Onc Nurse on Call

In this special episode of The Vitals, we ring in the New Year 2024 by combing through 2023 FDA approvals. Listen as editor, Lindsay Fischer, recounts key approvals on a month-by-month basis. To read the full information surrounding the approvals, be sure to check out our news coverage below.  As always, thank you for listening to The Vitals, and for all the engagement in 2023. We look forward to bringing you more oncology news in 2024. We want to hear from you! Which drugs approved in 2023 have been practice changing? Have you had any difficulty or success in incorporating these novel agents into clinical use? Any challenges with supporting patients on these regimens? Email ONNeditors@mjhlifesciences.com with your feedback January  Tucatinib and Trastuzumab Combination Gains FDA Approval for RAS Wild-Type HER2+ mCRC FDA Approves Zanubrutinib for CLL/SLL Adjuvant Pembrolizumab Gets FDA Approval in NSCLC FDA Grants Pirtobrutinib Accelerated Approval for Relapsed/Refractory MCL  February  Sacituzumab Govitecan Receives Indication for Unresectable, Locally Advanced or Metastatic HR+/HER2- Breast Cancer FDA Grants Regular Approval to Dostarlimab for dMMR Endometrial Cancer March  Abemaciclib Indication Expands to Include HR+, HER2–, Node+, High-Risk, Early Breast Cancer FDA Approves Single-Dose Autoinjector of Biosimilar Pegfilgrastim-cbqv for Febrile Neutropenia FDA Approves Dabrafenib With Trametinib for Pediatric BRAF V600E–Mutant Low-Grade Glioma FDA Grants Accelerated Approval to Retifanlimab for Locally Advanced Merkel Cell Carcinoma Pembrolizumab Receives Full FDA Approval for Treatment of Select Patients With dMMR/MSI-H Solid Tumors April FDA Grants Accelerated Approval to Enfortumab Vedotin Plus Pembrolizumab for Locally Advanced or Metastatic Urothelial Cancer Omidubicel-onlv Gets Greenlight to Accelerate Neutrophil Recovery After Stem Cell Transplant in Hematologic Malignancies Polatuzumab Vedotin Approved in Combination With R-CHP for Treatment-Naïve DLBCL, High-Grade B-Cell Lymphoma May Cemiplimab Granted Full Approval for Metastatic Basal Cell Carcinoma Epcoritamab Obtains Accelerated Approval for Relapsed/Refractory DLBCL FDA Greenlights Avapritinib for Indolent Systemic Mastocytosis FDA Approves Radiohybrid PET Diagnostic Agent Posluma for PSMA-Positive Lesions in Prostate Cancer Olaparib Gains FDA Approval for BRCA+ mCRPC June Glofitamab Gains Accelerated Approval for Relapsed/Refractory DLBCL FDA Approves Talazoparib in Combination With Enzalutamide for mCRPC Blinatumomab Receives Full Approval for MRD-Positive B-Cell ALL July  Ready-to-Dilute Cyclophosphamide Injections Obtain FDA Approval Quizartinib Plus Chemo Gains FDA Approval for Newly Diagnosed, FLT3-ITD+ AML FDA Approves Frontline Dostarlimab in Combination With Chemotherapy for dMMR/MSI-H Endometrial Cancer August  FDA Approves Trifluridine/Tipiracil With Bevacizumab for Metastatic Colorectal Cancer Pralsetinib Gains Regular Approval for NSCLC With RET Gene Fusions Talquetamab Receives Accelerated Approval for Heavily Pretreated Multiple Myeloma FDA Approves Niraparib Plus Abiraterone Acetate to Treat BRCA+ mCRPC FDA Grants Elranatamab Accelerated Approval for Relapsed or Refractory Multiple Myeloma FDA Approves Hepzato Kit for Metastatic Uveal Melanoma With Liver Metastases September FDA Approves Motixafortide Plus G-CSF to Mobilize Hematopoietic Stem Cells in Multiple Myeloma FDA Approves Momelotinib to Treat Myelofibrosis With Anemia Bosutinib Is Approved for Pediatric Ph+ CP–Chronic Myeloid Leukemia October  FDA Grants Marketing Authorization to First DNA Test to Assess Multiple Cancer Predispositions FDA Approves Encorafenib/Binimetinib for BRAF V600E+ NSCLC FDA Approves Adjuvant Nivolumab for Stage IIB/C Melanoma Pembrolizumab/Chemotherapy is Approved for Neoadjuvant and Adjuvant Resectable Non-Small Cell Lung Cancer Entrectinib Is Approved for Pediatric Patients With NTRK+ Solid Tumors FDA Approves Ivosidenib to Treat Myelodysplastic Syndromes With IDH1 Mutation FDA Approves Toripalimab Regimens to Treat Adults With Nasopharyngeal Carcinoma November  FDA Grants Pembrolizumab New Biliary Tract Cancer Indication FDA Approves Fruquintinib for Patients With Pretreated Metastatic Colorectal Cancer FDA Approves Repotrectinib for Adults With Advanced/Metastatic ROS1+ NSCLC Pembrolizumab Is Approved for Patients With HER2– Gastric/GEJ Adenocarcinoma FDA Approves Capivasertib/Fulvestrant for Advanced/Metastatic, HR+, HER2- Breast Cancer FDA Approves Enzalutamide for High-Risk Nonmetastatic Castration-Sensitive Prostate Cancer FDA OKs Nirogacestat for Adults Patients With Desmoid Tumors December FDA Grants Pirtobrutinib Accelerated Approval to Treat CLL/SLL in the Third Line FDA Approves Eflornithine for Children, Adults With High-Risk Neuroblastoma FDA Approves Belzutifan for Patients With Advanced Renal Cell Carcinoma Enfortumab Vedotin Plus Pembrolizumab Snags Full Approval for Patients With Locally Advanced or Metastatic Urothelial Cancer

In this episode of The Vitals, Beth Finley-Oliver, MSN, ARNP, AGNP-BC, a nurse practitioner who works in the outpatient hematology clinic at Moffitt Cancer Center, revisits her presentation from the 2023 JADPRO Live Annual Meeting and discusses the growing number of therapies for patients with relapsed or refractory multiple myeloma. Episode Highlights “A clinical trial upfront would be my first option. After that, I have to try and find something their myeloma hasn't seen yet.” “With CAR T, the CRS incidence is higher, and I think we're doing better [at managing it] because we have multiple interventions. We see viral infections with [both] the CAR T and the bispecifics. We always have to kind of keep that in the back of our mind.” “The more medications we have, the more this is turning into a chronic illness.”  For More On Multiple Myeloma: Delivering Teclistamab in the Outpatient Setting Ambulation Improves Frailty Scores in Patients With Multiple Myeloma With New Bispecific Antibodies in Multiple Myeloma, Nurses Need To Know How to Manage CRS Video Interviews Managing Teclistamab-Induced CRS for Patients With Multiple Myeloma Data Supporting Elranatamab Approval in Multiple Myeloma Data Behind Talquetamab Approval in Multiple Myeloma More Podcast Episodes Beth Faiman Discusses Recent Changes in Multiple Myeloma Treatment Landscape ASH Data Offer Treatment Direction for Oncology Nursing Professionals A Look Back at 2022 FDA Approvals in Oncology Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma

