Daly Discusses Biomarkers and Emerging Targeted Therapies for Cancer Care

Kristin Daly, MSN, ANP-BC, AOCNP, discusses the clinical significance of tumor variants and how they are changing the direction of cancer care.

As more biomarker-directed therapies enter the treatment landscape for various tumor types, education on testing and toxicity profiles of new classes of drugs are needed for oncology nurses, according to Kristin Daly, MSN, ANP-BC, AOCNP. In a presentation at ONS Bridge, Daly presented on the challenges expanding tumor variants pose, new terminology to understand and convey to patients, and how to integrate new testing methodologies into clinical practice.

“Biomarker-driven therapy and biomarker-driven clinical trials are only going to increase because we are getting more and more refined by targeting these treatments [and by] targeting these variants we are able to give patients more effective and focused treatments,” Daly said.

In an interview with Oncology Nursing News®, Daly, a nurse practitioner specializing in head and neck cancer at Siteman Cancer Center in Washington University School of Medicine in St Louis, discussed the importance of keeping lines of communication open with patients especially as treatment options continue to expand.


Oncology Nursing News®: Why is biomarker testing important and which patient populations are having their treatment options drastically expanded by the identification of actionable targets?

Daly: Potentially all patients, [because] it’s growing week to week. My presentation [at ONS Bridge] was on biomarkers [and] I like to point out that biomarkers aren’t really new they’re just a growing class, it’s an inclusive term. Things that we already think about, ER [estrogen receptor]/PR [progesterone receptor] positivity, HER2, RET, those are all biomarkers. Now we have targeted therapies for a number of biomarkers, but we also have a number of [ongoing] clinical trials. There are plenty of things in the pipeline for a variety of cancers.

One of the exciting things is the new approvals of [several targeted] drugs are targeted for the biomarkers that are found in more than 1 cancer. It’s not just for a particular type of cancer, it’s for biomarkers or variants that are found across a number of cancers in some cases. In the case of tumor agnostic treatments, [such as] pembrolizumab [Keytruda] for tumor mutational burden high [and] dMMR [mismatch repair deficient] and MSI [microsatellite instability]-high tumors, it doesn’t matter what the primary site is of the cancer; all that matters is if the patient has that variant, that particular biomarker.

What is the oncology nurse’s role in biomarker testing?

It’s a multifaceted role [and] it’s very important. Often, the oncology nurse is the one who’s going to manage and do the actual ordering of the testing.

[Also, nurses] explain to patients why we need to do this. For example, sometimes we need to wait to start therapy until we get that testing back and that’s hard for patients to understand. [We should explain that] if we start them out on the best and most effective therapy it is better in the long run for them.

What steps are needed to achieve a broader understanding of testing?

Education is huge. [This includes] education of patients, [and expanding nurses’] knowledge of the types of tests when you order them. [We also need to understand] the fact that testing may need to be ordered more than once—maybe it’s a serial testing situation—and that when we test for biomarkers, [we do] testing at all phases of treatment.

What should nurses know about treatments directed towards actionable targets? How might management of these drugs differ from chemotherapy?

In some ways [targeted agents are] very similar [to chemotherapy] because in general as oncology nurses and advance practice providers, we always want to know the drug, know how it works, its method of action, and know its potential [adverse] effects.

[This allows us to] educate the patients so they can tell us how they’re tolerating the drug and we can mitigate [adverse] effects. That’s not different than chemotherapy. The way it’s different is the way any individual drug is different. Just as individual chemotherapy drugs are different, targeted therapy again a very broad class, but you can have very different adverse effects. You need to know the drug, you need to know the drug class, potential [adverse] effects, and really look up the medication and find out about the medication because even drugs within the same drug class can have different adverse effects.

The other thing is many of the targeted therapies, not all but many of them, are oral drugs and as we’ve encountered with other oral drugs sometimes patients don’t think [the drugs] are as strong if it’s a pill. [There can be thoughts] that they won’t have adverse effects. We really need to [have] education around that.