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Axel Stuart Merseburger, MD, PhD, explained that with TKIs like axitinib, it is necessary for oncology nurses to spend time with each patient to provide the best care.

Becoming Familiar With Patients’ AEs is Essential, Says Expert

Avelumab in combination with axitinib was found effective and safe as frontline treatment for advanced RCC in real-world findings.

Real-World Data Back First-Line Avelumab and Axitinib in Advanced RCC

Patient-reported outcomes were consistent between patients with RCC using tivozanib/nivolumab and tivozanib monotherapy according to study findings.

Person acute kidney injury Comprehensive image overview of kidneys showing sudden loss of function | Image Credit: © Premium Graphics - stock.adobe.com.

Tivozanib Combo Yields Similar PROs to Monotherapy in Advanced Clear Cell RCC

Katy Beckermann, MD, PhD, explained that oncology nurses and APPs should be ready to administer and explain dose modifications for patients with RCC.

Dose Reductions Possible for Tivozanib With and Without Nivolumab for RCC

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Breast cancer survivors treated with endocrine therapy alone reported better long-term physical health outcomes compared with those who received chemotherapy.

Chemotherapy Linked to Persistent Physical Health Decline in Breast Cancer Survivors

Neoadjuvant and adjuvant durvalumab plus FLOT followed by durvalumab monotherapy improved EFS for patients with resectable gastric or GEJ cancer.

Perioperative Durvalumab With Chemo for Resectable Gastric/GEJ Cancer Reaches EFS End Point

TLX007-CDx was approved by the FDA for PSMA-PET scanning in adult male patients with prostate cancer with suspected metastasis or suspected recurrence.

FDA Approves TLX007-CDx for Prostate Cancer Imaging

Oncology nurses and APPs provide support and can help to facilitate conversations with patients and families during end-of-life care.

Facilitating End-of-Life Care for Patients With Breast Cancer

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Sue Stephens, MSW, LCSW, ACSW, Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey

Pediatric oncology nurses and social workers routinely collaborate not only in the biopsychosocial assessment of families’ psychosocial needs and distress, but in developing interventions that can improve a patient’s and family’s quality of life while in pediatric cancer treatment and in survivorship.


 Collaboration Between Pediatric Oncology Nurses and Social Workers Decreases Treatment-Related Distress 

When compared to standard of care, ciltacabtagene autoleucel (cilta-cel; Carvykti) displayed improvements in patient-reported outcomes including greater health-related quality of life (HRQOL) and delayed worsening of symptoms in patients with relapsed, lenalidomide (Revlimid)-refractory multiple myeloma in findings from phase 3 trial CARTITUDE (NCT04181827) published in 

At a median follow-up of 15.9 months (IQR, 12.4-17.8), the Multiple Myeloma Symptom and Impact Questionnaire (MySIm-Q) compliance post-baseline score was 70% to 81% for patients who received cilta-cel and 79% to 89% for patients who received standard of care; the MySIm-Q median time to sustained worsening of symptoms was 23.7 months with cilta-cel and 18.9 months with standard of care (HR, 0.42; 95% CI, 0.26-0.68; 

European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core C30 (EORTC QLQ-C30) global health status (GHS) 12-month score mean changes were +10.1 points (95% CI, 7.0-13.1) for cilta-cel and −1.5 points (95% CI, −5.3 to 2.3) for standard of care; for EuroQol 5-Dimension 5-Level (EQ-5D-5L) visual analogue scale mean changes were +8.0 (95% CI, 5.2-10.7) and +1.4 (95% CI, −1.9 to 4.7), respectively.

“In CARTITUDE-4, cilta-cel provided greater improvements than standard of care in overall HRQOL, including multiple functional domains and patient-reported pain and fatigue, in patients with lenalidomide-refractory multiple myeloma after 1 to 3 previous lines of therapy,” Roberto Mina, MD, at the University of Turn, and author of the study, and fellow authors, stated. “Improvements were sustained until at least month 12 and encompassed overall health status, functioning, and multiple myeloma-specific symptoms including pain and fatigue.”