In May 2023, the FDA granted accelerated approval to epcoritamab-bysp (Epkinly) for the treatment of adult patients with relapsed/refractory (R/R) DLBCL, including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma (HGBL), following 2 or more lines of systemic therapies. Shortly thereafter, in June 2023, the FDA granted accelerated approval to glofitamab-gxbm (Columvi) as a fixed duration treatment for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified or large B-cell lymphoma (LBCL) arising from follicular lymphoma, after 2 or more lines of systemic therapy.  In this episode of The Vitals, Laura Zitella, MS, RN, ACNP-BC, AOCN, who is a hematology nurse practitioner in the Hematology, Blood, Marrow transplant, and Cellular Therapy (HBC) program at UCSF Health and associate clinical professor in the Department of Physiological Nursing at the University of California San Francisco, joins Oncology Nursing News to discuss how these newly approved bispecific antibodies are expanding third-line treatment options for patients with diffuse large B-cell lymphoma.   Episode Highlights “Bispecific antibodies are antibodies that generally have at least 2 antigen binding sites: 1 binding site is to the antigen of interest on the cancer cell, and in lymphoma, that's often CD19, or CD20. The other antigen binding site is to CD3, which is a T-cell marker.” “Unfortunately, we do not cure all patients with second-line therapy [and] the bispecifics are used for third-line therapy, where we have historically had limited treatment options.” “One of the big advantages of bispecific antibodies is that they are ‘off-the-shelf;’ they do not need to be manufactured, and they are available immediately." “Epcoratimab is a subcutaneous [administration] bispecific antibody, whereas glofitamab is an intravenous [administration]. Both require step-up dosing, which means that you start with a small dose and then the subsequent doses are a little bit higher, and a little bit higher until you reach your treatment dose.” For More on DLBCL Glofitamab Gains Accelerated Approval for Relapsed/Refractory DLBCL Epcoritamab Obtains Accelerated Approval for Relapsed/Refractory DLBCL Investigators Unveil Real-World Experiences on Shared Decision-Making in R/R DLBCL For More On Bispecific Antibodies With New Bispecific Antibodies in Multiple Myeloma, Nurses Need To Know How to Manage CRS Novel Immune Checkpoint Inhibitors, Bispecific Antibodies Become Clinical Mainstays in Melanoma Nursing Smith Discusses Evolving Landscape of Lymphoma Treatments Bispecific Antibodies May Change Lung Cancer Paradigm More Podcast Episodes in Hematology  Beth Faiman Discusses Recent Changes in Multiple Myeloma Treatment Landscape Oncology Nursing Stories: Off-The-Shelf CAR T Therapy for Acute Lymphoblastic Leukemia Oncology Nursing Stories: Pregnancy After Lymphoma Chemoradiation Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma Stephanie Jackson Unpacks Recent Advances in Leukemia Treatments

In honor of lung cancer awareness month, for this episode of The Vitals, Nicole Gay, APRN-C, joins Oncology Nursing News to share how she counsels patients about lung cancer screening.  Gay is a nurse practitioner at the University of Miami Sylvester Comprehensive Cancer Clinic, and a nurse navigator for the clinic’s lung cancer screening program. In the conversation, she shares how she addresses patient fears and concerns around screening, helping them feel comfortable and confident in navigating their health. Episode Highlights “Lung cancer screening, unfortunately, has a bit of a stigma around it. Part of my job is reducing that stigma, making patients feel comfortable and relaying how important screening for lung cancer really is.” “This is a low-dose CT scan. The amount of radiation they are getting is reduced when you compare it to a normal CT scan.” “We are very grateful for the change in the guidelines. It really widened the pool of patients that can be screened.” Online Articles How I Counsel Patients About Lung Cancer Screening Innovative Patient Education Strategies Continue to be Developed for Lung Cancer Screening Opinion: Cancer Screenings, Although Not Perfect, Remain Valuable Updates in Lung Cancer Screening Criteria Increase African American Patient Participation Videos Johanna Garibaldi On Strengthening Cancer Prevention Tactics With Mobile Screening Clinics Confidence Is Key in Oncology Nurse Navigation References Lung cancer: screening. US Preventive Services Task Force. March 19, 2021. Accessed August 16, 2023. https://uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening Lung cancer screening billing guide. American Lung Association. Accessed August 30, 2023. https://www.lung.org/getmedia/bd0af1bf-1cd8-4fd0-9f8f-47e55c783448/ALA-Lung-Cancer-Screening-Billing-Guide-FINAL.pdf Cancer facts and figures 2021. American Cancer Society. Accessed August 16, 2023. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html Lung nodules. American Cancer Society. Accessed August 16, 2023. https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/lung-nodules.html Lung cancer screening. Mayo Clinic. February 11, 2022. Accessed August 30, 2023. https://www.mayoclinic.org/tests-procedures/lung-cancer-screening/about/pac-20385024 Lung cancer screening: questions for the doctor. US Department of Health & Human Services. Updated May 26, 2023. Accessed August 18, 2023. https://health.gov/myhealthfinder/doctor-visits/talking-doctor/lung-cancer-screening-questions-doctor

