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Nurse practitioner Beth Faiman outlines nursing strategies to monitor, assess, and manage toxicities associated with talquetamab in multiple myeloma.

How Nurses Can Assess and Manage Talquetamab Toxicities

Beyond administering CAR T-cell therapy and bispecifics, oncology nurses must apply proactive, supportive care and an understanding of complex treatments.

Transformative Care: A Nurse Guide to Novel Therapies in Blood Cancers

David A. Braun, MD, PhD, explained that personalized cancer vaccines can be associated with toxicities typical of both vaccines and immunotherapies.

Personalized Cancer Vaccines: Watching For Immune-Related, Vaccine AEs

Experts outline AE risks—including ICANS, CRS, HLH—as T-cell engager use expands, highlighting the crucial role of nurses and APPs.

Nurses, APPs Key to AE Management as T-Cell Engagers Move Into Solid Tumors

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Bridget Hoyt is the assistant editor for Oncology Nursing News. She earned her BA in communication studies at Rider University with a minor in public relations. She can be reached at 

Melissa Rikal, MSN, FNP-BC, AOCNP, shares strategies to help nurses improve adherence and patient education for oral oncolytic therapies.

Simplifying Oral Oncolytic Adherence in Oncology Practice

Sabrina Serani is a senior editor for Targeted Oncology.

Articles

IMvigor011 showed significant improvement in survival outcomes with adjuvant atezolizumab in ctDNA-positive MIBC.

IMvigor011 Confirms ctDNA-Guided Care in Bladder Cancer

Ronald Bleday, MD, is the section chief of the Division of Colorectal Surgery and vice chair for quality and patient safety in the Department of Surgery at Brigham and Women’s Hospital in Boston, Massachusetts.

A significant reduction of opioid use in patients after colorectal surgery was supported by clinician and patient compliance, says Ronald Bleday, MD.

Opioid Reduction in Surgical Oncology Supported by Cultural Shift

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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 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. 

Neurotoxicities can be monitored long term with personalized questions, according to Mary Steinbach, DNP, APRN.

Personalizing Neurotoxicity Monitoring After CAR T-Cell Therapy

Treatment access can still affect patients in urban communities, said Mary Steinbach, DNP, APRN.

What Are the Barriers to CAR T-Cell Therapy Access in Multiple Myeloma?

Nurses should be familiar with PET scan protocol and what to ask patients with lung and bone cancers before administering biology-guided radiation therapy.

What Should Oncology Nurses Know About Biology-Guided RT?

New FDA approvals in July include therapies for NSCLC, relapsed multiple myeloma, liver cancer, and B-cell malignancies.

July FDA Oncology Approvals Include Options for NSCLC, Myeloma, and More

Beth Faiman, PhD, MSN, APN-BC, shares strategies for monitoring and managing toxicities linked to talquetamab in patients with multiple myeloma.

Managing Talquetamab Toxicities: Insights From Beth Faiman

Monitoring for cytokine release syndrome, neurotoxicity, and managing dermatologic and oral toxicities are key strategies for supporting patients on talquetamab (Talvey), according to Beth Faiman, PhD, MSN, APN-BC, BMTCN, AOCN, FAAN, FAPO.

 Annual School of Nursing Oncology, an event hosted by Physicians’ Education Resource®, LLC, Faiman outlined practical guidance for nurses caring for patients receiving the bispecific antibody, which is FDA approved for multiple myeloma after 4 or more prior lines of therapy.

She explained that patients are often admitted during step-up dosing to monitor for early 

, such as cytokine release syndrome or immune effector cell–associated neurotoxicity syndrome (ICANS). Nurses assess patients with tools that evaluate cognitive changes, handwriting, and have the ability to detect early neurologic symptoms. Faiman also noted that short-term infection risk requires careful monitoring.

Beyond acute effects, she highlighted dermatologic and oral toxicities tied to GPRC5D expression on keratinized and oral cells. Supportive measures may include moisturizers, antihistamines, topical steroids, nail care, antifungals, and oral rinses. Dose adjustments or modified schedules may be considered to balance disease control with tolerability and keep patients on therapy.

Talquetamab is FDA approved for multiple myeloma after 4 prior lines of therapy. It’s a bispecific antibody that takes the CD3 and, like a helping hand, binds to a GPRC5D receptor and then causes cell death, cytokine release, etc.

