® met with Sarah Donahue, MPH, NP, AOCNP, a nurse practitioner at the University of California San Francisco Health, to discuss findings from the findings of DESTINY-Breast04 trial (NCT03734029).

, a phase 3, open-label pivotal trial, randomly assigned patients with unresectable or metastatic HER2-low breast cancer to receive the fam-trastuzumab deruxtecan-nxki (Enhertu) at 5.4 mg/kg every 3 weeks (n = 373) or physician’s choice chemotherapy at locally approved dosing (n = 184). All enrolled patients had already received at last 1 prior line of therapy in the metastatic setting.

The primary end point was progression-free survival (PFS) in patients with hormone receptor–positive breast cancer. The median PFS in the primary end point population was 10.1 months (95% CI, 9.5-11.5) with the antibody-drug conjugate vs 5.4 months (95% CI, 4.4-7.1) with standard of care (HR, 0.51; 95% CI, 0.40-0.64; 

 < .0001). The median overall survival was 23.9 months (95% CI, 20.8-24.8) vs 17.5 months (95% CI, 15.2-22.4), respectively (HR, 0.64; 95% CI, 0.48-0.86; 

These findings, according to Donahue, will 

result in the addition of another therapy

 that patients with unresectable or metastatic HER2-low breast cancer can benefit greatly from.

“One significant part [of] this trial is that included such a large population of patients,” Donahue says. “It really captured most patients with metastatic breast cancer—[there were] patients with liver metastases, lung metastases, and brain metastases that were stable. It really covered a very large representative group of patients.”

Further, Donahue adds, “The data that were presented at the [2022 ASCO Annual Meeting] showed that the patients that received the trials trastuzumab deruxtecan had a much [improved] PFS compared with those patients that were on the physician’s choice of chemotherapy. [Investigators] found that they could increase the median PFS from 5 months to about 10 months, so they could double it,” Donahue explains. “It was similar with the patients with hormone [receptor]–positive diseases, as with the entire population. It did not matter what the hormone receptor status was for these patients, [they all] received that benefit.”

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Modi S, Jacot W, Yamashita T, et al. Trastuzumab deruxtecan (T-DXd) versus treatment of physician’s choice (TPC) in patients (pts) with HER2-low unresectable and/or metastatic breast cancer (mBC): results of DESTINY-Breast04, a randomized, phase 3 study. 

. 2022;40(suppl 17):LBA3. doi:10.1200/JCO.2022.40.17_suppl.LBA3

Modi S, Jacot W, Yamashita T, et al; DESTINY-Breast04 Trial Investigators. Trastuzumab deruxtecan in previously treated HER2-low advanced breast cancer. 

. 2022;387(1):9-20. doi:10.1056/NEJMoa2203690

Podcasts

Sarah Donahue, MPH, NP, AOCNP, explains the trial design of the pivotal DESTINY-Breast04 trial and discusses how the promising performance of trastuzumab deruxtecan might impact patients with unresectable or metastatic HER2-low breast cancer.


Sarah Donahue Highlights Destiny-Breast04 Trial Takeaways for Patients With HR+, HER2-Low Metastatic Breast Cancer

® met with Lidia Schapira, MD, FASCO, to discuss key advances in the treatment of toxicities that may present later in cancer survivorship care.

Schapira is a professor of medicine and director of the Cancer Survivorship Program at Stanford. Schapira specializes in breast cancer with a focus on the psychosocial aspects of cancer care and issues that relate to patient experience and health equity. She recently participated in a poster discussion in the Symptoms and Survivorship track at the 2022 

Schapira discusses recent innovation in addressing later toxicities in survivorship care. She highlights the importance of baseline measurements and health equity considerations in clinical practice and underscores the potential effect evolving technologies may have on the treatment landscape.

“The idea that we can [provide] certain interventions that help people with cognitive reframing and psychoeducation—delivered in their own time, without the need of a specialist—[is] very powerful,” Schapira said. “If we add up all the possible physical, psychological, emotional toxicities of cancer treatments, we come up with a large burden, not to even mention the financial hardship that many of the patients endure as well.”

In this episode of The Vitals, Lidia Schapira, MD, FASCO, recounts highlights from the 2022 ASCO Symptoms and Survivorship track and underscores key takeaways for practitioners seeking to enhance the delivery of cancer survivorship care. 

Key Advances in Cancer Survivorship Toxicity Management

® spoke with Sri Kota, MSN, BA, RN, OCN, a nurse clinician with the Rutgers Cancer Institute of New Jersey, about important updates in the breast cancer treatment paradigm for nurses to consider.

The increasing availability of options for patients with metastatic disease is exciting, said Kota, with promising drugs such as fam-trastuzumab deruxtecan-nxki (Enhertu) and sacituzumab govitecan-hziy (Trodelvy) continuing to make waves in the field.

“[There] is something to look forward to,” she said. “The pipeline looks great.”

In this episode of “The Vitals,” Sri Kota, MSN, BA, RN, OCN, reflects on nurse-specific takeaways from SABCS 2021, exciting changes in the breast cancer space, and the importance of patient education in the face of new regimens. 