In this episode of The Vitals, Holly Chitwood, DNP, FNP-C, AGACNP-BC, walks through a patient case with a 70-year-old male with metastatic colorectal cancer.1 His providers used circulating tumor DNA (ctDNA) testing to monitor his minimal residual disease (MRD) levels throughout active treatment. This approach, although not currently addressed in National Comprehensive Cancer Center Guidelines, allows patients and providers to have an idea of how the treatment is working earlier compared with what imaging can usually demonstrate, she explains. Chitwood is an assistant professor in the College of Nursing at the University of Kentucky, as well as a practicing oncology APRN who primarily cares for patients with gastrointestinal, hepatic-biliary, and sarcoma tumors in her clinic. To read the full case study, please check out our show notes below. Episode Highlights “This is a new technology that we have. It is basically looking at what is in your blood to see how much circulating tumor DNA is floating around.” “In this case, and in a lot of my patients, you will see ctDNA is about, you know, anywhere from 2 to 3 months [ahead], predating what you will see on imaging.” “You have to be very judicious in explaining the results, especially if you have a positive result, and the patient should be included in the decision making.” Online Articles ctDNA Continues to Emerge As A Potentially Useful Disease Monitoring Tool in CRC ctDNA Makes Headway as Promising Marker for Patients With Anal Cancer and Other GI Malignancies ESMO Guideline on Liquid Biopsy Address Quality Standards for Clinical Implementation New Treatment Methods Launch a Shift in CRC Treatment Videos Metastatic CRC Nursing Webinar Podcast Terri Pollack Offers Perspective on 2023 ASCO GI Cancers Symposium Overcome Screening Barriers in CRC References Chitwood H, Myers A. Use of circulating tumor DNA to monitor minimal residual disease among patients with colorectal cancer. Clin J Oncol Nurs. 2023;27(4):369-374. doi:10.1188/23.CJON.369-374

In this episode of The Vitals, Patricia Jakel, RN, MN, AOCN, co–editor-in-chief with Oncology Nursing News, sits down with Quanna Batiste-Brown, DNP, RN, NEA-BC, FAAN, to discuss the reality of racism in nursing. Batiste-Brown is an adjunct associate professor and Chief Nursing Officer at UCLA health. The pair discuss the implications of the National Commission to Address Racism in Nursing, which, in 2021, published survey findings from 5,623 nurses. The findings showed that 50% of nurses feel that there is “a lot” of racism in nursing; that 63% of nurses have personally experienced racism in the workplace; and that 56% of nurses say that racism has impacted their mental health in the workplace.   Moreover, although 3 out of 4 nurses have witnessed racism in the workplace, 64% of those who actively challenged racism or stood up for their colleagues said their actions effected no change.  Batiste-Brown, who is part of California ANA and helped created a workforce in her group that led to the larger ANA’s commission on nursing report, discussed the implications of racism in nursing, and offered insight in how to talk to administration and coworkers about creating an inclusive community that protects employees and promotes better patient care.   Episode Highlights  “Nurses across the state were really upset and tired and wanted to do something about their own lived experiences, [and the] experiences of their patients. [They] wanted to talk about what nurses could do to affect change in racism and health equity, or the care that they are delivering and what their patients were experiencing.”  “There is opportunity for everyone to come together to have honest conversations about how we move change forward.”  “Be mindful of someone's mental health and be sure that they're not keeping that information inside of them, because it can be detrimental to your health to be going through something as severe as racism and not tell anyone about it.”  Podcast Episodes Equity, Diversity, and Inclusion in Oncology Nursing Leadership Championing Diversity in Nursing and Oncology Oncology Nursing News Articles The Future of Nursing Must Be Diverse Nurse Leaders Must Foster Change to Develop a Healthy Workplace Environment Diversity and Inclusion Should be Valued in Leadership Roles Creating a Safe Space: Preventing Bullying and Violence Among Oncology Nurses Video Interviews Establishing Equity, Diversity, and Inclusion Throughout Oncology Practice Starting the DEI Conversation in Oncology Nursing References  1. Our Racial Reckoning Statement. American Nurses Association. Accessed October 11, 2023. https://www.nursingworld.org/practice-policy/workforce/racism-in-nursing/RacialReckoningStatement/  2. National Commission to Address Racism in Nursing. Accessed October 11, 2023. https://www.nursingworld.org/practice-policy/workforce/racism-in-nursing/national-commission-to-address-racism-in-nursing/ 

In this episode of The Vitals, Ryan Tamargo, NP, AONCP, a nurse practitioner with the inflammatory breast cancer (IBC) program at the Dana-Farber Cancer Institute, talks about IBC and why it is often misdiagnosed. She discusses the launch of an online IBC Scoring System tool, which was developed through Susan G Komen, the Milburn Foundation, and the Inflammatory Breast Cancer Research Foundation. According to Tamargo, this tool may prove helpful in raising awareness about this rare form of breast cancer and make it easier for primary care providers to recognize the symptoms and make the correct diagnosis.  Resource Inflammatory Breast Cancer (IBC) Scoring System online tool Episode Highlights “What can be tricky about [IBC] is that there is sometimes no mass. The symptoms can be very progressive that it can look like an infection to primary care providers or providers in the community.” Time stamp (TS) 1:48 “The tool can be really helpful in going step-by-step [through] what you're actually seeing, and then will give you a score at the end." TS 4:00 “The best thing to prevent this [from] becoming metastatic is going to be treatment with chemotherapy as soon as possible.” TS 9:30 Online Articles Inflammatory Breast Cancer Is Often Missed, But May Now Be Easier to Diagnose Fast Facts for the Frontline: Inflammatory Breast Cancer Raising Awareness of Inflammatory Breast Cancer The Argument for Better Patient-Centered Care in Oncology USPSTF Suggests Lowering Breast Cancer Screening Age in Draft Recommendation The Vitals Podcast Episodes Nurse Practitioners Weigh in on Data From the San Antonio Breast Cancer Symposium Video Interviews Kara Morris and Christine Wylie on Oral Cryotherapy for Chemotherapy-Induced Mucositis in Breast Cancer Johanna Garibaldi On Strengthening Cancer Prevention Tactics With Mobile Screening Clinics Pattie Jakel Highlights the Challenges With Oral Therapies in Breast Cancer Reference Jagsi R, Mason G, Overmoyer BA, et al. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat. 2022;192(2):235-243. doi:10.1007/s10549-021-06434-x

In this episode of The Vitals, Heather Santone, an oncology nurse navigator with Allegheny Health Network, shares which unique challenges nurse navigators face when caring for geriatric patients. She points out that many of these patients have difficulty securing transportation to and from their appointments, or struggle to navigate online applications or internet services. Luckily, nurse navigators can play a large role in helping patients overcome these obstacles and ensuring that patients do not fall through the system’s cracks. Episode Highlights I live in Erie; we are a smaller city. A lot of our testing has to be done in Pittsburgh. Time stamp (TS) 5:56 Transportation is a large barrier to care for older people because [oftentimes] they have stopped driving, and they may not have the transportation. TS 7:28 Technology is huge, because a lot of our services, like American Cancer Society’s great Road-to-Recovery program, is on an App—they give us [a 1-800] number so we can call in, but a lot of things, like Lyft goes back to an app or a computer system. TS7:37 The nice thing about navigation is the that we are there to help prevent the gaps. For the most part, we do a really good job of keeping those gaps very small, to make sure we are trying to follow [patients] all the way through treatment so that they are not lost.” TS 10:07 Online Articles Defining and Quantifying the Oncology Nurse Navigator Role Geriatric Assessments Help Guide Meaningful Cancer Treatment Geriatric Assessment Rates Improve With Nurse Navigator Intervention Geriatric Assessments Help Promote Comorbidity-Related Discussions in Patients With Advanced Cancer Video Interviews: Setting Boundaries Can Be a Challenge for Nurse Navigators Supriya Mohile on Lack of Representation of Geriatric Patients in Clinical Trials Claire Friedman on Considerations for Older Patients Receiving Immunotherapy Podcast Episodes: Leana Cabrera Chien and William Dale Underscore The Value of Geriatric Assessments in Optimizing Cancer Care Access-Focused Care: The 4-1-1 on Oncology Phone Triage Programs Preparing Nurses for the 'Silver Tsunami' Behind Integrated Behavioral Health Services