A total of 419 patients were randomly assigned, in a 1:1 ratio, to receive cilta-cel (n = 208) or standard of care (n = 211). Those in the cilta-cel arm underwent apheresis, 1 or more cycles of bridging therapy depending on clinical status and cilta-cel manufacturing time, and lymphodepletion consisting of 300 mg/m

 fludarabine daily for 3 days. Then, 5 to 7 days after lymphodepletion, patients were given a single cilta-cel infusion at a target dose of 0.75x10

 CAR-T cells/kg. Standard of care was either 1800 mg of subcutaneous daratumumab (Darzalex), 4 mg of oral pomalidomide (Pomalyst), and 40 mg of oral or intravenous dexamethasone in 28-day cycles (n = 182), or 4 mg of oral pomalidomide, 1.3 mg/m

 of subcutaneous bortezomib (Velcade), and 40 mg of oral dexamethasone in 21-day cycles (n = 26).

To be included in the study, patients needed to be lenalidomide-refractory or relapsed/refractory multiple myeloma who received 1 to 3 prior lines of therapy with a proteasome inhibitor and an immunomodulatory drug, as well as an ECOG performance status of 0 or 1. Those who received prior CAR T-cell or anti-BCMA therapies were not permitted enrollment.

Clinical efficacy was previously reported with progression-free survival (PFS) as the primary end point, however, time to sustained worsening of patient-reported symptoms, change from baseline in the MySIm-Q, the EORTC QLQ-C30, and the EQ-5D-5L, were key secondary end points.

The median time to improvement on the MySIm-Q total symptom scale was 2.8 months (IQR, 0.3-6.2) for cilta-cel and 1.7 months (IQR, 1.2-3.0) for standard of care; on the total impact scale, it was 2.8 months (IQR, 0.4-6.5) and 1.4 months (IQR, 1.1-3.0). At month 12, 35% of the cilta-cel group and 14% of the standard of care group achieved clinically meaningful improvements in total multiple myeloma score compared with 11% and 33%, respectively, who achieved worse scores.

EORTC QLQ-C30 physical functioning, role functioning, and social functioning were all improved in the cilta-cel group, though they were not improved in the standard of care group.

In the cilta-cel group, EQ-5D-5L visual analogue scale scores fell from baseline to month 3, then increased over time to a least-squares mean of +8.0 points (95% CI, 5.2-10.7) at month 12 compared with a +1.4-point increase in the standard of care group. Results were similar at 18 months.

At the median follow-up of 15.9 months (IQR, 12.4-17.8), the primary analysis from the CARTITUDE-4 trial showed that cilta-cel “significantly improved” PFS over standard of care (HR, 0.26; 95% CI, 0.18-0.38; 

<.001), increased the overall response rate (ORR; 85% vs 67%, respectively), depth of response (73% vs 22%), and rate of minimal residual disease negativity (61% vs 16%).

“With previously reported data showing that cilta-cel significantly improves PFS, ORR, and depth of response vs standard of care, the improvements in HRQOL that we observed support the use of cilta-cel in earlier lines of treatment for lenalidomide-refractory multiple myeloma,” the authors concluded.

Mina R, Mylin AK, Yokoyama H, et al. Patient-reported outcomes following ciltacabtagene autoleucel or standard of care in patients with lenalidomide-refractory multiple myeloma (CARTITUDE-4): results from a randomised, open-label, phase 3 trial. 

. 2025;12(1):e45-e56. doi:10.1016/S2352-3026(24)00320-X

Median time to sustained worsening of symptoms was 23.7 months with cilta-cel, compared with 18.9 months with SOC.

