, a lymphoma specialist and primary nurse for Bijal Shah, MD, in the Department of Malignant Hematology, Moffitt Cancer Center in Tampa, Florida, about the trajectory of CAR T-cell therapy and what off-the-shelf CAR T-cell therapy options could represent for patients. According to these nurse experts, off-the-shelf CAR T-Cell therapy options could provide greater accessibility and benefit to patients.

Normalize Palliative Care as Part of the Oncology Treatment Plan

Patients with cancer benefit from basic and advanced palliative care services and the American Society of Clinical Oncology has recommended that palliative care be considered an essential element of cancer treatment; however, helping patients gain access to these services still represent a barrier to care.

In this piece, Marjorie Leslie, DNP, ACNP-BC, AOCNP, discusses an initiative based out of the Allegheny Health Network to connect more patients to palliative care services.

According to Leslie, this project has helped normalize the concept that palliative services as a core component of the medical oncology patient care plan. Future goals will be to maintain and grow this program as well as evaluate its outcomes.

Bioimpedance Spectroscopy May Play a Large Role in Proactively Preventing Chronic Lymphedema

Bioimpedance spectroscopy is a more accurate method of identifying which breast cancer survivors will need compression intervention for subclinical lymphedema compared with tape measurement to prevent chronic lymphedema, according to findings from a study published in Lymphatic Research and Biology. Moreover, the technology is easy to use and patient friendly, according to principal investigator Sheila H. Ridner, PhD, RN, FAAN.

“It is as easy to use as putting someone on a scale and getting their weight,” Ridner, research professor at Vanderbilt University School of Nursing in Nashville, Tennessee, explained in an interview with 

®, noting that the underlying technology is based on electrical currents that measure the fluid between the cells. “It’s very simple [and] very quick.”

How Social Media Helps AYA Patients With Cancer Find Support

Compared with young children or older adults, a cancer diagnosis for adolescents or young adults (AYA) is less common. However, this means that AYA patients often feel alone or social isolated when they look around their treatment center or local patient support group.

In this contributor piece, Marlee Kiel, LCSW, a social worker with Cancer Care, discusses how social media can be a useful tool to help AYA patients with cancer connect to others in their age group.

“In the past decade, there has been a significant rise in the use of social media. Apps [such as] Facebook, Instagram, and TikTok, have continued to garner attention over the years, but over the course of pandemic, these platforms became even more important,” Kiel writes. “Many individuals turned to these platforms to stay connected when they could not physically see family and friends. Social media apps proved to be a place of community for many— particularly for AYA patients navigating a cancer diagnosis.”

1. Oral Minoxidil Demonstrates Efficacy in Treating Later Stage Alopecia in Cancer Survivors

Cancer survivors who experience both frontal and occipital late alopecia following cytotoxic or endocrine therapy may derive clinical benefit with oral minoxidil, according to data from a study at Memorial Sloan Kettering Cancer Center (MSK), which were presented during the 2022 ASCO Annual Meeting.

“Treating late toxicities [is] the bread and butter of survivorship,” Lidia Schapira, MD, FASCO, Professor of Oncology at Stanford University with a specialization in survivorship, said in a discussion of the poster. “Patients are often left to manage these by themselves. The idea of helping patients understand, self-manage, and become better at handling toxicities, [starting] from the first day in the hospital, is a very important concept.”

Thank you for reading Oncology Nursing News® in 2022. We look forward to bringing you more news in 2023.

Oncology Nursing News: Top Stories from 2022

 takes a look back at our most popular stories

This month, new data highlighted the potential value that HER2-directed targeted therapy can offer patients who have metastatic breast cancer that has progressed following and has spread to the brain. This information is especially useful for regions that do not have access to newer drugs with better blood brain barrier penetration, according to study authors.

New ways to help individuals with cancer who have less access to care continued to grab the attention of nurses. A contributor highlighted the importance of making cancer screening accessible for people with disabilities and a feature story from our print publication on how to better support caregivers. This month, we also featured a presentation from the 

CFS® on the importance of proper immune-related adverse event (irAE) management.