In this episode of The Vitals, Shawna Douglas, BSN, RN, a head and neck oncology nurse navigator with Allegheny Health Network, highlights the unique challenges that this population faces, including access to proper dental care, nutrition specialists, and postsurgery speech and swallow therapy. She draws from personal experience to share a story of how she used the resources available at her institution to help a patient find transportation to and from her appointment—highlighting the value that nurse navigators can provide their patients.   Episode Highlights  “My role as their oncology navigator is to help be that one point of contact and to guide them through their cancer journey. I provide additional information resources, referrals, and support.” Time stamp (TS) 1:49  “They always need a dietician to follow them, [they may have] possible feeding tube considerations, [and] they always need to see a dentist regardless of treatment options. Patients also need that dental clearance if they are going to be receiving radiation to the head and neck. Stemming from the dental evaluation, a lot of our patients need to see an oral surgeon for some extractions.” TS 3:41   “There are sometimes issues with noncompliance because there are so many appointments that need to be scheduled. They get very overwhelmed. That's where I come in.” TS 4:37 Articles Advances in Head and Neck Cancers Yield New Clinical Implications for Nurses Investigators Say HPV Vaccination Rates Are Suboptimal Virtual Planning For Surgical Reconstruction May Improve Outcomes for Patients With Head and Neck Cancer Defining and Quantifying the Oncology Nurse Navigator Role Videos Setting Boundaries Can Be a Challenge for Nurse Navigators Confidence Is Key in Oncology Nurse Navigation Referring Patients to the Right Support Group Podcasts Are Hearing Tests Necessary For Adult Cancer Survivors? Access-Focused Care: The 4-1-1 on Oncology Phone Triage Programs

In this episode of The Vitals, Oncology Nursing News® spoke with Linda Bloom, MPA, RN, OCN, about strategies to improve communication among patients with limited English proficiency who are admitted to surgical oncology. Bloom, who is a clinical nurse IV at Memorial Sloan Kettering Cancer Center, presented on this topic during the 48th Annual Oncology Nursing Society Meeting, and the findings have been published in the Clinical Journal of Oncology Nursing.  As Bloom explains in the discussion, perianesthesia nurses and language assistance staff joined forces to improve communication for patients with limited English proficiency, including those with hearing, speech, or visual impairments. Nurses were provided with tablets embedded with 2 video interpreter applications, as well as smart phones and wearable communication devices with audio interpreter options. American Sign Language interpreters were available through the video interpreter tablets so that nurses could communicate with hearing impaired patients, and clear masks were distributed so that these patients could lip read. White boards were provided to help communication with non-verbal patients, and magnifiers and voice recorders were used to help improve communication with visually impaired patients.   Overall, the introduction of these devices allowed patients have a voice during their presurgical assessment and ensured that the information being discussed was accurate and clear. Moreover, by leveraging trained medical interpreters who understand medical terminology, nurses and health care staff could ensure that patients were fully informed of the procedures they would need to have.   “Patient safety should always be the priority,” Bloom told Oncology Nursing News.  “Accurate and precise communication ensures that patient safety is prioritized to the highest degree.”  Episode Highlights:  “When the patient had to go to the room for the procedure, she clutched the amplifier and earpiece and tried to grab the mic. [She] said, ‘You can't take this away—I haven't been able to hear since I [got] here.’” Time stamp (TS) 7:33 “The Creole language speaking assistant heard him before the interpreter had [time] to tell me and texted his daughter. I immediately knew we had to get a social worker involved.” TS 10:22 “Some of [this technology] is very low tech: a whiteboard for a patient who is nonverbal. They love it… people don't realize it's easier than pen and paper because you can erase it; you can write more.” TS 12:33 Oncology Nursing News Articles Opinion: New Technology Can Help Improve Patient Communication in the Oncology Setting Audiological Assessments May Be Vital Component of Cancer Survivorship Care Following Chemotherapy Navigator Offers Strategies to Support Non-English Speaking Patients Opinion: Clear Communication Is A Form Of Patient Advocacy The Vitals Podcasts Are Hearing Tests Necessary For Adult Cancer Survivors? A Chat on Communication Barriers in Childhood Cancer Video Interviews Better Understanding Your Patient's Situation References                                 1.     Bloom L. Nurses take on language access. Presented at 48th Annual Oncology Nursing Society Congress. April 25-30, 2023; San Antonio, TX. Accessed June 15, 2023.https://ons.confex.com/ons/2023/qi/eposterview.cgi?eposterid=2528  2.     Bloom L. Improving communication for surgical patients with cancer with limited English proficiency. Clin J Oncol Nurse. 2023;27(4):359-363. doi: 10.1188/23.CJON.359-363