Cilta-Cel Associated With Higher HRQOL for Lenalidomide-Refractory MM

While high-risk multiple myeloma can be difficult to treat with aggressive therapies, treatment considerations with the help of diagnostic tools may prove helpful when determining when to de-escalate treatment for certain patients.

At a recent Community Case Forum hosted by Oncology Nursing News, Mark Davis, PA-C, a physician assistant from Texas Oncology, Southwest Forth Worth Cancer Center, and colleagues discussed disease burden and diagnostic tools, as well as risk stratification and treatment approaches in high-risk multiple myeloma.

“In terms of risk stratification, we use the International Staging System [ISS], which is more or less the old way of doing it…” Davis explained during the event, adding that providers use the revised ISS with lactate dehydrogenase (LDH) levels and high-risk cytogenetics of chromosomal abnormalities. “So somebody who has a double-hit myeloma, that means they have 2 chromosomal abnormalities, and that is going to put them at a higher risk classification.”

Factors associated with high-risk disease or the progressive relapse setting include those with newly diagnosed myeloma who have a revised ISS of III, extramedullary disease, circulating plasma cells, and cytogenic abnormalities. For patients with newly diagnosed multiple myeloma, cytogenic abnormalities associated with high risk for disease progression or relapse include Del(1p32), t(4;14), t(14;16), t(14;20), Del(17p) or monosomy 

 mutation, 1q21 gain or amplification, and MYC translocation.

“As an [advanced practice provider (APP)] we can really help clinicians not only identify high-risk patients based on cytogenetics but also those who have a short course of remission and identify them as high risk as well,” Davis said in an interview with Oncology Nursing News. “And so patients who have disease progression within 2 years of their induction therapy, [that] automatically puts them in a subgroup of high-risk disease. And we are trying to tailor therapies differently in those patient populations that have more aggressive disease.”

Factors that may impact treatment for patients include their personal preferences, physical activity, work productivity, comorbidities, quality of life, disease symptoms and control, treatment-related toxicities that could lead to discontinuation, treatment convenience (oral vs intravenous), and financial toxicity.

With high-risk myeloma, it is a disease that can be difficult to treat. To further complicate management, many patients are unable to receive intense treatment because of comorbidities.

At the Community Case Forum, Davis presented a case of a 76-year-old female with ISS stage II myeloma, who is not eligible for a transplant and also presents with early-stage Parkinson’s disease that is currently controlled with treatment. At diagnosis, she presented with severe lower back and neck pain, has experienced increasing fatigue and mobility challenges, and reported with an ECOG performance status of 1.

The case, Davis noted, highlights certain patients’ inability–for example, older, frail, or transplant-ineligible patients–to receive aggressive therapy, whether considered high risk or not, and, in turn, the need for treatment de-escalation.

The attendees were polled on what regimen should be prescribed for the frontline treatment of this patient, including:

bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (VRd), which included CRd lite;

daratumumab (Darzalex) plus lenalidomide and dexamethasone (Dara-Rd);

ixazomib (Ninlaro) plus lenalidomide and dexamethasone (Ixa-Rd); or

a quadruplet regimen like Dara-VRd or Dara-VMP)

Results were evenly divided-50% of respondents said that they would consider VRd while the other half were in favor of Dara-Rd.

“Both of those responses are on par to what we would expect,” Davis said. “…Frail and elderly patients are technically considered high-risk patients because historically, they’re unable to go with more aggressive therapies that include transplants.”

He added that these patients will also often be offered, in the community setting, a doublet that has inferior results due to concerns of toxicity. “More recent data from the MAIA study [NCT02252172]

 showed similar tolerance in older patients who were treated with Dara-RD vs Rd. Hopefully, this data will encourage clinicians to move further away from doublets even in our frail patients.”

Similarly, he added, often patients who are elderly or frail would not be offered a quadruplet regimen either. “You're often going to have to de-escalate [treatment] in some form or fashion.”

