Oncology nurses can help reduce the number of central line-associated bloodstream infections (CLABSIs) in patients undergoing hematopoietic stem cell transplant (HSCT) by standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage, according to a presentation at the 2022 Transplantation & Cellular Therapy Meetings.

Following a peer-to-peer observation and validation process was implemented in June 2021, there was a 68% decrease in CLABSI incidences at NYU Presbyterian 10 West. The number of incidences improved from 2.82 events per 1000 central line days (pre-intervention January to May) to 0.90 events per 1000 central line days (June to August).

“Oncology nurses play a primary role in implementing strategies to help reducing preventable CLABSI,” Thanyanee McNinney, BSN, RN, OCN, of the New-York Presbyterian Department of Nursing, said in a poster presentation of the findings.

CLABSIs represent a significant mortality risk to patients and are also linked with financial toxicities; one case of CLABSI can cost around $40,000.

Furthermore,factors including long term central line placement and usage, high-dose chemotherapy, prolonged immunosuppression, and the possibility of posttransplant complications such as graft-vs-host-disease (GVHD) mean that patients undergoing HSCT are especially vulnerable to CLASBI. However, research has demonstrated that proper insertion techniques and central line management can help prevent CLABSI.

In 2020, there were 0.51 CLABSIs per 1000 central line days at the investigator’s institution; by the second quarter of 2021, there were 2.82 CLABSIs per 1000 central line days.

Therefore, investigators sought to increase competency and reduce the incidence at their institution. Their objective was to reduce incidence by 20% within 3 months on a 16-bed HSCT inpatient unit in an academic medical center.

Investigators collaborated with the Hospital Acquired Infection (HAI) champions and nursing leadership teams to develop an action plan. This plan consisted of a thorough root to cause analysis of incidences, interdisciplinary huddles, standardized validation tools to allow peer-to-peer observation and validation during blood culture and blood specimen collection via central lines and CHG use.

The CVL peer feedback tool assessed whether observed staff performed proper hand hygiene when indicated, needle endcaps were clean, CVC ports/lines not being used had an alcohol impregnated endcap in place, all intravenous (IV) tubing not being used had a red cap, that no IV tubing were expired and had adequate labels indicating last line change, and that the CVC dressings were clean, intact, and not reinforced.

Following peer-to-peer observation and validation, it was revealed that 35% of nurses did not adhere to NYP policy when collecting blood cultures or drawing blood via a central line. Furthermore, 66% of nurses did not know how to perform CHG treatments correctly.

In addition, the study revealed multiple opportunities for growth. Among some of the registered nurses, peers observed the donning of gloves without performing hand hygiene, opening equipment without proper aseptic technique; insufficient scrubbing of the hub, failure to replace new Q-site prior to drawing blood cultures, drawing blood cultures directly through the lumen without a new Q-site placement, and a failure to flush with required amount of normal saline post-blood draw and performing push-pause technique when flushing.

Ultimately, nurses can be pivotal in reducing CLABSIs by educating staff members on proper CHG wipe usage and standardizing central line blood draws. These efforts are consistent with the “zero harm” initiative adopted at various institutions and represents a commitment to providing a safe and caring environment for patients and staff by eliminating all preventable patient injuries and infections.

McNinney T, Roselli T, Miner D. Reducing central line-associated bloodstream infections (CLABSI) through standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage. Presented at: 2022 Tandem Meetings Transplantation & Cellular Therapy Meetings of ACTCT and CIBMTR; April 23-26, 2022; Salt Lake City, UT. Abstract 612. 

Articles

Oncology nurses at the 2022 ASTCT Meeting shared how a peer-to-peer observation and validation tool helped decrease central line-associated bloodstream infections by 68%.



Oncology Nurses Drastically Reduce Central Line Infection Incidences Through Peer-to-Peer Observation Strategy

Older men with prostate cancer who have received androgen-deprivation therapy (ADT) may be at an increased risk of major averse cardiovascular events, including myocardial infractions, stroke, or death from any cause, according to data presented at the 47th Annual Oncology Nursing Congress.