Sri Kota Weighs in On the Evolving Breast Cancer Paradigm

, we spoke with Donna Herrera Bell, MSN, APRN, FNP-C, an oncology nurse practitioner with The University of Texas MD Anderson Cancer Center (MD Anderson) who spent 14 years working with children and adolescents with leukemia and lymphoma as well as helped develop a Pediatric Onco-Fertility consult service with MD Anderson.

Bell recently presented at the 47th Annual Oncology Nursing Society Congress about eliminating barriers to conversations around fertility preservation for adolescent or young adult patients with cancer. In our discussion, Bell highlights common barriers that young men and women face, reasons why oncology nurses may not always feel comfortable addressing the topic of fertility, and why initiating the conversation and raising fertility risk awareness is crucial following a cancer diagnosis.

“Fertility preservation is not something that everyone can do. But it is something that every [patient should] discuss, and feel empowered about,” Bell says.

In this episode of The Vitals, Donna Herrera Bell, MSN, APRN, FNP-C, highlights how nurses can eliminate barriers to fertility discussions among adolescent and young adult patients with cancer.

Improving Onco-Fertility Conversations With Adolescents and Young Adult Patients With Cancer

Loyda E. Braithwaite, MSN, RN, AGPCNP-BC, AOCNP, an oncology nurse practitioner at the University of Wisconsin Carbone Cancer Center, provides an overview of the evolving treatment landscape in hormone receptor–positive breast cancer. Braithwaite highlights the emerging role of selective estrogen receptor degraders, selective estrogen receptor modulators, and updates on aromatase inhibitors within the space. She also discusses the management of potential treatment-emergent toxicities and how recently approved agents might make active treatment more accessible for certain patient populations.

“Decision-making doesn’t happen spontaneously,” Braithwaite says. “[There] are strong data and scientific research that show new therapies are emerging. It is up to us, as advanced providers, or as nurses, to make sure that we provide that education and that support [to our patients], because the evidence is out there.”

Loyda E. Braithwaite, MSN, RN, AGPCNP-BC, AOCNP, highlights nursing considerations in prescribing and administering endocrine therapy to patients with HR+ breast cancer. 

Loyda Braithwaite Discusses Evolving Treatment Options in HR+ Breast 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. 

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

® spoke with Hamid Emamekhoo, MD, an assistant professor of the Division of Hematology, Medical Oncology and Palliative Care with the University of Wisconsin Carbone Cancer Center. Emamekhoo offers a snapshot of recent advances in kidney cancer treatments, an overview of caring for patients receiving immunotherapy and TKI combinations, and where future advances for kidney cancer research are headed.

“We have used high dose interleukin-2 for the treatment of kidney cancer since 1992—we have been doing immunotherapy for kidney cancer before immunotherapy was cool. But it was not the best treatment modality because it is a little hard to tolerate. It causes a lot of side effects because it mimics a severe sepsis and riles up the immune system,” explains Emamekhoo. “Of course, with the advancements in immunotherapy [and with] the approvals of [various] immune checkpoint inhibitors, that has changed significantly.”

Goodman VL, Rock EP, Dagher R, et al. Approval summary: sunitinib for the treatment of imatinib refractory or intolerant gastrointestinal stromal tumors and advanced renal cell carcinoma. 

. 2007;13(5):1367-1373. doi:10.1158/1078-0432.CCR-06-2328.

Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. 

. 1995;13:688-696. doi:10.1200/JCO.1995.13.3.688.

Tung I, Sahu A. Immune checkpoint inhibitor in first-line treatment of metastatic renal cell carcinoma: a review of current evidence and future directions. 

 2021(11):707214. doi:10.3389/fonc.2021.707214.

FDA approves nivolumab plus ipilimumab combination for intermediate or poor-risk advanced renal cell carcinoma. FDA. News release. April 16, 2018. Accessed March 23, 2022. https://bit.ly/37Wi3Uz

FDA approves Merck’s Keytruda (pembrolizumab) in combination with Inlyta (axitinib) as first-line treatment for patients with advanced renal cell carcinoma (RCC). Merck. April 22, 2019. Accessed April 22, 2019. https://bit.ly/2IKrjMM

FDA approves nivolumab plus cabozantinib for advanced renal cell carcinoma. FDA. News release. January 1, 2021. Accessed March 23, 2022. 

FDA approves KEYTRUDA (pembrolizumab) plus LENVIMA (lenvatinib) combination for first-line treatment of adult patients with advanced renal cell carcinoma (RCC). News release. Merck. August 11, 2021. Accessed March 23, 2022. 

AVEO Oncology Announces U.S. FDA Approval of FOTIVDA® (tivozanib) for the Treatment of Adult Patients with Relapsed or Refractory Advanced Renal Cell Carcinoma. AVEO Oncology. News release. March 10, 2021. Accessed March 10, 2021. 