Lastly, one of our newest features, the Oncology Drug Crash Course sheet, provides a helpful overview of an agent approved across multiple indications and details what nurses need to know about adverse effects and any handling nuances. In November 2022, 3 nurses weigh in on what other oncology nurses need to know with the HER2-directed targeted therapy, fam-trastuzumab deruxtecan-nxki (Enhertu).

Aggressive HER2-Targeted Therapy May Have a Role Following Disease Progression in Patients With Breast Cancer and Brain Metastases

According to a retrospective analysis of real-world evidence which was reported in 

, aggressive HER2-targeted therapy may still be effective in patients with HER2-positive breast cancer who have experienced disease progression after HER2-directed therapy and who have brain metastases.

The findings showed that patients with disease progression and brain metastases achieved a median progression-free survival of 8 months (95% CI, 6.2-9.8) and a median overall survival (OS) of 14.0 months (95% CI, 10.8-17.2). The estimated 2-year OS rate was 25% (95% CI, 16.7%-34.4%).

Patients with HER2-positive metastatic breast cancer and brain metastases face poor prognoses, write investigators. However, these findings suggest that targeted therapy may play a useful role, even following disease progression. The authors added that these data may be useful to inform decision-making for patients who live in regions where newer HER2-directed therapies may be limited and real-world evidence surrounding local and systemic therapies are crucial.

Improvements in Accessibility to Cancer Screenings Are Needed for Individuals With Disabilities

Approximately 15% of the world’s population lives with a disability, writes Rebecca Kronk, PhD, MSN, CRNP, ANEF, FAAN, CNE, associate dean for academic affairs professor, Duquesne University School of Nursing. Moreover, in the United States, the Center for Disease Control has reported that 1 in 4 adults has at least 1 disability.

In oncology, there needs to be recognition of that disparities that people with disabilities, who have been described as the largest minority group in the world, face. It is imperative that nurses and other health care professionals acknowledged how disparities can affect preventative screenings and, more importantly, become part of the solution by helping to make early detection and cancer treatment more accessible for those living with disabilities.

Maximizing Potential of Immunotherapy Requires Appropriate irAE Management

Immunotherapy represents a very powerful force in the world of cancer treatment, according to Melinda S. Weber, DNP, APN, AOCN-C. This treatment modality has drastically improved outcomes for many patients across cancer subtypes.

However, because immunotherapy is linked to a unique and powerful mechanism of action, it is also associated with intense adverse effects which need appropriate management.

In a presentation during the Nursing track at the 

 Weber who is the director of care transformation and a charge APN in the Skin and Sarcoma Division at John Theurer Cancer Center at Hackensack University Medical Center Weber, touched on the marked success of the treatment in the field in melanoma and outlined the tenets of early recognition, appropriate grading, and best management practices for irAEs. 

Caring for the Caregiver: Practical Tips for Oncology Nurses

Those caring for an adult with cancer face substantial stress. Giving care, either voluntarily or not, impacts the psychical, social, and emotional health of a caregiver, and can influence their employment and financial stability.

In this feature story, Ellen Tichich, MFA, MSN, RN-BC, spoke with caregiver Debbie Legault, and Michelle Mollica, PhD, MPH, RN, OCN; and Sharon Cavone, BSN, RN, OCN, about practical ways that oncology nurses can help caregivers feels supported.

In November 2022, HER2-directed therapies made headlines in breast cancer as did innovations to help individuals who are often overlooked in oncology care. 

Oncology Nursing News Top Stories: November 2022

Advanced practice providers (APPs) and research nurses may be the best primary points of contact for patients with relapsed follicular lymphoma receiving immune checkpoint inhibitor (ICI) therapy in a clinical trial setting, according to investigators who presented on best ICI-related adverse event (AE) practices during the 2022 Pan Pacific Lymphoma Conference.