To aid in predicting long-term remission, the use of minimal residual disease (MRD) is growing in the multiple myeloma landscape.

“There's now studies ongoing about de-escalating therapy based on MRD, but also just even outside of that, from a prognostic value, it's more accurate than our M spikes,” Davis explained. “…MRD is most valuable when patients are wanting to de-escalate, and this could be a leverage point.”

In the case study, the patient was treated with frontline Dara-Rd. Following 9 months of treatment, she presented with an ECOG performance score of 2, a complete remission that was followed by a partial response at month 1 and very good partial response at month 8, with stable chemistry labs. In addition, the patient experienced grade 3 neutropenia that lasted for 1 cycle of treatment and appeared refractory to a single dose of granulocyte colony-stimulating factor. Her imaging revealed no new findings.

At 12 months, the patient’s ECOG performance score was 1 and she is stable in CR, chemisty and hematology labs, and continuance of no new findings on her imaging. Of note, her Parkinson’s disease remained in control with daily functioning that was consistent with baseline findings.

“MRD negativity at 12 months alone has also been associated with overall survival improvement. So again, it just highlights, for us, the relevance of deepening responses and maintaining somebody in a state of undetectable disease,” he said, highlighting that MRD negativity led to a median progression-free survival of 63 months, compared 27 months among patients with CR achievement, based on data from a pooled analysis of 3 Pethema/GemDavis clinical trials.

NCCN. Clinical Practice Guidelines in Oncology. Multiple myeloma, version 1.2025. Accessed December 12, 2024. 

https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf

Facon T, Kumar S, Plesner T, et al. Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. 

. 2019;380:2104-2115. doi:10.1056/NEJMoa1817249.

Lahuerta JJ, Paiva B, Vidriales MB, et al. Depth of Response in Multiple Myeloma: A Pooled Analysis of Three PETHEMA/GEM Clinical Trials. 

. 2017;35(25):2900-2910. doi:10.1200/JCO.2016.69.2517.

“Treatment effectiveness can have different meanings to patients,” a physician assistant said when discussing therapy for high-risk myeloma. 

High-Risk Myeloma Treatment Is Not One-Size-Fits-All

I never considered communication an area where I would struggle as a nurse or even as a nurse practitioner. My first degree was in social work; if anything, I felt I excelled at communication. As a nursing professor for the past 8 years, I have always prioritized communication and patient education, having taught prelicensure, graduate, and doctoral students. In my nursing career, I found communication and education to be important tools used to empower, reduce anxiety, and build therapeutic relationships with patients and families.

However, this was not always true. One of the hardest lessons learned occurred after I inadvertently failed at communication and education before transferring a patient to the intensive care unit (ICU). The patient’s family tearfully shared their perception of not being prepared for the possibility of toxicities necessitating the ICU when they began treatment. In addition, a goals-of-care conversation was initiated while in the ICU and without the involvement of the oncology team.

The family verbalized feelings of abandonment and uncertainty without the oncology team to guide decisions and the perception that I did not educate them that the ICU team was assuming all care. This event was a catalyst for a personal journey to make certain each patient and caregiver is empowered with the information needed and that interprofessional communication is a goal.

I was reminded of this patient’s experience and applicability with emerging bispecific T-cell engager therapies. Our institution has a robust cellular therapy program that has previously focused on hematologic malignancies. Bispecific T-cell engager therapies have recently been introduced for solid tumor diagnoses such as small cell lung cancer, uveal melanoma, and synovial sarcoma. The delivery of bispecific T-cell engager therapies for patients with solid tumors presents new challenges requiring effective communication among teams. These patients are often comanaged by the cellular therapy team, the medical oncology team, and sometimes ICU teams consisting of nurses, advanced practice providers, pharmacists, physicians, and social workers.