ADT is often used as a treatment for patients with advanced prostate cancer. Nurses caring for patients receiving ADT may be aware to look out for a list of adverse events (AEs), including hot flashes, cognitive impairment, muscle wasting, and anemia. However, in recent years, providers have also begun to turn their attention to 

cardiac complications associated with this treatmen

Previous literature has demonstrated an association between the treatment and cardiovascular risk; however, there is still debate on whether ADT causes that risk or if it is other comorbidities, said Deborah Boldt-Houle, an author on the study and senior director of medical affairs at TOLMAR Pharmaceuticals, which manufactures the ADT therapy Eligard (leuprolide acetate), during the presentation.

This study, which included the medical records of 44,339 patients, evaluated the relationship between risk of major cardiovascular events and age in patients with prostate cancer on ADT. Patients included in the study were divided into age group: younger than 60 (6%); 60 to 70 years old (24%); 70 to 80 years old (39%); or 80 years or older (31%).

In the overall population, major averse cardiovascular events risk was between 2% and 6% one year after ADT initiation, and 12% and 31% four years after.

Additionally, risk of major adverse cardiovascular events was more common in older patients compared to younger patients in the first seven years after ADT.

Boldt-Houle added that these results are significant and a possible explanation for this is because older patients tend to have more comorbidities that could cause cardiovascular issues, such as diabetes, obesity and frailty, she explained.

The results highlight that a patient’s care team should be cognizant of their age and risk for major averse cardiovascular events prior to starting treatment with ADT. Future studies are needed to evaluate the role comorbidities play in cardiovascular problems during ADT.

Vandross J, Atkinson S, Boldt-Houle D. Risk of major adverse cardiovascular events after initiation of androgen deprivation therapy is higher for older patients.

Older men who have received androgen-deprivation therapy are an increased risk of heart issues, however, the root of the risk is still not well understood. 

Following ADT, Older Patients With Prostate Cancer Are at an Increased Risk of Cardiac Complications

Single nucleotide polymorphism (SNP) genotyping could be used to predict radiation dermatitis in patients with breast cancer, according to findings that were presented during the 47th Annual Oncology Nursing Society (ONS) Congress.

Through an evaluation of 16 cohort studies, 13 of which had a low risk of bias, the following 7 genotypes were found to be associated with severe radiation dermatitis: 

Lower radiation dermatitis was found in those with 

“[This association] can be used to contribute to planning of radiation therapy as well as improve the nursing follow-up of patients most likely to develop severe radiation dermatitis, based on clinical and genetic assessment,” lead study author Beatriz Aguiar, of the University of Brasilia in Brazil, said in a virtual presentation of the data.

Radiation dermatitis, which occurs in an estimated 95% of patients with breast cancer who are undergoing radiation, typically has an impact on the continuity of treatment for patients with breast cancer, along with their quality of life and their body image.

Prior radiogenomic studies have evaluated the potential of SNPs to predict the risk of severe radiation dermatitis, the authors noted in their poster.

In the analysis presented at the ONS Congress, investigators sought to identify whether SNPs are associated with the rate of severe radiation dermatitis with the use of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. The authors also performed the search at CINAHL, Cochrane CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science in the gray literature and in a reference list of articles.

Additionally, the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies tool was utilized to assess the risk of bias from the individual studies. Investigators conducted a meta-analysis of 16 cohort studies to evaluate the association between SNPs and severe radiation dermatitis. Grading of Recommendation, Assessment, Development, and Evaluation was also utilized to assess evidence.

Further findings showed that there was a low certainty of evidence for association with severe radiation dermatitis in the 

 gene – SNP rs3957356 – CT genotype (odds ratio [OR]: 5.57; 95% CI, 1.73-17.87; 

 = .004). This was also the case in the GG genotype with the 

 gene – SNP rs2282367 (OR, 2.03; 95% CI, 1.18-3.48; 

Aguiar B, Normando AG, Guerra E, et al. Association of single nucleotide polymorphisms with severity of acute radiation dermatitis in breast cancer patients: systematic review and meta-analysis. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P7.