Early identification and management of irAEs are critical to provide best care and promoted treatment continuation.

Institutions providing a multidisciplinary team, including a primary investigator, attending physician, clinical nurse, advanced practice provider (APP), and research nurse, are uniquely poised to address potential ICI-related toxicities during the clinical trial period. Cross-functional teams promote closer monitoring of signs and symptoms related to irAEs, assessment of a patient’s ability to self-report symptoms, and early and frequent education for patients about what to expect throughout the treatment cycle.

In a retrospective chart review, investigators assessed data from an investigator-initiated, open label, single-center phase 2 study (NCT02446457) conducted at The University of Texas MD Anderson Cancer Center (MD Anderson). The trial enrolled patients with stage I-III, relapsed or refractory follicular lymphoma who were age 18 years or older and had absolute neutrophil counts of at least 1.0 × 109 cells/L, platelet counts of at least 50 × 109 cells/L, and adequate renal, cardiac, and pulmonary function. Although patients needed to have received at least 1 line of prior therapy, prior ICI therapy was ground for exclusion. Other exclusion criteria included a history of autoimmune disease within the past 2 years requiring systemic therapy, history of any other malignancy within the past 5 years, uncontrolled serious illness or comorbidities, or history of HIV, active hepatitis B or C infection.

Enrolled patients received 375 mg/m2 of intravenous rituximab (Rituxan) on days 1, 8, 15, and 22, during cycle 1, and 200 mg of IV pembrolizumab (Keytruda) every 3 weeks for up to 16 cycles, beginning on day 2 of cycle 1. Providers used the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE), version 4.0 to grade the AEs.

Overall, 30 patients with follicular lymphoma were treated on the study, 80% of whom experienced an irAE in accordance with the terminology criteria. Thirteen percent of patients experienced a grade 3 or 4 irAE, 33% (10 patients) completed 16 cycles without early discontinuation, and 20% (6 patients) discontinued treatment following the manifestation of an irAEs.

The onset time to first irAE ranged from 1 day to 207 days with a median of 35 days. In addition, 5 patients had pre-existing conditions (asthma, diarrhea, rash, hepatitis), which study authors noted could be further analyzed as an irAE risk factor.

The work-up for irAEs in this study included cultures, diagnostics imaging, and biopsies. Providers also referred their patients to other specialties for nuances diagnosis or management of certain irAEs, such as pulmonary medicine, infectious disease, dermatology, gastrointestinal endoscopy, ophthalmology, and endocrinology.

“Providers should pay close attention to signs [and] symptoms of irAEs,” the study authors wrote a poster of the findings. “Providers should consider treatment hold [or] discontinuation of checkpoint inhibitors when concerning irAEs occur.”

Corticosteroids continue to be a mainstay of treatment for various irAEs and higher grade, recurrent, or persistent irAEs may require the use of steroids. Moreover, as certain irAEs may be severe, and unfortunately difficult to diagnose, investigators recommend using the services of gastrointestinal, pulmonary, and infectious disease teams, for diagnostic testing and treatment recommendations. Further, collaboration with dermatology and ophthalmology are advised for skin or eye conditions.


Study authors explained that ICI therapies have been incorporated into the treatment landscapes for several cancer types, including non-Hodgkin lymphoma. However, the mechanism of action with these drugs results in immune system activation and can therefore result in irAEs. Common events include dermatitis, colitis, hepatitis, pneumonitis, and endocrine disorders including thyroid dysfunction. Because irAEs may develop at various timepoints throughout treatment and progress quickly, early detection and intervention is key in providing quality care to patients.

The ICI associated with more irAEs in the study was pembrolizumab, and the most common mitigation strategy was to hold or discontinue pembrolizumab and administering systemic corticosteroids. Following treatment hold, 4 patients were rechallenged with pembrolizumab (median of 28.5 days; range 14-51), but permanently discontinued treatment due to persistent immune-related diarrhea (n = 3) and pneumonitis (n = 1). Another patient was rechallenged with pembrolizumab and successfully completed all 16 cycles without irAE recurrence.