FDA approves pembrolizumab for adjuvant treatment of renal cell carcinoma. FDA. News release. November 17, 2021. Accessed March 23, 2022. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-adjuvant-treatment-renal-cell-carcinoma

Choueiri TK, Escudier B, Powles T, et al. Cabozantinib versus everolimus in advanced renal-cell carcinoma. 

Cella D, Choueiri TK, Hamilton M, et al. Health-related quality of life (HRQoL) in previously untreated patients with advanced renal cell carcinoma (aRCC) in CheckMate 214: five-year follow-up results. 

. 2022;40(suppl 6):307. doi:10.1200/JCO.2022.40.6_suppl.307

Choi WSW, Boland J, Lin J. Hypoxia-Inducible Factor-2α as a Novel Target in Renal Cell Carcinoma. 

. 2021;8(2):1-7. doi:10.15586/jkcvhl.v8i1.170

FDA approves belzutifan for cancers associated with von Hippel-Lindau disease. FDA. News release. Accessed August 13, 2021. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-belzutifan-cancers-associated-von-hippel-lindau-disease?utm_medium=email&utm_source=govdelivery

In this episode of “The Vitals,” Hamid Emamekhoo, MD, discusses the evolving treatment landscape of kidney cancer. 

Carbone Cancer Center Expert Shares Biggest Updates in Kidney Cancer Treatment

In this episode of “The Vitals,” we spoke with Caitlin Benda, MBA, MS, RD, CSO, LDN

 a clinical oncology nutritionist supervisor at American Oncology Network, about dietary strategies to support patients undergoing curative cancer therapies.

Throughout our conversation, Benda discussed how nurses can help change a patient’s approach to diet in order to combat complications brought about by nausea and appetite loss. In addition, she highlights the importance of allowing patients some autonomy in their diet, common gastrointestinal—related side effects with different cancer treatments, and the importance of nutrition screening tools in increasing necessary referrals.

“Oncology nurses, especially infusion nurses, are spending a lot of time around patients, gathering information from these patients that maybe the patient did not have time to communicate in the same amount of detail to the physician or to whoever they were seeing in the office,” notes Benda. “Using that information and sending referrals to dieticians early on in the process [is vital]. We know that malnutrition is a very significant problem among individuals going through cancer treatments, and it is much easier to prevent malnutrition than it is to treat malnutrition.”

In this episode of “The Vitals,” Caitlin Benda, MBA, MS, RD, CSO, LDN, discusses important dietary considerations for patients with cancer.

Food for Thought: Nutrition Considerations for Patients With Cancer

® met with Matt Iwaniec, PsyD, a licensed clinical health psychologist with the stem cell transplant and CAR-T therapy program at Allegheny Health Network, to discuss fully integrated behavioral services as it relates to oncology.

In our discussion, Iwaniec highlights the mechanisms behind psychosocial treatments like cognitive behavior therapy (CBT) and acceptance and concomitance therapy (ACT), discusses recent advances in the behavioral health space, and underscores the need to normalize behavioral therapy for patients facing a cancer diagnosis.

“Psychologists and behavioral health professionals have a unique skill set that we can bring to the practice of oncology to help patients, families, clinicians, doctors, nurses, teaching assistants, nurse practitioners, etc deal with the stress of cancer—because it is not just stressful on the patient. It is stressful on the whole family, and it is stressful on the teams that are treating them, too.”

Iwaniec expresses that he believes integrated behavioral health care is the “way to go” for the future and should become a standard part of cancer care treatment. However, there still are a lot of unmet needs that need to be addressed, he says.

“There is still a big gap between availability of mental health care and the need for mental health care. It is a problem that is endemic everywherethroughout through all our systems. We are on this path to better integration of mental health care from start to finish with the patient. There are examples of places where that is happening, but often, behavioral health care is not fully integrated [although it] needs to be. The 2 biggest impediments to that are having the [proper] staff, but also getting the general patient population to acknowledge that mental health care is a part of cancer health care.”

In this episode of “The Vitals,” Matt Iwaniec, PsyD, discusses the value of integrated behavioral health programs in cancer care. 

Behind Integrated Behavioral Health Services 

® met with Mark Honor, PA-C, Department of Malignant Hematology, Moffitt Cancer Center, to discuss managing adverse events (AEs) related to cancer therapies. In our conversation, we discuss the different mechanisms of action of today’s most popular therapeutic options, and best principles for responding to adverse events in patients receiving combination or immunotherapies.

“I went to school to be a medical provider; they didn't go to school to be a patient. They're not going to walk up to me and say, ‘Mark, I think I had gastroparesis, can you prescribe me some metoclopramide?’ They're not going to do that. The thing is, we can be ignorant of the facts if we don't ask the right questions. You must ask the right questions.”

“[If you are] the triage nurse, or the primary nurse, you have to be invasive,” he added. “Once a patient tells you they're having a problem, you need to know what they ate last night, and what they have been eating recently. Because a lot of times by asking all those questions, the nurse can [actually] solve a lot of these problems.”

In this episode of “The Vitals,” Mark Honor, PA-C, discusses adverse event management in patients receiving different therapeutic options. 