Single nucleotide polymorphism (SNP) genotyping could be used to predict radiation dermatitis in patients with breast cancer.

Single Nucleotide Polymorphism Genotyping Could Predict Severe Radiation Dermatitis in Breast Cancer 

Bioimpedance spectroscopy (BIS) is a more accurate method of identifying which breast cancer survivors will need compression intervention for subclinical lymphedema compared with tape measurement (TM) 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 Oncology Nursing News®, noting that the underlying technology is based on electrical currents that measure the fluid between the cells. “It’s very simple. It’s very quick.”

 Results from the PREVENT study (NCT02167659) showed that among patients who received compression intervention after early lymphedema detection, only 7.9% of patients who were assessed through BIS developed chronic lymphedema. In comparison, 19.2% of patients who were assessed using TM developed this chronic disease. These statistically significant results (P = .016) may translate into an absolute reduction of 11.3% and a relative reduction of 59% in lymphedema progression at 3 years, according to the study authors. 

Chronic breast cancer–related lymphedema (C-BCRL) has become more concerning as the rate of breast cancer survivorship has continued to rise. As such, the number of patients affected by pain, infections, limited arm function, reduced quality of life, and very expensive therapies because C-BCRL has likely grown in recent years. 

“To me, it is [a] numbers game,” Ridner said. “More survivors equal more opportunity for chronic pain…but if we can keep people from getting it, then there is a whole set of lymphedema-related pain issues breast cancer survivors may be able to avoid.” Currently, 5% of patients who undergo breast-conserving surgery with sentinel lymph node biopsy (SLNB) alone experience C-BCRL, as well as more than 50% of patients who undergo axillary lymph node dissection, regional node irradiation, and/or taxane-based chemotherapy. These statistics underscore the value of proper C-BCRL identification in breast cancer survivors, the authors explained. However, early-stage C-BCRL identification can be challenging. 

Although subclinical disease and extracellular fluid occurs before changes become visible, C-BCRL diagnoses do not typically occur until a visible change or symptom has become apparent. Therefore, investigators decided to use BIS to identify early-stage subclinical lymphedema and to initiate treatment to prevent C-BCRL (defined as ≥ 10% arm volume change from baseline, requiring complex decongestive physiotherapy CDP) in survivors. BIS technology can recognize extracellular fluid change and has been found to improve patient outcomes when combined with short-course compression therapy, as was administered in this study. 

“The BIS can pick up changes in the fluid that exists between each human cell. [TM] can’t do that, pyrometry can’t do that, and MRI can’t do that,” Ridner said. “The earlier you catch this fluid, the less likely you are to have a large inflammatory process in the arm. We are now able to identify the subclinical lymphedema when there is less inflammation that needs to be treated.” 

The stratified, randomized, international trial included patients with recent breast cancer diagnoses who were undergoing either mastectomy/partial mastectomy, axillary treatment (dissection, SLNB > 6 nodes or radiation), radiation therapy, or taxanebased therapy. Exclusion criteria included history of breast cancer, neoadjuvant chemotherapy, and previous radiation on the breast, chest wall, or axilla. 

Participants were randomized 1:1 following a postsurgery eligibility reassessment and underwent prospective surveillance via either BIS or TM. If surveillance detected C-BCRL, patients were to wear a class 2 (23-32 mm Hg, mediven flat-knit custom or Harmony circular knit) compression sleeve and gauntlet for 12 hours per day for 4 weeks. 

Patients were recruited between June 24, 2014, and September 11, 2018. In total, 442 evaluable patients were enrolled in the BIS cohort, and 437 evaluable patients were enrolled in the TM cohort. The median follow-up was 32.9 months. 

Presurgical measurements were collected at baseline for both the BIS or TM cohorts; collected again at 3, 6, 12, 18, 24, and 36 months; and again following compression intervention. Some sites also conducted a 15- and 21-month follow-up. 