In this episode of The Vitals, Oncology Nursing News® spoke with Leana Cabrera Chien, MSN, RN, GCNS-BC, GNP-BC, and William Dale, MD, PhD. The pair discuss the value of geriatric assessments in optimizing cancer care for older adults, especially considering the recent update to the American Society of Clinical Oncology (ASCO) guidelines, stating that all patients with cancer who are older than 65 years should receive a geriatric assessment. The update emphasizes the overarching recommendations from the previous guidelines, except that the new guidelines are based on data which suggest that geriatric assessments can improve patient outcomes and are therefore a critical component of quality care.  Both Cabrera Chien, who is a nurse practitioner in the Center for Cancer and Aging at City of Hope, and Dale, who is vice chair for academic affairs in the Department of Supportive Care Medicine at City of Hope, as well the director of City of Hope’s Center for Cancer and Aging, were investigators on the pivotal GAIN trial (NCT02517034), which was one of the large randomized clinical trials that supported the ASCO guideline update.2,3 The findings from this research demonstrated that when patients undergoing chemotherapy receive geriatric assessments, they experienced fewer treatment-related toxicities—preserving quality of life—without affecting survival outcomes. According to these specialists, geriatric assessments also improve patient and caregiver satisfaction, communication surrounding aging concerns, and the completion of advanced directives. Episode Highlights “The importance of the GA is how it is individualized with each patient.” Time stamp (TS) 4:42 “Since this visit, she has written to us and told us how thankful she is for the care she received at City of Hope. Utilizing the GA really [helped us] find out what this patient needed, and we met that need” TS 7:38 “When we developed the PGA, we asked a lot of nurses, because we knew that they were going to be the key to giving us the real-time, real-world implementation guidance that would be needed to take these academic studies like GAIN and put them into the actual practice.” TS 10:00 Oncology Nursing News Articles: ASCO States That All Older Adults With Cancer Should Receive Geriatric Assessments Geriatric Assessment Intervention Helps Reduce Symptom Burden for Older Patients With Advanced Cancer Geriatric Assessment Rates Improve With Nurse Navigator Intervention Geriatric Assessments Help Promote Comorbidity-Related Discussions in Patients With Advanced Cancer Video Interviews: Supriya Mohile on Lack of Representation of Geriatric Patients in Clinical Trials Claire Friedman on Considerations for Older Patients Receiving Immunotherapy Podcast Episodes: Preparing Nurses for the 'Silver Tsunami' Behind Integrated Behavioral Health Services References Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol. Published online July 17, 2023. doi:10.1200/JCO.23.00933 Li D, Sun CL, Kim H, et al. Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol. 2021;7(11):e214158. doi:10.1001/jamaoncol.2021.4158 Mohile SG, Mohamed MR, Xu H, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. 2021;398(10314):1894-1904. doi:10.1016/S0140-6736(21)01789-X

In this episode of The Vitals, Oncology Nursing News® spoke with Jacki Garcia, RN, BSN, CNRN; and Kristin Hendrickson, BA, RN, to discuss phase 0 trials, also known as window-of-opportunity trials, in neuro-oncology.   Phase 0 trials are designed to identify new drugs capable of slowing tumor progression in patients who face poor prognoses. Patients who enroll in a phase 0 trial receive a subtherapeutic dose of an agent prior to undergoing surgery. When the tissue is resected, investigators determine whether the agent penetrated the blood-brain barrier and whether the agent had the anticipated effect. If the agent demonstrates therapeutic effect, patients may be able to continue the treatment going forward. According to Garcia, who is a nurse navigator, and Hendrickson, who is a research program manager, both with the Ivy Brain Tumor Center at Barrow Neurological Institute, phase 0 trials are important because they offer patients with brain tumors another potential treatment option.   The nurses note that despite the prevalence of malignant brain tumors with poor prognoses, such as glioblastoma, they are on the frontline of a lot of exciting research efforts, and are optimistic about the trajectory of the treatment paradigm.   “There are long-term survivors out there,” Garcia said. “I have seen them. So, for [individuals] who have a view of this disease is that this as a terminal diagnosis, just know that there is some element of hope out there. “  Episode Highlights  “Once it has been determined that the patient is a surgical candidate and is being recommended for a phase 0 trial, then the research nurse team has discussions with the patient where we talk about the requirements for the clinical trial. We make sure that they can consent [to] the clinical trial, [that] they meet the inclusion criteria for the trial and do not meet any of the exclusion criteria. We are looking at the whole picture.” Time stamp 2:44  “There are different courses for each patient, but we want to make sure that they are exploring every avenue possible [to] treat [patients with] this diagnosis.” TS 11:47  “As an institute, [and] a clinical trials program, we really want to reach underserved populations who may have no knowledge of clinical trials. It is really important that those populations know that there are multiple treatment options to consider so they can make the best-informed decision for themselves and their families.” TS 11:56  Oncology Nursing News Articles: Vorasidenib Demonstrates PFS Benefit in IDH-Mutant Low-Grade Glioma Investigational CAR T Product GD2-CART01 Displays Safety and Efficacy in Pediatric Neuroblastoma Chemoimmunotherapy Yields Promising Objective Responses in Patients With High-Risk Neuroblastoma Reirradiation May Play a Role in Recurrent Glioblastoma, Although Optimal Treatment Remains Controversial Clinical Trials Continue to Propel Field of Oncology with Nurses on The Frontline Video Interviews:  Manmeet Ahulwalia on Targeting the Blood-Brain Barrier With Novel Immunotherapies and Precision Oncology Kathryn Beal on Aftercare for Patients with Primary Brain Tumors Anita Mahajan on the Nurse’s Role When Treating Patients with Brain Cancer The Vitals Podcast:  A Look Back at 2022 FDA Approvals in Oncology Focus on ‘A Different Kind of Hope’ in Cancer References 1.     Vogelbaum MA, Krivosheya D, Borghei-Razavi H, et al. Phase 0 and window of opportunity clinical trial design in neuro-oncology: a RANO review. Neuro Oncol. 2020;22(11):1568-1579. doi:10.1093/neuonc/noaa149 2.     Siegel, RL, Miller, KD, Wagle, NS, Jemal, A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17- 48. doi:10.3322/caac.21763

