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Nivolumab plus chemotherapy significantly improved OS vs chemo alone in resectable NSCLC, per updated CheckMate-816 findings.

Neoadjuvant Nivolumab Regimen Improves OS in Resectable NSCLC

Relacorilant plus nab-paclitaxel improved PFS and showed a trend toward longer OS in platinum-resistant ovarian cancer in ROSELLA.

Relacorilant Combo Boosts PFS in Resistant Ovarian Cancer

Lasting survival benefits vs chemotherapy or monotherapy were achieved with nivolumab and ipilimumab for patients MSI-H/ dMMR metastatic colorectal cancer.

Nivolumab/Ipilimumab To Be New MSI-H/dMMR mCRC Standard of Care

T-DXd led to an ORR of 59.4% vs 33.9% with chemo, regardless of biomarker status, in HR+, HER2-low metastatic breast cancer, per DESTINY-Breast06.

T-DXd PFS Benefit Significant Across HR+, HER2-Low Breast Cancer Mutations

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Dr. Jackson is a certified oncology and bone marrow transplant clinical nurse specialist with clinical expertise in hematology/stem cell transplantation/cellular therapy. She is currently unit director–providing oversight of the clinical and fiscal operations of an inpatient hematology unit. Dr. Jackson is also a member of the National Association of Clinical Nurse Specialist, American Asociation of California Nurse Leaders, and the Oncology Nurses Society.

Oncology nurses are paramount to the success of patients, especially through their work on clinical trials.

The Evolving Role of the Oncology Nurse in Clinical Trials

Randi Kihnel, MSN, APRN, ACCNS-AG is an advanced practice nurse who works in GI Medical Oncology at Ochsner MD Anderson Cancer Center.

Advanced practice providers have the opportunity to instill hope in patients through education and personalized care.

Case Study: Bridging the Gap for Patients With Metastatic CRC

Oncology Nursing News connects oncology nurses and APPs with updates on therapy advances, side effect management, and patient-centered cancer care.

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The FDA has issued a clinical hold on the phase 1 MELANI-01 trial evaluating the CAR T-cell product UCARTCS1A in the treatment of patient with relapsed/refractory multiple myeloma, according to Cellectis, the manufacturer of the product.

FDA Issues Clinical Hold on CAR-T Cell Trial for Patients With Myeloma

Caregivers of patients with multiple myeloma face similar challenges to those faced by the patients themselves. 

Examining Distress Levels in Caregivers of Multiple Myeloma Patients

 Beth Finley-Oliver, MSN, ARNP, AGNP-BC, a nurse practitioner who works in the outpatient hematology clinic at Moffitt Cancer Center, revisits her presentation from the 2023 JADPRO Live Annual Meeting and discusses the growing number of therapies for patients with relapsed or refractory multiple myeloma.

“A clinical trial upfront would be my first option. After that, I have to try and find something their myeloma hasn't seen yet.”

“With CAR T, the CRS incidence is higher, and I think we're doing better [at managing it] because we have multiple interventions. We see viral infections with [both] the CAR T and the bispecifics. We always have to kind of keep that in the back of our mind.”

“The more medications we have, the more this is turning into a chronic illness.”

Delivering Teclistamab in the Outpatient Setting

Ambulation Improves Frailty Scores in Patients With Multiple Myeloma

With New Bispecific Antibodies in Multiple Myeloma, Nurses Need To Know How to Manage CRS

Managing Teclistamab-Induced CRS for Patients With Multiple Myeloma

Data Supporting Elranatamab Approval in Multiple Myeloma

Data Behind Talquetamab Approval in Multiple Myeloma

Beth Faiman Discusses Recent Changes in Multiple Myeloma Treatment Landscape

ASH Data Offer Treatment Direction for Oncology Nursing Professionals

A Look Back at 2022 FDA Approvals in Oncology

Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma

Beth Finley-Oliver, MSN, ARNP, AGNP-BC, recaps part of her presentation from the 2023 JADPRO meeting about caring for patients with high-risk multiple myeloma. 

Finley-Oliver Talks Talquetamab and Other Later Line Multiple Myeloma Therapies

, Beth Faiman, PhD, CNP, weighs in on the current trajectory of research and clinical practice in multiple myeloma.