The BIS evaluation was conducted via L-Dex U400, and TM evaluation was conducted using Gulick II tape. The patients’ arms were measured twice at 10-cm increments, starting at the wrist and continuing up to 50 cm above the wrist. A truncated cone formula was used to automatically calculate arm volume. Ultimately, the number of patients whose disease progressed following compression intervention was lower in the BIS group than the TM group (7.9%, n = 7 vs 19.2%; n = 23, relative risk, 0.41; 95% CI, 0.13-0.81; absolute reduction 11.3%; 95% CI, 2.3-20.3; P = .016). 

Notably, Ridner’s patients have expressed satisfaction with the technology. “The first patient I ever measured [with BIS] loved the technology,” she said. “Patients can tell [TM] techniques vary from therapist to therapist, doctor to doctor, or nurse to nurse. [BIS] standardizes the way you do the measurement.” 

“Surveillance with early intervention is clearly in the best interest of the patients,” Ridner said. “We can change outcomes in this population and address not only the chronicity of the lymphatic issues many of these patients have but also reduce the discomfort they may experience.”

Ridner SH, Dietrich MS, Boyages J, et al. A comparison of bioimpedance spectroscopy or tape measure triggered compression intervention in chronic breast cancer lymphedema prevention. 

. 2022;10.1089/lrb.2021.0084. doi:10.1089/lrb.2021.0084

Patients who underwent prospective surveillance with bioimpedance
spectroscopy were less likely to develop chronic breast cancer–related
lymphedema compared with patients who were assessed with tape measure.

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

The practice of structured journaling may be a cost-effective method of empowering patients to monitor their adverse events and improve quality of life while undergoing cancer therapy, according to results of a study (NCT03258892) recently published in the 

Sixty-four patients were enrolled, 53 of whom were eligible for evaluation. Over half of the patients (55%) felt that the journaling was moderately useful. Furthermore, patients who responded positively also experienced improved communication scores (

= .019). In addition, investigators observed that patients who initiated journaling early into their treatment experienced a smaller decrease in QOL than those who began journaling later (

“The sarcoma treatment guide (STG) encouraged self-reporting in the form of journaling, which provided, at times, valuable narrative data. Narrative data revealed through journaling includes subjective data reflecting the patient's story, insight, mental state, and body awareness,” the authors said, adding that participants reported that journaling helped them recall and describe information better, and remind them of concerns to bring up with their oncology team.

Investigators were interested in better understanding the utility of self-monitoring, as it has already demonstrated a potential association with improved symptom burden for patients and families and because one-third of patients already claimed to engage in some form of self-monitoring prior to the trial initiation. The study defined self-monitoring as the intentional practice of observing, measuring, and/or recording symptoms, sensations, daily activities, thoughts, and emotions.

Treatment-naïve patients with sarcoma were enrolled and randomized to either receive a symptom management journal at treatment initiation or to receive a symptom management journal following 2 complete cycles of therapy. The journals were codesigned by a cancer patient focus group and by education experts; the clinical staff reviewed recent journal entries with the patient during each visit.

Questionnaires were utilized to assess patient responses to the intervention. At the conclusion of the intervention, patients were asked to assess how the journaling impacted their communication with the physician and nursing staff.

Overall, participants share that the journaling moderately improved their communication with the physician (64%) and nursing staff (61%). In addition, 28% of patients felt the communication with their physician greatly approved, and 30.8% of patients felt that communication with their nursing staff greatly improved. Furthermore, a subset of patients included extra text in their journals providing additional details regarding their symptoms­: many of these “add-ins” included concerns regarding their psychosocial wellbeing, including depression and anxiety. Care teams used this extra information to guide patient education and engage the social work or psychology teams as well.

In addition, patient call volumes were measured through electronic health records.

In conclusion, study authors acknowledge that in the digital age, many patients find themselves face to face with an abundance of digital survey and questionnaires. They sought to provide patients with a way to track their symptoms without experiencing digital fatigue.

