Linking Patient Experience With Next Steps in Renal Cell Carcinoma

When a patient with renal cell carcinoma (RCC) progresses on or following the combination of a tyrosine kinase inhibitor (TKI) and immunotherapy, advanced practice providers (APPs) can use patient experience to inform future treatment decisions, explained Gigi Jameel, MFN, MPH, APRN.

In an interview with Oncology Nursing News after moderating a Community Case Forum centering around care for patients with RCC, Jameel, a nurse practitioner at Moffitt Cancer Center in Tampa, Florida, emphasized that APPs are in a position to not only track patients’ experiences when pausing one part of a combination treatment, but help patients understand how those observations factor into future treatment options.

When patients are experiencing adverse effects (AEs) from their treatment combination, 1 part of it (the TKI or the immunotherapy) may be held or reduced to determine what the source of the AEs is.

In this way, APPs can support treatment decisions from both the clinician side, by determining whether patients are experiencing AEs from a TKI or immunotherapy, and from the patient side, explaining how their next options for treatment will give them a different experience from their previous regimen.

Oncology Nursing News: What should APPs take into consideration when supporting patients receiving belzutifan (Welireg)?

Jameel: We see a lot of anemia and hypoxia with belzutifan. I usually tell my patients to get a pulse oximeter. Everyone knows what that is because we all went out and bought them during the pandemic. They all know what it is, and they all probably have it somewhere. I have them monitor their [blood oxygen saturation] quite a bit. I also monitor their hemoglobin levels, and especially when they first start treatment. I like to monitor it weekly and then do a telemedicine visit, just to go over it and see how they’re doing. I have had several patients who have ended up in the hospital because their [blood oxygen saturation] has been so low and their hemoglobin has dropped.

How does tivozanib differ from other TKIs in terms of safety?

With tivozanib, we have to be cognizant of blood pressure. A lot of the time patients are not getting the same hand-foot syndrome that the other TKIs are [linked with], but we have to [be aware of blood pressure], especially with patients. That’s not something they’re typically worried about. They’re worried about the things that happen to them on a daily basis and interfere with their quality of life…like hand-foot syndrome and diarrhea. …But [the need to monitor blood pressure] is something APPs should be aware of.

What makes the role of APPs unique in the care of patients with RCC?

A lot of our role comes into play in the education aspect of care. If we are able to talk to our patients about these AEs that they can expect before the AEs happen, then we can help empower the patients to also be advocates for their care, because our basic role right is to be advocates for the patient. It’s important that we need to also provide that information to our patients on how to advocate for themselves, and if they know what to expect, then they’ll feel more comfortable telling us about [symptoms] and how we can help them.

When patients with RCC progress on a TKI and immunotherapy combination, how do APPs inform treatment decisions?

We’re limited in renal cell carcinoma. We don’t have a lot of choices. Most patients start their first line of therapy with a TKI and immunotherapy together, and those people who have a lot of AEs, we then have to figure out, because it’s APPs, who are managing the AEs. You get to know the patient, you see what AEs they’re having.

You’re holding either the TKI or the immunotherapy and figuring out what the AEs are from so that when the patient does progress, you can look back and [choose the appropriate next treatment].

[Then you can tell] the patient, “I know you have these AEs, and I know you don’t want to take any more treatment because you feel so miserable on this, but the AEs were from this particular medicine that we’re not giving you anymore. We’re giving you a similar medicine to the one that you’re on. …This is what we’re going to try next.”

This transcript has been edited for clarity and conciseness.