Interprofessional communication and patient education are crucial aspects of oncology care from diagnosis to end of life. When considering bispecific T-cell engager therapies, patients and caregivers require education regarding expectations, the treatment regime, supportive care, potential toxicities, and identification of team members involved and the roles of each. Although this is true with every oncologic therapy, bispecific T-cell engager therapies require additional considerations.

Initially, the patient may need assistance with resources, education on treatment timeline, and coordination of outpatient vs inpatient hospitalization. Education should also focus on the potential for serious toxicities commonly associated with oncologic therapies, such as cytopenias requiring transfusions, infections, neutropenic fever, tumor lysis syndrome, and hypersensitivity reactions, but also toxicities such as cytokine release syndrome (CRS) and immune effector–associated neurotoxicity syndrome (ICANS).

There should be clear and concise education on being near the facility in case of complications, home monitoring of vital signs and symptoms, when to notify the team, how to contact the team, time frame, and specific dates patients will be at the highest risk of these potentially life-threatening complications.

 Patients and caregivers should be taught the frequency of monitoring at home in addition to symptoms of concern. CRS symptoms may consist of fever above 100.4°F, hypoxia less than 90% or change from baseline, hypotension with a decrease in systolic blood pressure of over 10 mm Hg from baseline or less than 90 mm Hg, and/or an increased heart rate greater than 100 or more than 20 beats per minute above baseline at rest.

In addition, patients are taught to monitor for ICANS, which often presents with headache and dizziness; other symptoms can be progressive with confusion, difficulty writing or speaking, changes in consciousness, abnormal behaviors or actions, and/ or seizures.

 Initially, it is important to educate that CRS and ICANS are managed based on severity and symptoms, and both conditions may overlap. The severity of CRS may necessitate hemodynamic monitoring in an ICU with increased oxygenation needs requiring mechanical ventilation, vasopressors, intravenous fluids, and medications.

 The severity of ICANS may also necessitate an ICU admission due to altered levels of consciousness, seizures, and cerebral edema.

The patient and caregiver should be empowered with information. Still, we cannot forget the interprofessional aspect of delivering these therapies and how we approach communication with the patient and caregiver. The patient and caregiver need to understand that the severity of these complications may involve a multidisciplinary effort between the oncology teams, intensivist, and neurointensivist. Any acute ICU admission related to a complication of bispecific T-cell engager therapy should necessitate a goals-of-care discussion. Caregivers should be educated early to request the oncology team be present and involved in conversations regarding goals of care and decision-making while under ICU care. This is crucial as ICANS and CRS can mimic other conditions, and the patient may appear critically ill.

However, there may be potential for recovery with appropriate management based on the severity of the illness, with the oncology team providing expertise and information. Mnemonics such as REMAP can guide the interprofessional team: reframe, expect motion, map out goals, align with goals, and propose a plan.

 This mnemonic can be used to discuss the overall prognosis, acknowledge distress, evaluate the perception and wishes of the patient and caregiver, and develop a plan moving forward. Social workers or a palliative care team may also be required to address associated psychological distress. In addition, there may be a need for frequent delineation of team member roles to enhance interprofessional communication among multiple disciplines.

In reflection, my experience almost a decade ago continues to impact why I advocate for patients today. As professionals, we must also realize the power of a patient’s or caregiver’s perception and the impact when communication is lacking or education has not been delivered. Communication and education are driving factors affecting the successful delivery of all oncologic care, especially with emerging bispecific T-cell engager therapies. We must initiate difficult conversations early to plan for the unknown. The patient and caregivers must have the resources and knowledge to help recognize, monitor, and report common toxicities; understand management; and be empowered to request and participate in goals-of-care conversations with their oncology teams.

Crombie JL, Graff T, Falchi L, et al. Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy. 

. 2024;143(16):1565-1575. doi:10.1182/blood.2023022432

Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: a framework for goals of care conversations. 