Several patients (n = 7) received corticosteroids to manage their irAEs. The median duration of time on corticosteroids was 125 days (range, 40-319). Three of these patients received topical corticosteroids only for rash, and the remaining were observed until resolution.

Notably, the study authors noted that for a small number of patients, irAEs did not present until after pembrolizumab was permanently discontinued. Nevertheless, all patients included in the study had eventual resolution of their irAEs.

The study authors acknowledged that patients enrolled at MD Anderson clinical trials have multiple avenues to contact a member of their care team, including direct phone calls, emails, texts, to research nurses and APPs, phone call to clinic teams, or emails to clinical teams through an online patient portal. Having multiple lines of communication between a patient and a research nurse/APP may be critical, they observed, as this facilitates effective communication.

“Providers should especially monitor patients for recurrence of irAEs who are undergoing a treatment rechallenge with a checkpoint inhibitor [and] be aware that irAEs can occur even once treatment is permanently discontinued, and continue to monitor for irAEs,” The authors wrote, noting that “multiple irAEs can occur in the same patient at different times.”

Dsouza S, Nastoupil L, Mims J. Diagnosis and management of immune-related adverse events in follicular lymphoma patients treated with a checkpoint inhibitor. Presented at: 2022 Pan Pacific Lymphoma Conference: July 18-22, 2022; Koloa, Hawaii.

Because immune-related adverse events can be hard to diagnose, patient education and clear avenues of communication with an oncology care team are critical, according to investigators at the 2022 Pan Pacific Lymphoma Conference.

Oncology APPs, Research Nurses Are Uniquely Poised to Tackle irAE Management in Follicular Lymphoma

Improving caregiver education, allowing time for a patient to process their diagnosis before discussing treatment, and utilizing multidisciplinary support systems are critical in improving the lived experiences of patients with relapsed or refractory diffuse-large B-cell lymphoma (DLBCL), according to investigators who presented on preferences and perceptions at the 2022 Pan Pacific Lymphoma Conference.

Results from a survey analysis revealed gaps in shared decision-making including limited treatment options in this setting, a lack of tailored materials to guide caregivers in their newfound roles, and few resources for physicians to integrate real-world experience into their workflows. Findings also showed that the shock of the diagnosis, and the short period time between diagnosis and treatment initiation, also represents barriers to shared decision-making as this overwhelming experience tends to negatively affect the quality of patient-provider discussions surrounding treatment elections.

“Real-world evidence generated from this study fills a major gap in evidence on the preferences and goals for this patient population, specifically,” study authors wrote in a poster of the data.

Additionally, the “findings from this qualitative research study suggest that there may be opportunities to further integrate aspects of patient and caregivers’ lived experiences into treatment decision-making for [relapsed or refractory] DLBLC, increase [the] use of individualized multidisciplinary support services that can support the holistic health needs of patients, [and] develop tailored educational materials for caregivers that can equip them as trusted and engaged members of the patients treatment decision-making process.”

Although shared decision-making is associated with improved patient experience, engagement, and treatment satisfaction, there are currently few resources for patients with DLBCL whose disease has relapsed. This is accentuated by the National Comprehensive Cancer Network guidelines, which recommend multiple systemic therapies for second- and third-line treatment regimens. If a patient’s disease does not response to first-line treatment, patients can undergo either an autologous or allogenic stem cell transplant, or CAR T-cell therapy, depending on their eligibility.

For patients who are not transplant eligible, available treatment options include tafasitamab-cxix (Monjuvi) plus lenalidomide (Revlimid), polatuzumab vedotin-piiq (Polivy) with or without rituximab (Rituxan) and with or without bendamustine, or gemcitabine and oxaliplatin with or without rituximab. Navigating between these choices can be overwhelming for patients and caregivers, and although literature exists regarding the real-world evidence on patient preferences for later-line therapies, most studies focus broadly on lymphoma or non-Hodgkin’s lymphoma rather than the relapsed or refractory DLBCL population specifically.

