Cytoreducive Nephrectomy in RCC: Challenges Nurses Face


There are concerns when a patient undergoes a cytoreductive nephrectomy after immunotherapy or targeted therapy that nurses should be aware of.

Nurses must be aware of the adverse events (AEs) and challenges of patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy after treatment with immunotherapy agents such as nivolumab (Opdivo) or ipilimumab (Yervoy) or targeted treatment, according to Ziad Bakouny, MD, MSc, of the Dana-Farber Cancer Institute.


In general, 1 challenge I think for the whole care team, and I think nurse will see this more acutely than physicians because they treat patients much more closely than physicians often... is the fact that we're going to go with surgery in patients who are already on systemic therapy, which I think is a particularly challenging scenario. These are patients that could have a few doses of nivolumab/ipilimumab, which can be associated with severe toxicities. Then we'd have to go on to surgery. I think this will form a particular challenge to nurses.

This is also true not only in the immune checkpoint era, but also with targeted therapies, because when we're giving TKIs et cetera, healing and all the peri-operative care becomes much more complicated. So I think this will present new challenges, and as we select the patients more, the benefits will still outweigh the risks.

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