. 2017;13(10):e844-e850. doi:10.1200/JOP.2016.018796

Huddle card: immune effector cell associated neurotoxicity syndrome. Oncology Nursing Society. October 2023. Accessed December 15, 2024. https://www.ons.org/sites/default/files/2023-10/Huddle%20Card-ICAN%20.pdf

Huddle card: oncologic emergencies: cytokine release syndrome (CRS). Oncology Nursing Society. November 2024. Accessed December 15, 2024. https://www.ons.org/sites/default/files/2024-11/huddle-card-cytokine-release-syndrome.pdf

Advanced Practice Corner

Communication and Education: Improving Patient Outcomes With Bispecific T-Cell Engager Therapies

Oncology nurses and APPs should prioritize active listening and deeper patient engagement to build trusting, long-term relationships with patients with MPNs.

Building a Foundation of Trust in Patients With MPNs 

For oncology nurses and APPs caring for patients with chronic conditions like MPNs, fostering a comfortable environment begins with active listening that extends beyond clinical data, an expert said.

Understanding the patient's life outside the exam room—their sources of joy and their personal challenges—is essential for providing holistic care. Given the nature of MPNs, these providers often develop long-term relationships with patients, sometimes seeing them more frequently than they see their own families. Therefore, prioritizing the establishment of trusting relationships through deeper patient engagement is paramount for optimizing care and support throughout the patient's journey.

Oncology Nursing News spoke with Kathryn Johnson, DNP, MSc, FNP-BC, to learn more about how connections like these can really benefit patients with MPNs.

Johnson is a Clinical Program Manager at Icahn School of Medicine at Mount Sinai New York.

I think the best thing to do to help people feel at ease is to listen, not just superficial listening, but really active listening. I love to learn about my patients and who they are outside of the exam room, because when they come to us, it's such a small part of their lives. Understanding what brings them joy, what struggles they're having beyond what their blood counts show, is so important to helping making sure that we're doing holistic care for our patients.

MPNs are chronic disorders, which means that we actually get to establish really lovely, long-term relationships with our patients. I have patients that I've seen over the last 5 years once or twice a month, which is more often than I even get to see my own family in Virginia. So, I think making sure, again, that we're building those long-term relationships with a good foundation of trust by getting to know the patients on a deeper level, is really important.

This transcript has been edited for clarity and conciseness

Building a Foundation of Trust in Patients With MPNs

Navigating Immune-Related Adverse Events With Nivolumab in Upper GI Cancer

Video content above is prompted by the following:

•	What are the key irAEs to monitor in patients receiving nivolumab, and how do you differentiate these from disease-related symptoms ?

•	How do you approach the management of moderate to severe irAEs, and what factors determine whether immunotherapy should be paused or discontinued?


Experts discuss key immune-related adverse events (irAEs) to monitor in patients receiving nivolumab, how to differentiate these from disease-related symptoms, and how to manage moderate to severe irAEs, including factors that determine whether immunotherapy should be paused or discontinued.

The 1945 atomic bombings in Japan left instantaneous death and destruction, but it wasn’t until years later that the devastating lasting effects began to appear in the population. At first, leukemia from radiation exposure was diagnosed among bombing survivors. Then, cases of solid cancers, such as bladder, breast, colon, lung, and thyroid, emerged.

Although the scientists who created the atomic bomb understood the increased risk of cancer from radiation exposure, this wasn’t common knowledge to the average person. Still, today, with the known risks, radiation is routinely used to treat many types of cancer. Furthermore, chemotherapy, chimeric antigen receptor (CAR) T-cell therapy, and certain targeted therapies are also some of the best ways to eradicate cancer cells that are growing inside of a person’s body despite the possibility that these treatments may lead to the formation of secondary cancer.

The development of a new cancer following primary cancer treatment is called secondary malignancy, and these account for 19% of all cancer diagnoses in the United States.

Patients who receive certain cancer treatments are at greater risk of secondary malignancies and must be educated accordingly.

Sue Stephens, MSW, LCSW, ACSW

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