Navigating TNBC: Nurse-Led Insights on ADCs and Toxicity Management

In an era of rapid advancements in precision oncology, targeted therapies and antibody-drug conjugates (ADCs) are redefining treatment paradigms for complex malignancies like triple-negative breast cancer. To explore these profound clinical shifts, Oncology Nursing News sat down with Alanna Iorio, APRN-C, OCN, an adult-geriatric primary care nurse practitioner at cCARE. Having recently moderated a case-based roundtable discussion on triple-negative breast cancer, Iorio shares her clinical insights on navigating this rapidly evolving treatment landscape.

With 15 years of oncology experience, Iorio highlighted how precision medicine has dramatically extended patient survival, turning once-rapidly terminal metastatic diagnoses into manageable chronic conditions. However, increasingly complex regimens bring unique management challenges.

From proactive monitoring of toxicities like neutropenia, nausea, and diarrhea to utilizing accessible patient education tools, Iorio emphasized that oncology nurses remain the critical frontline defense in maintaining treatment adherence and optimizing quality of life.

Beyond direct patient care, Iorio calls on oncology nurses to deepen their clinical engagement through continuous education and professional membership in organizations like the Oncology Nursing Society. In this interview, we delve into the essential clinical strategies, specialized patient-centered resources, and vital nurse-led leadership practices that empower modern oncology nurses in their practice today.

With targeted agents and ADCs rapidly altering treatment paradigms, what specific nursing considerations, such as toxicity profiles or monitoring schedules, should practicing oncology nurses prioritize today?

If you're a nurse and going into these situations, you need to know what the big side effects are. And if they're not being seen by a provider, then that's the nurse's responsibility. Are you having vision changes? Are you having diarrhea? Are you having nausea? Let me look at your labs and review your labs. I know not all patients are seen by a provider with each visit, so making sure they're not neutropenic, haven't had neutropenic fevers, diarrhea, nausea, vision changes, depending on what treatment they're on, or side effects in general. You need to know the side effects of the drugs you're giving.

As these regimens become increasingly complex, side effect management remains essential to maintaining treatment adherence. What strategies or best practices would you recommend for early identification and mitigation of emerging toxicity?

I think education with the patient foremost is the most important thing because if the patient doesn't understand side effects and what to look out for, or they don't report things to you when you say, "Hey, you need to report this early so we can manage it early instead of waiting until it's too late,” I think that education with the patient is very important.

When discussing advanced treatment options with patients and their families, what communication techniques or educational tools do you find most effective for setting expectations around side effects and quality of life goals?

Yeah, so I use mostly ChemoCare.com. I think it's an easy reading level for all of our patients, and depending on what drug it is, some of the companies have really great side effect management sheets, or even starter kits. It really just depends on the drug. And then we at our practice have what we call our chemotherapy packet, it outlines what to do if you have diarrhea, nausea, how to take these different medications, all the contact numbers to call if you are to experience side effects. It's just very comprehensive, so the patients have that on paper.

How have recent advancements in precision oncology and biomarker testing reshaped your day-to-day workflow, and where do you see the AP role evolving over the next few years?

I think we're going to get busier. I do. We're people are living longer. We didn't have this when I started 15 years ago. I mean, you had triple-negative breast cancer, unfortunately, if it was metastatic, you were dead within less than two years. Now our patients are living longer. I mean, I have someone that, gosh, she's going on 14 years. It's just incredible, and she has metastatic disease. We're giving more therapies. We're seeing side effects, but we're managing them. That's what we do. But our patients are living longer with metastatic disease, so we're just we're busy, and it's great, right? We're having them meet their milestones. But I just foresee this; it's a good thing. Not only busy with seeing these patients, but busy with keeping up with all the new drugs that are coming out on the market too.

For oncology nurses who are looking to deepen their engagement in clinical discussions, case reviews, or professional leadership, what advice would you offer to help them translate educational insight into actionable practice?

I think you need to seek out educational opportunities on your own. You can't expect someone that's just orienting you or training you to just teach you about everything. I personally set up for the nurses and the APPs general oncology learning about twice a month so they can learn about different emergencies or drug classes. And I always encourage them, “If there's a dinner, you should go. You should go learn. You should go network. Join the Oncology Nursing Society. Join the Advanced Practice Oncology Nursing Society. Go to different oncology conferences. If you want to be in oncology and if you want to really understand it, you do have to do a little bit more than just the basic go to work, look up a drug, and you have to really use those different tools.”

Transcript has been edited for clarity and conciseness.