Charise Gleason, MSN, NP-BC, AOCNP: I explain monoclonal antibodies to patients by talking about the synergy and their immune system. I think with patients who have a diagnosis of cancer, they’re disappointed in ways that their body has let them down. But when you talk about monoclonal antibodies to a patient, explaining that it’s their immune system that’s also helping them overcome the plasma cells in their cancer, I don’t have a specific analogy. But I like to draw pictures for patients of that specific cell, show them the target on the surface of the cell, how the monoclonal antibody attaches to it, and how it works for the patient.
Kathleen Colson, RN, BSN, BS: Generally, I start off in explaining that it’s very simple, that monoclonal antibodies help to enhance or stimulate the immune system so that the patient’s own immune system can fight their cancer cells. Also, I can use an analogy in using the key in the lock, that we use the key and it unlocks the immune system for the patients to attack, fight, and eliminate their cancer cells, their myeloma cells.
Wendy Vogel, MSN, FNP, AOCNP: Most patients when they come in for a cancer treatment are expecting traditional chemotherapy. So, it’s fun and exciting to explain to them what the difference is between a targeted therapy or a monoclonal antibody therapy versus chemotherapy. I use an analogy like laser therapy and a shotgun. With a shotgun, you’re getting a lot of scatter, a lot of damage done to the cancer, but also to the normal cells as well. When we’re talking about a targeted therapy or a monoclonal antibody therapy, I describe that more as a laser therapy directed at what causes that cancer cell to be abnormal. There still are some side effects, but they’re very different and they don’t have the devastating effects that chemotherapy has sometimes.
When we’re talking about change in therapy, sometimes patients wonder why they go from a 3-therapy regimen or a 2-therapy regimen down to a 1-therapy regimen. And there are different reasons for that. We obviously explain the rationale from that if they’ve had a previous backbone therapy. Sometimes, we’ll be adding that third drug to it instead of taking it away. So, it depends upon the situation and that patient’s previous history of drugs, how their performance status is at that time, and if they can tolerate certain drugs. And so, it depends upon the patient and how we explain that as to what’s going on with them.
Kathleen Colson, RN, BSN, BS: Whether it’s a single therapy, a doublet, or a triplet, it is a multifactorial decision that their physician will make a decision on. And this is based upon a patient’s performance status, their age, and whether a patient has any comorbidities like renal insufficiency, cardiac issues, and lung issues. And so, again, all of these factors come into the decision-making process, how much of a type of treatment the patient will receive. Generally, I will tell you that we do use a combination therapy because that is the key for overcoming drug resistance and looking at better responses for our patients. Multiple myeloma is a heterogeneous disease. It’s really not a one-size-fits-all treatment regimen.
Charise Gleason, MSN, NP-BC, AOCNP: How I talk to a patient about change in therapy is it’s very common to use multidrug regimens, and so we talk about the fact that you’re building on that response for them by gaining that synergy with these multi drugs, less side effects when you use them. Patients frequently have a question about, “Well, if this isn’t working for me, how is adding this third drug or this fourth drug going to make this better?” And so, you have to explain to them that these drugs all work in different ways. They hit different targets and even though one of these drugs may stop working for you, when you add an additional one, such as a monoclonal antibody, it still can overcome that relapse that we’re seeing. The additional drugs make the other drugs work better.