With talquetamab, like most of our bispecific antibodies, patients are often admitted to the hospital. On day 1, they’re given a tiny, baby dose, watched for 48 hours to make sure they don’t have this cytokine release syndrome or neurotoxicity, such as ICANS. There’s a neurotoxicity tool that we administer, asking the patient to count backwards from 10 and then from 100, do handwriting samples, make sure they’re not confused or having headaches. Then the third thing is the infection: short-term, during the step-up phase of talquetamab, that’s what you see.

Unfortunately, even in the first week, a rare and unique toxicity, is dermatologic adverse events in patients with talquetamab. GPRC5D is a receptor that is expressed on keratinized cells, such as your skin and oral cells, so during my presentation, I described some of the things that you can do.

Dry skin is common in the first month, so we recommend heavy moisturizers such as ammonium lactate at 12%, especially to the hands and feet, because you can get a hand and feet rash. You can get some nail thinning and peeling. People will walk into my office with bandages around their nails because the nails are peeling off, so I recommend nail hardeners, some topical vitamin E oil, and triamcinolone at 0.025%.

Sometimes you can get itchy skin, especially in the first month. That’s where we recommend non-sedating antihistamines, such as loratadine and then the topical triamcinolone at 0.1%. Sometimes you can get a more severe, maybe grade 3 rash, where it’s itchy, peeling skin, and you might need a steroid taper, such as methylprednisolone, but fortunately, I don’t see a lot of that. It tends to be more of a mild rash.

These skin toxicities will go away faster than the oral toxicity. The oral toxicity that’s seen starts about 2 to 4 or more weeks in my experience, and according to the clinical trials where people will get taste changes, dry mouth, sometimes trouble swallowing. It’s important to look in your mouth.

If you’re a nurse seeing these patients, you want to look in their mouth and make sure they don’t have any thrush because we’re not always putting people on antifungal medications. Sometimes we’ll recommend oral nystatin. It depends on the hospital. Sometimes they just have thrush and they need a little bit of antifungal, but we do recommend an oral solution with dexamethasone.

Again, there’s been a lot of research. Donna Catamero, NP, who is a colleague of mine, and 

 published recommendations in August 2024, in 

with some nursing recommendations. I published this year, as well, about the over-the-counter dry mouth rinse; gel sprays; and small, frequent meals.

Unfortunately, the oral toxicity doesn’t go away quickly. What I recommend is giving talquetamab every other week. If by month 2 or so, it’s bothersome to the patients, I say, “Listen, your myeloma is already responding to this drug. Let’s just skip this dose. See how your myeloma numbers are.” Then by month 3, especially, sometimes we’re going down to talquetamab once monthly.

We’re balancing the disease control and with the adverse effects to keep patients adhering to the treatments. Drugs don’t work if people don’t take them, and we’re trying to keep them on the treatment as long as we can at the dose that works for them.

This transcript has been edited for clarity and conciseness.

Presenters from the 2025 Immune Cell Effector Therapies Conference emphasize the role of nurses and APPs in ensuring patients can remain on treatment through AE management.

Immune Cell Effector Therapy AE Management in the Words of Experts

As T-cell engager therapies expand from hematologic malignancies into solid tumors, oncology nurses and advanced practice providers (APPs) play a critical role in managing an evolving spectrum of immune-related toxicities, experts reported at the 2025 Immune Cell Effector Therapies (ICE-T) Conference.

Daniel Carrizosa, MD, MS, a physician at Atrium Health Levine Cancer Institute and associate professor of cancer medicine at Wake Forest University School of Medicine in Charlotte, North Carolina, noted that 

 such as tarlatamab (Imdelltra) in small cell lung cancer can cause adverse effects (AEs) uncommon in solid tumors, including immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS).

Additionally, Nausheen Ahmed, MD, an associate professor of hematologic malignancies and cellular therapeutics at the University of Kansas Medical Center, highlighted the importance of maintaining normalcy for patients receiving immune effector cell therapies, such as reinforcing cues that preserve circadian rhythm.

Al-Ola Abdallah, MD, a myeloma physician, associate professor, and director of plasma cell disorder program at the University of Kansas Medical Center, added that 

 for hematologic malignancies is now associated with AEs not seen in trials, including hemophagocytic lymphohistiocytosis (HLH) and prolonged cytopenias, underscoring the need for early detection and monitoring.

 It’s important to always realize that it is a team effort to take care of every one of our patients, especially in [non–small cell] lung cancer and in small cell lung cancer. Tarlatamab is obviously a new drug, so we’re going to be looking at things such as CRS as well as ICANS. These are things that we don’t typically see in solid tumors. We’re going to be relying on our nursing staff as well as our APPs to help recognize this in patients, as well as catch it early and know how to treat it well.