Therefore, investigators conducted a literature review to better understand the current body of evidence for treatment preferences. Using findings from the literature review, they then interviewed 14 adult patients, 8 caregivers, and 8 oncologists. All 30 interviews were transcribed.

The patients and caregivers were linked; however, no oncologists were the treating physician of any participating patient. Patients needed to either the undergoing second-line or third-line treatment or have completed it within the past 5 years. Caregivers had to be caring for patients who fit the patient inclusion criteria. Oncologists could either be community-based in a large health system, or academic setting.

Patients were queried about their attitudes and beliefs surrounding both their and their caregiver’s involvement in shared decision-making, their preferences and goals surrounding second- and third-line treatment options, and their treatment satisfaction in regard to quality of life and treatment schedules.

Caregivers were asked to share what their current practices were for shared decision-making and their attitudes or beliefs surrounding their involvement.

Most patients (71%) and 38% of caregivers shared that they felt limited in their ability to make decisions because their clinician had expressed that they were already following a well-established standard of care. Further, the shock of the diagnosis significantly affected their ability to be actively involved in treatment decision-making. Physicians echoed the sentiments of patients and caregivers in the study, noting that limited second and third line options offer limited opportunities for integrated treatment selection. In addition, 50% of patients felt that their caregivers were very important in supporting their understanding of second and third line treatment options; however, only 1 caregiver felt that had enough time between diagnosis and treatment initiation to make an informed decision.

Among clinicians, 75% responded that they routinely ask patients about support system and social needs during their initial treatment planning visit, such as transportation issues or living situations. One physician also reported having asked about specific events influencing treatment selections, such as upcoming weddings or travel. Generally, oncologists in a community-based setting were less able to provide a care team model, and therefore, as the patient’s main point of contact, felt limited in their ability to provide comprehensive care and address all the patient’s concerns.

One hundred percent of participating clinicians stated that patients should have a high degree of autonomy, yet 62% stated that a lack of patient understanding or a lack of education regarding treatment options was a major barrier in including patients in the selection process.

Patients were mixed about their specific experiences with treatment. One thing that many patients felt unprepared for was changes to treatment plans. Overall, 3 patients (21%) shared that when details of their care journey were inconsistent with what was previously communicated (ie, the route of administration), they felt overwhelmed. Four patients (29%) felt that their physicians did not address ancillary health concerns including mental health, in an adequate manner, and 2 patients shared that their care plan had been limited to the standard of care, and that other treatment options, such as novel methods to relieve treatment symptoms, were not made available to them.

Many patients (36%) also felt that their oncologist had overemphasized the efficacy of the first line therapy, leaving them unprepared for the possibility of requiring second or third line treatment. Younger patients felt that issues like fertility or major life events in their lives were not calculated into the treatment planning process.

Overall, the survey highlighted gaps which exist in the relapsed or refractory DLBCL treatment plan schema and offers direction for providers who want to provide a more integrative care delivery. Moving forward, real-world evidence studies should seek to focused on the needs and preferences of minority patients in this setting.

Vukcevic M, Yung M, Khan M, Houpt B, Schnell F. Preferences and perceptions regarding treatment decision-making for relapse or refractory diffuse large b-cell lymphoma. Presented at: 

 Pan Pacific Lymphoma Conference East: July 18-22, 2022; Koloa, Hawaii.

The ideal model for promoting effective shared decision-making involves tailored caregiver education, adequate time before treatment, and use of multidisciplinary support. 

Investigators Unveil Real-World Experiences on Shared Decision-Making in R/R DLBCL 

Each month, we take a look back at the most popular 

Each month, we take a look back at the most popular Oncology Nursing News® stories. Here are the top 5 stories from June 2022.

Oncology Nursing News