Faiman is a nurse practitioner and researcher with the Cleveland Clinic, as well as a board member of the NP/PA Center of Excellence in Multiple Myeloma. According to her, one of the biggest changes of late was the publication of a study in 

, findings of which suggest that patients with biomarker-defined defined disease, as well as 60% or more bone marrow plasma cells (BMPCs), or a free light chain ratio (FLCratio) of at least 10, have a longer time to progression and a lower 2-year progression risk than was previously believed.

Whereas the median time to progression was previously reported to be 9.2 months, the new study found the median time to be 30.1 months. Moreover the 2-year progression risk was 45.45%, rather than the previously reported 85.21%.

As Faiman points out, in 2014, the International Myeloma Working Group had added patients with at least 60% BMPCs, FLCratio equal to or greater than 100, and greater than 1 MRI-defined focal lesion of at least 5 mm (SLiM CRAB multiple myeloma) to the diagnostic category of multiple myeloma. However, this newer review suggests that this classification may need to be revisited.

Faiman also touches on shifts in approved BCMA-directed therapies for patients, namely, the accelerated approval of teclistamab-cqyv (Tecvayli) in October of 2022, and the removal of belantamab mafodotin-blmf (Blenrep) from the market in November 2022.

 She notes that there are ongoing efforts to reincorporate belantamab mafodotin into clinical practice and that she is optimistic about reintroducing this treatment back into her practice—as the dosing schedule and toxicity profile was favorable for patients. 

“Supporting [a] patient while they are in their maintenance phase [of treatment]; checking the blood counts, keeping up [with] health maintenance, making sure their bones are strong and all those other supportive care things, are so important.”

“If you have a heavily pretreated patient on some of the new cellular therapies or bispecifics, that they have to be admitted to the hospital, we have to logistically manage who’s going to be admitted on what day and when.”

“The nice thing about belantamab was that it was an [intravenous] IV [therapy] every 3 weeks, it is directed against BCMA, and it was very well tolerated.”

Hematologic Oncology Undergoes Transformation With Drug Updates and Approvals

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

Belantamab Mafodotin Will No Longer Be Available For Multiple Myeloma

Ocular Visits Are a Necessity for Patients With Multiple Myeloma Who Receive Belantamab Mafodotin

Ludwig H, Kainz S, Schreder M, Zojer N, Hinke A. SLiM CRAB criteria revisited: temporal trends in prognosis of patients with smoldering multiple myeloma who meet the definition of ‘biomarker-defined early multiple myeloma’-a systematic review with meta-analysis. 

. 2023;58:101910. doi:10.1016/j.eclinm.2023.101910

FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. FDA. October 25, 2022. Accessed April 10, 2023. 

GSK provides an update on Blenrep (belantamab mafodotin-blmf) US marketing authorization. News release. GlaxoSmithKline. November 22, 2022. Accessed April 10, 2023. 

Beth Faiman, PhD, CNP, discusses reclassifying patients with multiple myeloma, the accelerated approval of teclistamab, and the removal of belantamab mafodotin from the US market. 

CRS and ICANS rates were similar in adults 75 years or older vs younger individuals with relapsed/refractory multiple myeloma.

Teclistamab Safe, Effective for Older Adults With Multiple Myeloma

CT0596 was well tolerated and showed preliminary efficacy in relapsed/refractory multiple myeloma, early phase 1 data show.

Allogeneic CT0596 Shows Early Activity, Safety in R/R Myeloma

A registered nurse gives best practices for use of subcutaneous daratumumab in multiple myeloma.

Rx Road Map: Subcutaneous Daratumumab in Multiple Myeloma

Final data from the phase 3 ALCYONE trial support frontline use of daratumumab-based therapy for patients with transplant-ineligible newly diagnosed multiple myeloma.

Daratumumab Combo Maintains Benefit in Transplant-Ineligible NDMM

Cilta-Cel Improves QOL, Extends Treatment Breaks vs SOC in R/R Myeloma

A research APRN describes how educating patients can help them feel more at ease and better prepared to prevent adverse events.

Education Reassures Patients With Multiple Myeloma Receiving Subcutaneous Daratumumab

While subcutaneous daratumumab with hyaluronidase-fihj (Darzalex Faspro) is considered widely tolerable and reduces chair time for patients being treated for multiple myeloma, oncology nurses should be aware when administering the injection that patients may be intimidated by the needle size and may need some reassurance, according to Stephanie Mompoint, APRN, a research advanced practice nurse at the University of Miami.

Mompoint recommends talking through what to expect with patients, from the injection volume to potential adverse events (AEs). As Mompoint emphasized, subcutaneous daratumumab can cause a rash at the injection site, and while systemic reactions are not always expected of subcutaneous injections, they are still possible.