 In terms of neurological toxicities [associated with immune cell effector therapies], [another presenter at the ICE-T Conference] brought up a very good point that some of these could be delirium, or some of this could be very simple things, like people being hard of hearing and so they can’t answer your questions properly.

Make sure that the patient has as normal an environment as possible. If they’re an admitted inpatient, have their hearing aids in place, very simple things such as that, and cues that help the patient maintain a normal sense of day and night. Those things will help to prevent the delirium aspect of it, especially in older patients who may be admitted as an inpatient or is getting steroids. This will help to balance that.

 The more important thing is to understand the indications of CAR T-cell therapy. That’s the very important thing for nurses and APPs to understand about how to evaluate AEs associated with CAR T-cell therapy short term and long term. Understanding long-term AEs is very important and critical. Because of the extensive use of CAR T-cell and bispecific T-cell engagers, we’re seeing some rare adverse effects that we didn’t see as much in clinical trials that may [cause patients to] opt out, such as HLH or enterocolitis from diarrhea, and these are challenging AEs. Prolonged cytopenias for patients who have no stem cell boost are also very important AEs. These are toxicities that we’re going to start seeing more because of the CAR T-cell therapy that we’re using in multiple myeloma more often. Knowing these adverse effects or these complications of the CAR T cell earlier might benefit patient survival.

 Nurses and APPs can be the liaisons to understand the signs of CRS, neurotoxicity, and infection. Those are the main things, and that’s a very important role.

An advanced practice nurse gives advice on adminstering subcutaneous daratumumab.

The basics of subcutaneous dartumumab administration

The CD38-directed monoclonal antibody daratumumab in its subcutaneous formulation (Darzalex Faspro) offers patients with multiple myeloma a quicker treatment experience with a similar adverse event (AE) profile to its intravenous (IV) formulation (Darzalex), said Stephanie Mompoint, APRN, in an interview with 

Mompoint, a research advanced practice nurse at the University of Miami Health System, emphasized that with the subcutaneous formulation, patients are able to get in and out of the clinic 

 since they do not have to sit through a lengthy infusion. While subcutaneous is widely tolerable, it requires some 

, as Gina Fries, PA-C, a physician assistant at the University of Rochester Medical Center, pointed out in a prior interview with 

Tylenol [acetaminophen], Benadryl [diphenhydramine], dexamethasone combination

 that is for multiple drugs, including daratumumab infusions and subcutaneous injections," said Fries. “For the very first 4 doses of subcutaneous daratumumab, we give montelukast beforehand.”

Subcutaneous daratumumab should be injected slowly in the abdomen, where the hyaluronidase helps the drug absorb into the fatty tissue, according to Mompoint.

Daratumumab has been approved as a monoclonal antibody drug as a treatment for [patients with] multiple myeloma. The subcutaneous form of the drug has been approved to be used, as well. It’s given as one infusion, combining daratumumab with hyaluronidase. These 2 components really help for better absorption of the daratumumab in the fatty tissue. The AEs are expected to be the same [as for the IV formulation]. That’s why it’s important to premedicate patients, just like you would have with IV daratumumab.

The benefit is that to the patient, it’s a shorter stay in the infusion unit. Daratumumab must be given in the infusion unit; it’s not something that a patient can take at home on their own. The patient will come in and have the injection administered by a nurse. It’s a 15-ml injection given slowly in the abdomen.

The benefit for the patient is that they don’t have to sit here and have an IV inserted and stay in the infusion unit for 3 to 4 hours.

Subcutaneous daratumumab offers shorter clinic visits and high tolerability for patients with multiple myeloma, says Stephanie Mompoint, APRN.

Subcutaneous Daratumumab Provides Speedier Multiple Myeloma Treatment

Heather Wenberg, a regional nursing director for American Oncology Network, discusses the benefit of subcutaneous vs IV daratumumab.

Subcutaneous daratumumab requires less chair time and premedication for patients with multiple myeloma

The subcutaneous formulation of daratumumab with hyaluronidase-fihj (Darzalex Faspro) allows patients with multiple myeloma to spend less time receiving treatment and requires fewer premedications than the intravenous (IV) formulation of daratumumab (Darzalex), according to Heather Wenberg, BSN, RN, OCN.

Wenberg, a regional director of nursing at the American Oncology Network, explained in an interview with 

, patients with myeloma receive premedication and observation for the first cycle of treatment but can for the most part forgo premedication and observation following that cycle.

Patients receiving subcutaneous daratumumab have less chair time and premedication than those receiving IV formulation, says Heather Wenberg, BSN, RN, OCN.

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