Nurses: Are You Prepared to Handle Immune-Related Toxicities?

Immune checkpoint inhibitors are causing a sea of change in the way that cancer is treated. However, with exciting new therapies come new adverse events (AEs), such as gastrointestinal toxicities, that oncology nurses must familiarize themselves with and know how to handle.

At the 3^rd Annual School of Nursing Oncology (SONO) meeting, Oncology Nursing News ^® sat down with Marianne Davis, DNP, ACNP, AOCNP, associate professor at the Yale School of Nursing and oncology nurse practitioner at the Smilow Cancer Hospital at Yale New Haven to discuss immunotherapy — and how nurses can keep up with the changing landscape.

How has immunotherapy changed the oncology treatment landscape, particularly when it comes to AE management?

The oncology treatment landscape has been changing drastically in recent years, particularly in the last 2 to 3 years. It used to be that most patients were managed with cytotoxic or targeted therapies. But immune checkpoint inhibitors have really changed that treatment landscape with many new indications for the use of checkpoint therapy. What's very unique about immune checkpoint inhibitors is that they have a very different toxicity profile than standard cytotoxic or targeted therapies.

What is the main takeaway you have for oncology nurses to bring back to their practice?

As far as immune-related toxicities, we continue to expand our knowledge of what the etiology or mechanism of action of these immune checkpoint inhibitors is and what the toxicities are. That's really been an update.

We now have additional resources to help support the nurses in their clinical practice. While we've presented a lot of data, we also provided them with some tools that they can bring to their clinical practice that they can use for themselves as far as checklists and guidelines go, that can help support their decision making in the clinic, as well as some other strategies on how they can help educate the patients to really partner in the management of these immune toxicities. Specifically, [there are] specific national guidelines that have been developed by our professional organizations.

There are a lot of updates and new information out there for nurses to navigate and adapt to. What can these new updates be attributed to, and how can nurses keep up?

People in the lay public might think that we just all of a sudden have this abundance of new information that has just been cast upon us to deal with. But in reality, the approvals of immune checkpoint therapies have been evolving over the past 5 to 6 years. Because there have been so many ongoing trials, one closes and another might close a few months later.

So in reality, there's an evolution of the clinical data not just for immune checkpoint therapies, but all of the new treatment regimens that these patients have. We're always looking at what is the next best thing we can do to help improve overall survival for our patients, that, at the same time, minimize toxicities and improve quality of life?