“Most computer-generated surveys provide generic data—they allow the patient to capture details through checking a box with little or no room to provide a narrative or personal context,” study authors noted. “Providing patients with a low-[technology] monitoring tool in the form of a traditional journal allows them to record and share their stories in a meaningful way, not only for themselves but also for their medical team.”

Speece NJ, Xu M, Tinoco G, Liebner DA, Chen JL. Randomized prospective trial exploring the impact of structured journaling in patients with sarcoma on the management of treatment-related adverse events. 

. 2022;18(2):e250-e260. doi:10.1200/OP.21.00309

Journaling may help patients with sarcoma feel more in control of their symptoms and communicate better with their care team. 

Journaling May Be a Useful Symptom Monitoring Tool for Patients With Sarcoma 

mutated, platinum-sensitive, recurrent ovarian cancer who needed to reduce or interrupt treatment with olaparib during their first 12 weeks of treatment did not experience worse survival outcomes compared with those who received the recommended dose, according to ancillary findings from the SOLO2 study (NCT01874353). These data suggest that patients who need to alter their treatment with the PARP inhibitor because of adverse events (AEs) will not be negatively affected.

The findings, which were published in the 

, demonstrated that median overall survival (OS) rates were consistent across different dosages.

Relative dose intensity (RDI) represented the administered dosage compared with the recommended standard dose during the first 12 weeks of treatment, which is 30 mg twice a day. Investigators categorized participants as RDA greater than 98%, RDI 90% to 98%, and RDI less than 90%. After 12 weeks of olaparib, the mean 12-week RDI was 91.4%.

Furthermore, the median OS, following 12 weeks of olaparib, was 49.7 months in the greater than 98% group, 49.5% in the 90% to 98% group, and 54.1 months in the less than 90% group (

 = .84). The median PFS was 14.2 months, 49.5 months, and 54.1 months, respectively (

Moreover, patients were at an increased risk of requiring a dosage less than 90% of the recommended dose if they exhibited a baseline performance status of 1 (odds ratio [OR], 2.54; 95% CI, 1.11-5.82), any nausea (OR, 3.17; 95% CI, 0.9-11.23), or had a body weight of 70 kg or lower (OR, 1.86; 95% CI, 0.92-3.76).

The international, multicenter, double-blind, randomized, placebo-controlled, phase 3 SOLO2 trial enrolled patients with platinum-sensitive, relapsed ovarian cancer patients whose disease harbored a 

 mutation and who had been pretreated with at least 2 lines of previous chemotherapy. Patients were randomized to receive either maintenance olaparib (300 mg in two 150 mg tablets twice daily) or placebo. The trial revealed that olaparib yielded significantly longer PFS than placebo (19.1 vs 5.5 months, respectively), meeting its primary endpoint (HR, 0.30; 95% CI, 0.22-0.41; 

Because maintenance therapy is a long-term therapy, it is often associated with necessary alterations to mitigate potential AEs, the authors noted. Investigators analyzed data from SOLO2 to determine the impact of treatment interruptions or reductions on survival outcomes as well as to reveal which characteristics were linked with treatment alteration.

Throughout the SOLO2 study, AEs caused 50% of patients to interrupt treatment, 28% of patients to reduce their dosage, and 17% of patients to discontinue treatment. There were 110 patients in the RDI greater than 98% category, 29 patients in the RDI 90% to 98% category, and 45 patients in the RDI less than 90% category.

The association between RDI categories with progression-free survival (PFS) and overall survival (OS) were examined using a 12-week landmark Cox regression analysis. Logistic regression analysis was used to correlate baseline factors with RDI at 12 weeks.

No impact on survival from dose reduction and interruption for the management of olaparib associated adverse events. ESMO. News release. March 8, 2022. Accessed April 4, 2022. https://bit.ly/3NMOiWr

 The impact of olaparib dose reduction and treatment interruption on treatment outcome in the SOLO2/ENGOT-ov21 platinum-sensitive recurrent ovarian cancer. 