In this episode of The Vitals, Clint Koerkenmeier, MHS, BSN, RN, joins Oncology Nursing News® to discuss retention strategies at his institution.   Koerkenmeier is associate nursing officer at the Vanderbilt-Ingram Cancer Center, which is a National Cancer Institute–designated cancer center which recently received its 4th Magnet Recognition. It was also named as a best place to work by the American Association for Men in Nursing. As Koerkenmeier points out in the discussion, Vanderbilt is home to multiple initiatives intended to improve nurse satisfaction and support lateral career development. Some of these programs include a tuition reimbursement program, where nurses can receive up to $8000 a year for their education, Daisy awards, and certification support. The center also sponsors staff whose abstracts are selected for the Oncology Nursing Society (ONS) Congress. This year 13 Vanderbilt nurses presented their research at the ONS Congress, according to Koerkenmeier.   Lastly, Koerkenmeier explains how the Vanderbilt Professional Nurse Practice Program (VPNPP) improves nurse satisfaction at his institution.   “It helps us to retain nurses, because they know that they can grow here without having to leave,” he says. We want to hear from you! How does your institution boost nurse enthusiasm and retain employees? Email lfischer@mjhlifesciences.com   Episode Highlights  “We started a specific oncology orientation, to give people the backstory of the of the cancer center and our 13 locations. We think it is important to make sure that they see and are reminded that they are part of something bigger than just being a Vanderbilt nurse. It helps you remind us of the mission, [of] why we all went into nursing, and [of] why we are in oncology.” Time stamp (TS) 2:56  “Another thing we do is leadership rounds. The associate operating officer and I will round through the clinics weekly, to talk about what we can do differently, what the frontline staff need and [if] nothing else, make sure they know that we are here for them.” TS 5:39  “[The VNPPN] gives us a “carrot” to help encourage our nurses to get certified. We pay for the certification, but then we also give them a raise for it.” TS 7:37 Oncology Nursing News® Online Articles: After Recruiting Oncology Nurses, Focus on Retention Structured Onboarding Processes Boost Employee Retention Uncracking the Code on Oncology Nurse Satisfaction During a Magnet® Journey Recruitment and Retention Efforts Address Oncology Nursing Shortage The Vitals Podcast: The Value of Nurse Mentorship in Oncology Equity, Diversity, and Inclusion in Oncology Nursing Leadership Video Interviews: Elizabeth Loach on Integrating Frontline Staff in Nursing Task Forces Aliènne Salleroli on Starting the DEI Conversation in Oncology Nursing References 1.     Our magnet designation. Vanderbilt University Medical Center. Accessed June 29, 2023. https://www.vumc.org/vanderbilt-nursing/our-magnet-designation  2.     Batcheldor M. VUMC named best workplace for men in nursing. Accessed June 29, 2023. https://www.vumc.org/vanderbilt-nursing/vumc-named-best-workplace-men-nursing  3.     Vanderbilt professional nursing practice program (VPNPP). Vanderbilt University Medical Center. Accessed June 29, 2023. https://www.vumc.org/vpnpp/what-is-vpnpp 

For this episode of The Vitals, Oncology Nursing News® talks with Lauren Mahon, MSN, FNP-BC, about the role of PARP inhibitors in the treatment of ovarian cancers. Mahon, a family nurse practitioner specializing in gynecologic oncology at the University of Rochester, recently presented on this class of therapeutics during the 48th Annual Oncology Nursing Society Congress.  Onsite at the Congress, Mahon discussed the potential benefit of oral maintenance therapy with PARP inhibitors, the importance of genetic testing in this setting, and the different toxicity profiles associated with these treatments.  Niraparib (Zejula), olaparib (Lynparza), and rucaparib (Rubraca), are approved by the FDA for the treatment of patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer in the maintenance setting. Niraparib is approved as a maintenance therapy for adult patients who are in a complete, or partial response to first-line platinum-based chemotherapy. It is also approved as a maintenance treatment for adult patients with deleterious or suspected deleterious germline BRCA-mutated disease who are in a complete or partial response to platinum-based chemotherapy. Olaparib is approved as a maintenance treatment for adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer, who are in a complete or partial response to platinum-based chemotherapy; it is also approved as a maintenance treatment for adult patients with deleterious or suspected deleterious germline or somatic BRCA-mutated advanced disease who are in complete or partial response to first-line platinum-based chemotherapy; and it is approved as a maintenance therapy, in combination with bevacizumab (Avastin) for patients with advanced disease who are in complete or partial response to first-line platinum-based chemotherapy and whose cancer is associated with homologous recombination deficiency–positive status defined by either: a deleterious or suspected deleterious BRCA mutation, and/or genomic instability. Rucaparib is approved as a maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer whose disease harbors a deleterious germline or somatic BRCA mutation following either a partial or complete response to platinum-based chemotherapy. Although controversy surrounds these drugs in other settings, Mahon explains that they offer patients some peace of mind and freedom in the maintenance setting, as they minimize recurrence risk without forcing patients to come in for regular intravenous (IV) infusions.  “Oral medications, in general, give you more flexibility,” she said. “People have their quality of life back. They’re not tied to an IV every 3 to 4 weeks. They can go and travel they can spend time with their family members.” Episode Highlights What I’ve seen throughout my practice is that, once we are done with the IV chemotherapy: patients are saying—what’s next? What else can I do to make sure that I have the highest chance that this does not come back? Time stamp (TS) 1:55 They have hematologic toxicities, but the main PARP inhibitor that causes anemia and thrombocytopenia is niraparib. TS 4:40 Doing that genetic testing both—for themselves and their family members—is really important. TS 6:00 Further Reading Oncology Nursing News® Articles: Nurses Play Key Role in Facilitating Maintenance Therapy With PARP Inhibitors in Ovarian Cancer Olaparib Maintenance Yields Long-Term Remission for Women With BRCA+ Ovarian Cancer Post-hoc Analysis Shows Maintenance Niraparib Provides Additional Antitumor Activity in Advanced Ovarian Cancer Rucaparib Maintenance Extends Progression-Free Survival in Advanced Ovarian Cancer Real-World Data Identify Significant Differences in Tolerability Among Approved PARP Inhibitors in Ovarian Cancer Video Interviews Paula Anastasia Emphasizes Importance of Genetic Testing in Selecting Maintenance Therapy for Ovarian Cancer Expert Weighs In On The Future of PARP Inhibitors The Vitals Podcast: Bringing a New Approach to Symptom Management in Ovarian Cancer A Look Back at 2022 FDA Approvals in Oncology References 1.     Zejula. Prescribing information. GlaxoSmithKline; 2020. Accessed June 6, 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/208447s015s017lbledt.pdf  2.     Lynparza. Prescribing information. AstraZeneza; 2023. Accessed June 6, 2023. https://den8dhaj6zs0e.cloudfront.net/50fd68b9-106b-4550-b5d0-12b045f8b184/00997c3f-5912-486f-a7db-930b4639cd51/00997c3f-5912-486f-a7db-930b4639cd51_viewable_rendition__v.pdf  3.     Rubraca. Clovis oncology, Inc; 2022. Accessed June 6, 2023. https://clovisoncology.com/pdfs/RubracaUSPI.pdf 