She advises nurses to keep an eye out for signs of systemic reactions such as chills during and after administration of daratumumab. When educating patients on AEs, nurses should encourage patients to report persistent redness that spreads so that they can receive topical treatment to reduce irritation.

Daratumumab has been approved as a monoclonal antibody drug treatment of multiple myeloma. It’s given as 1 infusion, together with daratumumab and hyaluronidase.

You’re going to have that reaction from the patient seeing the needle when they see the volume that’s going to be inserted. It’s [essential to] reassure them and let them know that the premedications will help with reaction, and, as the nurse, to be alert for possible immediate systemic reactions.

Now, just because the drug is given subcutaneously, that doesn’t mean that the systemic reactions are not going to happen, like fevers [and] chills. It’s important to talk to the patient, and you yourself be on the lookout for that. If your patient starts to have chills, even while you’re doing the subcutaneous injection, you have to stop the injection and give the patient time to settle down, take their temperature, do their vitals, and call the provider if extra medication is needed.

I’ve gotten questions about that, and it’s important, because imagine that the patient’s going to start a new therapy, and they know it’s subcutaneous, but a lot of time you don’t think about the quantity of some subcutaneous [injections] that’s going to be administered. The more the patient knows, the more at ease they will be, and the more alert they will be also. Then they know what to look out for.

One simple thing [to do] is let them know, “Yes, you’re going to start with a needle stick. And it might sting at the beginning.” And then as we’re pushing more and we’re having conversation, educating them that the site might be a little bit swollen, and when you go home, you might find a rash there.

“Now it’s OK to have some redness, but if that redness continues to spread, you need to let us know, because something as simple as some topical steroid could help with that.” It goes back to education, to letting them know, and reassuring them, and explaining things in a way that they will understand.

This transcript has been edited for clarity and conciseness.

Education before subcutaneous daratumumab administration can both reassure patients and reduce the occurrence of adverse events, according to Stephanie Mompoint, APRN.

Education Reassures Patients With MM Receiving Subcutaneous Daratumumab

Yi Lin, MD, PhD, explains that nurses and APPs can prevent Parkinson's disease following cilta-cel by monitoring lymphocite counts and side effects in multiple myeloma

Yi Lin, MD, PhD, discusses ways nurses and APPs can prevent Parkinson's disease in multiple myeloma

Oncology nurses and advanced practice providers (APPs) can play an active role in preventing long-term and potentially debilitating adverse events (AEs) associated with the treatment of multiple myeloma with ciltacabtagene autoleucel (cilta-cel; Carvykti), says expert Yi Lin, MD, PhD.

2025 American Society of Clinical Oncology Annual Meeting

 regarding her research presented at the conference on identifying risk factors for delayed toxicity in patients receiving 

According to Lin, peak absolute lymphocyte count (ALC) greater than 3 x 10

/L was an indicator for the later onset of AEs such as parkinsonism. Remaining vigilant of absolute blood count (ALC) and taking potential signs of AEs seriously both while patients remain at CAR T-cell therapy centers and after they go home can help ensure that nurses and APPs give patients the best chance to avoid such toxicities and remain on treatment longer.

Yi Lin, MD, PhD is an oncologist, hematologist, and professor of medicine at the Mayo Clinic Health System in Rochester, Minnesota.

We’ve had FDA-approved [CAR T-cell therapy] for patients with multiple myeloma for multiple years now. We’re now seeing some emerging signals, both in clinical trial and in standard-of-care practice, that some patients beyond that first month when they’re staying at the CAR T treatment centers, when they’ve returned home—somewhere in that first 6-month window—there may be some 

 that are showing up. So we wanted to take a look and see if we can understand who the patients are who might be at risk for this.

We found, not surprisingly, the risk factors that are more associated are features of patients who have had either slightly more disease burden or more inflammatory response after CAR T, and those patients who had high expansion of the lymphocyte count. Typically, in that week 2 window, where we expect to see CAR T expansion, [an ALC of 3 x 10

/L] is the clinical cut-off range. For patients who had these lymphocytes go beyond that, they had close to 8%-9% risk of getting parkinsonism vs those patients who didn’t have such high expansion. And for those patients [who did not have high lymphocytic expansion], their risk was less than 0.2%.