 2022;S0923-7534(22)00338-6. doi:10.1016/j.annonc.2022.02.222.

Pujade-Lauraine E, Ledermann JA, Selle F, et al. Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomized, placebo-controlled, phase 3 trial [published correction appears in 

. 2017;18(9):1274-1284. doi:10.1016/S1470-2045(17)30469-2

New research suggests that olaparib treatment interruption or dosage reduction is not linked with inferior survival outcomes in patients with BRCA1/2–mutated, platinum-sensitive, recurrent ovarian cancer.  

Olaparib Dosage Can Be Reduced Without Affecting Survival in Ovarian Cancer 

® spoke with Heidi Donovan, PhD, RN, professor of nursing and medicine, and co-director of the National Center on Family Support, at the University of Pittsburgh. Donovan recently co-led a study evaluating the utility of an online symptom management tool for women with recurrent ovarian cancer.

found that women who used the intervention experienced higher satisfaction with their symptom management.

“[In my opinion] some principles of our intervention are critical and actually overdue in clinical practice for ovarian cancer and other cancers,” she noted, emphasizing the importance of systematic symptom assessment in clinical settings, and enhancing women’s confidence in their ability to manage their symptoms, as well as their confidence communicating these symptoms to their healthcare providers.

“[By systematic] I mean [asking] the same questions repeatedly, over time, in order to pick up on changes that that are affecting patients and on symptoms that are affecting their quality of life, and their ability to function on a day-to-day basis,” she said. “The second principle was really enhancing women's confidence… A lot of what we did in this intervention was try to motivate women to recognize how much [of an] effect their symptoms were [causing] and build their confidence in their ability or their knowledge of things that they could try to get better management.”

Donovan HS, Sereika SM, Wenzel LB, et al. Effects of the WRITE symptoms interventions on symptoms and quality of life among patients with recurrent ovarian cancers: an NRG Oncology/GOG Study (GOG-0259). Published online ahead of print February 7, 2022. 

Podcasts

In this episode of “The Vitals,” Heidi Donovan, PhD, RN, discusses novel symptom management intervention for women with recurrent ovarian cancer.

Bringing a New Approach to Symptom Management in Ovarian Cancer

 (BIS) allows oncology nurses to be more proactive in managing subclinical lymphedema, according to Sheila Ridner, PhD, RN, FAAN.

Ridner, a research professor at Vanderbilt University School of Nursing, was co-principal investigator in the 

 (NCT02167659), which found patients who received compression intervention after assessment with BIS were less likely to develop lymphedema compared with those who received compression intervention after assessment with tape measure. The percentage of patients who developed lymphedema in these 2 populations were 7.9% and 19.2%, respectively (

These findings suggest that the oncology care team can leverage outcomes by proactively identifying and managing this adverse event without necessarily involving lymphedema specialists, explains Ridner.

“Nurses and research assistants did the measurements in the study,” she said. “We have [shown] that the cancer treatment team can do the initial diagnosis and we can have the nurses or research aids fit the patients for the garment and run that 30-day intervention.”

“That's important because there is a shortage of trained lymphedema therapists,” Ridner explained. “Now we know that multidisciplinary breast cancer teams can do this short-term intervention [along with] surveillance; if you can get the right people to do the right pieces of patient care, then you can take some of the stress off some of the highly burdened lymphedema clinics.”

However, implementing BIS technology will start with nurse education and advocacy, she noted.

“Nurses are the advocates for patients in this world,” she concluded. “Now [we] have an evidence base that they can use to become informed advocates.”

Videos

Sheila Ridner, PhD, RN, FAAN, discusses the implications of the PREVENT study and how oncology nurses can advocate for patients with breast cancer. 

Oncology Nurses Can Help Better Prevent Chronic Lymphedema With BIS Technology 

The approval of relatlimab/nivolumab (Opdualag) is exciting because it represents a new immunotherapy combination for patients with unresectable or metastatic melanoma, according to Hussein A. Tawbi, MD, PhD.