In this episode of The Vitals, Seth Eisenberg, ASN, RN, OCN, BMTCN, discusses ongoing research efforts to quantify the value of toilet seat covers in oncology care settings.  As Eisenberg explains, health care professionals who care for patients with cancer are at an increased risk of developing health issues because of their chronic exposure to the hazardous drugs. Specifically, the bathroom represents a repeated source of exposure, as this is where residue from these harmful substances is often found. To that end, Eisenberg, and a co-investigator, sought to test the efficacy of 2 interventions designed to reduce the spread of hospital toilet contaminants. “Both interventions were virtually equal in effectiveness,” he says. “They reduced the particles by at least 99%.” Episode Highlights “ONS has been recommending using plastic-backed pads for covering toilets for patients getting chemotherapy for a long time, [but] there’s really not been a lot of evidence on that.” Time stamp (TS) 1:46 "Both interventions were virtually equal in effectiveness, they reduced the particles by at least 99%." TS 4:03 “We actually did the testing at 2 heights, we [tested] right above the toilet level and at 40 inches. That 40-inch area was chosen because that is within what we call the inhalation zone.” TS 4:16 Oncology Nursing News® Articles: Splashblocker Shows Promise in Reducing Spread of Hospital Toilet Contaminants USP <800>: Still a Work in Progress? Hazardous Drugs and Reproductive Effects: Understanding the Risks New Safety Requirements for Nurses Handling Antineoplastic Agents Video Interviews: Seth Eisenberg Compares the Effectiveness of Plastic-Backed Pads Vs The Splashblocker in Reducing Toilet Aerosols AnnMarie Walton on Reducing Antineoplastic Drug Residue in Inpatient Units Kim Christen on Safe Handling for Hazardous Drugs Amy Callahan on Barriers to Safe Handling References Eisenberg S, Cai C. A comparison of plastic-backed pads to Splashblocker in reducing toilet aerosols. Presented at: 48th Annual Oncology Nursing Society Annual Congress; April 27-May 1, 2022; San Antonio, TX. Accessed April 25, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/13249 Eisenberg S, Cai Changjie. Comparing two methods of reducing hospital toilet aerosols. Clin J Oncol Nurse. 2023;27(2):191-197. doi:10.1188/23.CJON.191-197

On this episode of The Vitals, Oncology Nursing News® talks with Amber Pierce RN, BSN, OCN, regional nurse manager at Oncology Hematology Associates, an American Oncology Network partner practice, about the importance of 2-step verification with nivolumab and relatlimab-rmbw (Opdualag), which was approved for patients with unresectable or metastatic melanoma in March 2022. The FDA approval was supported by data from the phase 2/3 RELATIVITY-046 trial (NCT03470922), which demonstrated that patients who received nivolumab/relatlimab as a frontline treatment experienced a median progression-free survival (PFS) that was double that of patients who received nivolumab alone.  As Pierce highlights in the discussion, the combination is novel because relatlimab is a LAG-3 inhibitor. Moreover, the combination was approved as a fixed dose regimen comprised of a single intravenous infusion of 480 mg nivolumab and 160 mg relatlimab to be given every 4 weeks. Because of this, it is important that nurses understand the potential risk of medication errors. “I think that’s what makes it really unique, because there are other drugs that have a combination of 2 drugs in them, but they may be dosed only on 1 of the drugs that’s in that vial; whereas this particular drug is a flat dose of 640 [mg],” Pierce says.  “That is where there can be some confusion and some misunderstanding between how we are actually dosing these patients,” she adds.  Episode Notes “Opdualag is a combination of nivolumab and relatlimab; it is a new combination of the PD-1 inhibitor, which is your nivolumab and the LAG-3 blocking antibody, which is your relatlimab.” Time stamp (TS) 4:13 “It is really important for nurses to understand and pay attention to what the drug amount is [with] the medication that they are infusing and [that they are] double checking.” TS 6:56. “As a nurse, we are the last line of defense, so to speak, before [therapies] reach the patient. As nurse, it is our responsibility to make sure that patient safety is a top priority.” TS 8:37 Podcast A Look Back at 2022 FDA Approvals in Oncology Online Articles Independent 2-Nurse Verification Process in Distribution of Oral Investigational Chemo/Immunotherapy Proves Helpful Updated PFS Data Continue to Support Nivolumab Plus Relatlimab in Advanced Melanoma Experts Provide an Institutional Perspective on the Safe Handling of Immunotherapy Treatments Video Interviews Stephanie Jackson on Improving the Double Verification Process For High-Alert Medications Expert Talks Significance of Relatlimab/Nivolumab Approval for Metastatic Melanoma Reference US Food and Drug Administration approves first LAG-3-blocking antibody combination, Opdualag (nivolumab and relatlimab-rmbw), as treatment for patients with unresectable or metastatic melanoma. News release. Bristol Myers Squibb; March 18, 2022. Accessed May 16, 2023. https://bit.ly/3wk6PDx

In this episode of The Vitals, Krista M. Rubin, RN, MS, FNP-BC, joins Oncology Nursing News® to discuss best nursing practices with tebentafusp-tebn (Kimmtrak) for patients with unresectable or metastatic uveal melanoma. Rubin is a nurse practitioner with the Center for Melanoma at Massachusetts General Hospital, with over 20 years of experience caring for patients with melanoma. She is also the chair of the Melanoma Nursing Initiative. Tebentafusp was approved in January 2022 for the treatment of patients with unresectable or metastatic uveal melanoma in adult patients whose disease harbors HLA-A*02:01. Findings from the phase 3 IMCgp100-202 trial (NCT03070392) showed that patients who received this agent experienced superior overall survival than patients who received investigators choice of therapy (HR, 0.51; 95% CI, 0.37-0.71; P < .0001). As Rubin highlights in the discussion, cytokine release syndrome and rash are some of the most common adverse events (AEs) observed with the bispecific antibody. A step-up dose is used to ease patients onto treatment. Patients are admitted to inpatient care for the first 3 infusions to observe their reactions; however, according to Rubin, after that third cycle, management of AEs becomes straightforward and if patients show positive responses, they can continue to receive a weekly dose indefinitely.  Episode Notes: Discussion Highlights: The drug is it's intravenous; it is given in our outpatient clinic, however, patients are admitted to the hospital overnight. Time Stamp 6:37 If there was a serious case of CRS, then these patients would get medications, specifically tocilizumab, to minimize the effects. TS 7:38 With nurses that are able to proactively identify and know how to manage [AEs], patients can do extremely well. TS12:52 Online Articles FDA Follow-Up: Utilizing Tebentafusp in Clinical Practice for Metastatic Uveal Melanoma FDA Approves Tebentafusp to Treat HLA-A*02:01 Positive Uveal Melanoma Tebentafusp Boosts Survival in Metastatic Uveal Melanoma Podcasts A Look Back at 2022 FDA Approvals in Oncology Videos Newly Approved Tebentafusp Requires Up-Front Active Toxicity Management in Melanoma More for Melanoma: Nurse Discusses Unmet Needs First-in-Human Trial for Tebentafusp In Advanced Melanoma Shows Promising Safety Profile