Fortunately, this is happening in the window when patients are still under close monitoring at the CAR T treatment centers, and so we and other centers have initiated processes where our nurse practitioners, physician assistants, and nurses, who are involved in the care of the patients, are very vigilant to say, “Now we’re heading into day 10 and day 14”—that it’s a window where we really see on that [complete blood count] was differential, that lymphocyte number’s starting to go up.

There are things that the nurses, physician assistants, and nurse practitioners can do in the broader oncology/hematology clinic when the patients return home. Being mindful that in that first 6 months, if they’re starting to have a little bit of that diarrhea, of course, [nurses] still need to do the usual testing for potential infections [if needed], but in the back of the mind, to be mindful of the possibility that this could be a late CAR T [adverse] effect would be important, so that [they] can make that connection to the CAR T centers and start some of those early management interventions before the patient becomes too debilitated from their nutrition loss and calorie loss from the diarrhea.

Recognizing some of the early onset of the parkinsonism symptoms that is not necessarily just “the patient seems to be more tired or just behaving a little bit differently” could make a difference in trying some of these early management [interventions] that could help the symptom resolve, vs waiting too late and having too many [adverse] effects piled on top of each other.

We would rather get a false alarm and say, “Hey, is this potentially related? This seems to be something that’s different than how the patient is behaving normally,” and just have that conversation, rather than missing that window of opportunity for evaluation and management. I think that’s an important evolving knowledge on what we need to watch for once the patient has returned home.

By monitoring patients’ CBC and other symptoms, nurses and advanced practice providers can spot early indicators of parkinsonism risk, per Yi Lin, MD, PhD.

Advanced Practice Corner

Nurses, APPs Can Help Prevent Parkinsonism During Cilta-Cel in Myeloma

Samantha Shenoy, MSN, NP, gives insights on managing adverse effects associated with talquetamab used for multiple myeloma

A nurse practitioner gives her advice for managing AEs associated with talquetamab in myeloma.

Oncology nurses and advanced practice providers (APPs) administering treatment with talquetamab (Talvey) for multiple myeloma should educate patients early on to look out for adverse events (AEs) such as dysgeusia, nail ridging, and dry mouth, according to an expert.

Samantha Shenoy, MSN, NP, a nurse practitioner at the University of California San Francisco, has been seeing patients treated with talquetamab for years on the phase 1b TRIMM-2 (NCT04108195) and MonumenTAL-2 (NCT05050097) trials.

From her experience with the more unusual AEs that accompany talquetamab treatment, she has compiled a handout that she shares with her patients and peers on best practice for managing such events.

When confronted with these AEs, she worked with APPs at other institutions and professionals from different specialties at her own institution for clinical advice. Shenoy mentioned that she also learned some techniques, like protecting the hands with finger cots, from her patients.

We had the TRIMM-2 trial and MonumenTAL-2 trial at UCSF. Both of these trials were looking at combinations of medications with talquetamab. Our first patient started about 4 years ago, and they were having the taste changes, so the dysgeusia, the dry mouth, the skin peeling.

Really, I’d never seen anything like that before in my clinic. I reached out to some 

 at [Mount Sinai Health System]. So Sinai had had probably the most patients on talquetamab, and I learned a lot from their group there. I reached out to them and learned from them about how they’re managing their AEs related to talquetamab.

Then I reached out to a nutritionist and started having them see my patients. And they gave me many great tips, 1 of them being [that] there’s this fat, acid, salt, sweet formula they use for people with taste changes. So if something tastes bitter, they recommend using these sorts of interventions, if it tastes too sweet, too bland, et cetera.

Also, I started to collaborate a lot with [the dermatology department]. Sometimes I had cases that were pretty easy to treat (rashes, et cetera), but sometimes there were cases that I needed more guidance [on], so I would consult with dermatology. Basically, [I learned from] collaborating with other APPs, speaking to nutrition and dermatology [experts], and also learning from patients.

I had a patient who walked in—and with talquetamab, you can have nail ridging, and your nails can start to fall off at different points in treatment—and showed me, “Look, I bought these finger cots.” They’re just single finger gloves. And so I learned things from patients.

Basically, I took everything I learned and…put in it all together into a handout, which I’ve now addended probably 20 times over the last 4 years. I made a handout that I have now circulated to staff and patients.

I think it’s really important, with a drug like talquetamab, specifically, that has these unique adverse events, to have a handout and give it to patients ahead of time, so that patients are empowered to try some of the things and have some of the materials available before they’ve even started.

A nurse practitioner gives her advice for managing adverse events during treatment with talquetamab for multiple myeloma.

Multiple Myeloma

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