However, the newly approved agent will not replace PD-1/CTLA-4 combination immunotherapy, he explained. Rather, the 2 will now co-exist in the treatment landscape, providing oncology care teams multiple therapeutically relevant treatment options to offer their patients.

The fixed-dose PD-1/LAG-3 inhibition regimen was 

 on the indication of unresectable or metastatic melanoma for adults of at least 12 years of age and who weigh at least 40 kg. Notably, the approval was based off findings from the RELATIVITY-047 study, which demonstrated the combination 

Tawbi, a professor of the Department of Melanoma Medical Oncology at The University of Texas MD Anderson Cancer Center, and principal investigator in the RELATIVITY-046 trial, recently met with 

todiscuss what this approval means for patients with unresectable or metastatic melanoma.

“It is a really important development for our patients,” he said. “We know that single agent PD-1 has been capable of curing almost 40% of our patients with unresectable or metastatic melanoma. We really think that this [agent] will add a significant proportion of [successfully treated patients].”

“The one thing that we will always need to be very clear about is that this study did not compare the combination [of nivolumab/relatlimab] to the combination of PD-1/CTLA-4 inhibition,” noted Tawbi.

“There will be decision making in the first-line setting, [we will ask ourselves], ‘can I rely on nivolumab/relatlimab or do I give nivolumab/ipilimumab [Yervoy] despite the toxicity?’ From my perspective, that combination of nivolumab/relatlimab will replace single-agent PD-1 inhibitors.”

Hussein A. Tawbi, MD, PhD, principal investigator of the phase 2/3 RELATIVITY-046 trial, highlights the importance of relatlimab/nivolumab’s recent FDA approval in melanoma.          

Expert Talks Significance of Relatlimab/Nivolumab Approval for Metastatic Melanoma

Managing nausea and monitoring complete blood counts (CBC) for drops in hemoglobin are crucial when administering olaparib (Lynparza) to patients with germline 

-mutated, HER2-negative, high-risk early breast cancer, according to Charles E. Geyer, MD, FACP.

 as a treatment for patients with this disease type and who have already undergone chemotherapy before or after surgery, after 

 demonstrated that the oral PARP inhibitor resulted in a 42% improvement in invasive disease-free survival compared with placebo.

®, Geyer, who is chief scientific officer of the National Surgical Adjuvant Breast and Bowel Project (NSABP) Foundation, and an investigator in the OlympiA trial, 

 to discuss dosing strategies and adverse event management with olaparib.

The starting dose in OlympiA was 300 milligrams twice a day, Geyer explained. “The medication comes in tablets, there are 150 milligram tablets that are a greenish color, and 100 milligram tablets, which are yellow. Patients start out by taking 2 green tablets twice a day.”

Furthermore, because olaparib is taken twice a day and can cause nausea (particularly in the first month), nurses should stress the importance of taking the agent with food.

“Doctors on the study found that sometimes patients do not hear how important it is to take [olaparib] with food,” noted Geyer. “It can be a light meal [or] a snack, but we do [stress the importance of] taking it with food. That is a hugely important message.”

Another important consideration when treating patients with olaparib is anemia, he continued. He emphasized the importance of adjusting dosage if a patient’s hemoglobin begins to drop, adding that since patients will need to take the agent for 1 year, it is important to find a dose that is manageable.

“Sometimes hemoglobin can drop quick enough [that] patients get symptomatic and might require transfusions; about 6% of the patients required a blood transfusion, but only 2% required more than 1 transfusion,” said Geyer. “It is important [to monitor] complete blood counts carefully, and [understand] that it is okay to hold the drug.”

“Sometimes patients feel, ‘I need to take it, I can take it, and I don't feel bad enough to stop it.’ However, you don't want the hemoglobin to drop: [the treatment] is a marathon—[they take it] for a whole year, so we want to work to find the correct dose. That will be important to keep in mind,” he concluded.

Charles E. Geyer, MD, FACP, discusses dosing strategies and adverse event management with olaparib.

Adverse Event Management