In this episode of The Vitals, Beth Faiman, PhD, CNP, weighs in on the current trajectory of research and clinical practice in multiple myeloma.  Faiman is a nurse practitioner and researcher with the Cleveland Clinic, as well as a board member of the NP/PA Center of Excellence in Multiple Myeloma. According to her, one of the biggest changes of late was the publication of a study in Lancet Discovery, findings of which suggest that patients with biomarker-defined defined disease, as well as 60% or more bone marrow plasma cells (BMPCs), or a free light chain ratio (FLCratio) of at least 10, have a longer time to progression and a lower 2-year progression risk than was previously believed. Whereas the median time to progression was previously reported to be 9.2 months, the new study found the median time to be 30.1 months. Moreover the 2-year progression risk was 45.45%, rather than the previously reported 85.21%.  As Faiman points out, in 2014, the International Myeloma Working Group had added patients with at least 60% BMPCs, FLCratio equal to or greater than 100, and greater than 1 MRI-defined focal lesion of at least 5 mm (SLiM CRAB multiple myeloma) to the diagnostic category of multiple myeloma. However, this newer review suggests that this classification may need to be revisited.  Faiman also touches on shifts in approved BCMA-directed therapies for patients, namely, the accelerated approval of teclistamab-cqyv (Tecvayli) in October of 2022, and the removal of belantamab mafodotin-blmf (Blenrep) from the market in November 2022. She notes that there are ongoing efforts to reincorporate belantamab mafodotin into clinical practice and that she is optimistic about reintroducing this treatment back into her practice—as the dosing schedule and toxicity profile was favorable for patients.  Episode Notes “Supporting [a] patient while they are in their maintenance phase [of treatment]; checking the blood counts, keeping up [with] health maintenance, making sure their bones are strong and all those other supportive care things, are so important.” “If you have a heavily pretreated patient on some of the new cellular therapies or bispecifics, that they have to be admitted to the hospital, we have to logistically manage who’s going to be admitted on what day and when.” “The nice thing about belantamab was that it was an [intravenous] IV [therapy] every 3 weeks, it is directed against BCMA, and it was very well tolerated.” The Vitals Podcast:   ASH Data Offer Treatment Direction for Oncology Nursing Professionals A Look Back at 2022 FDA Approvals in Oncology Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma Oncology Nursing News® Online Articles: Hematologic Oncology Undergoes Transformation With Drug Updates and Approvals Teclistamab-cqyv Snags Accelerated Approval for Relapsed or Refractory Multiple Myeloma Belantamab Mafodotin Will No Longer Be Available For Multiple Myeloma Ocular Visits Are a Necessity for Patients With Multiple Myeloma Who Receive Belantamab Mafodotin References 1.     Ludwig H, Kainz S, Schreder M, Zojer N, Hinke A. SLiM CRAB criteria revisited: temporal trends in prognosis of patients with smoldering multiple myeloma who meet the definition of ‘biomarker-defined early multiple myeloma’-a systematic review with meta-analysis. EClinicalMedicine. 2023;58:101910. doi:10.1016/j.eclinm.2023.101910  2.     FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. FDA. October 25, 2022. Accessed April 10, 2023. https://bit.ly/3f3HffB 3.     GSK provides an update on Blenrep (belantamab mafodotin-blmf) US marketing authorization. News release. GlaxoSmithKline. November 22, 2022. Accessed April 10, 2023. http://bit.ly/3gniPi1

In this episode of The Vitals, Lindsay Diamond, MSN, AGNP-C, AOCNP, spoke on updated data from the CheckMate 274 trial (NCT02632409), which were presented during the 2023 ASCO Genitourinary Cancers Symposium (ASCO GU), and commented on different trials paving the way in urothelial carcinoma.  According to Diamond, who is a nurse practitioner and clinical program manager of the GU Oncology Clinical Trials Department at the Icahn School of Medicine at Mount Sinai, the disease-free survival (DFS) outcomes from Checkmate 274 were very promising, as they signify that adjuvant treatment with nivolumab (Opdivo) may be able to help patients reach certain milestones. This trial showed that at a median follow-up of 36.1 months, the median DFS with adjuvant nivolumab was 52.5 months vs 8.4 months with placebo in the PD-L1 population (1% or greater). Moreover, in the intention-to-treat population, the median DFS were 22.0 vs 10.9 months, respectively. Adjuvant nivolumab was approved for patients with urothelial carcinoma who are at high risk of recurrence after radical resection based on earlier data from CheckMate 274. Moving forward, she hopes to continue to see positive readouts from this trial, as well as more research in bladder-sparing treatment approaches and better tumor markers to help patients track their diseases responses to treatment.  Interested in learning more from the meeting? Check out our coverage of 2023 ASCO GU here.  We want to hear from you! Which ASCO GU data do you think will be practice-changing?  Email lfischer@mjhlifesciences.com with your feedback. Episode Notes: "There is this mentality when patients have localized disease, of ‘well, it’s not metastatic and you had it removed so you’re fine,’ but those patients still live with cancer every day of their life after that surgery and it’s a waiting game." Time stamp (TS) 3:05 "We, as providers, know that 30% of patients or so could have a serious immune-related adverse effect from immunotherapy, but the majority of patients are going to do fine on it." TS 5:17 "Generally, clinical trials looking at bladder sparing approaches [are important], whether it’s our study HCRN GU16-257 [NCT03558087]—that looks at chemotherapy and immunotherapy—or other trials that look at just chemotherapy." TS 6:47  Oncology Nursing News® Online Articles ·      CheckMate 274 Follow-Up Supports the Use of Adjuvant Immunotherapy in Bladder Cancer ·      Pembrolizumab Shows Antitumor Activity at 45-Month Follow-Up in BCG-Unresponsive Papillary NMIBC ·      Real-World Data Supports Front-Line Maintenance With Avelumab For Locally Advanced, Metastatic Urothelial Carcinoma ·      Neoadjuvant Split-Dose Chemotherapy Represents Potential New Standard of Care for High-Risk UTUC ·      Maximizing Potential of Immunotherapy Requires Appropriate irAE Management Video Interviews ·      Laura Wood on the Integration of Avelumab, Erdafitinib, and Enfortumab Vedotin into Urothelial Cancer Care ·      Predicting Immunotherapy Response in Bladder Cancer   The Vitals Podcast ·      Chemo Cheat Sheets Help Nurses During Drug Delivery ·      A Look Back at 2022 FDA Approvals in Oncology References 1.     Galsky M, Witjes JA, Gschwend J, et al. Extended follow-up results from the CheckMate 274 trial. J Clin Oncol. 2023;41(suppl 6):LBA443. doi:10.1200/JCO.2023.41.6_suppl.LBA443 2.     FDA approves nivolumab for adjuvant treatment of urothelial carcinoma. FDA. News release. August 19, 2021. Accessed April 3, 2023. https://bit.ly/3ztbkfm 

It takes a special skillset for nurses to care for patients whose disease continues to relapse after multiple lines of therapy, shares Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN. “I tell my younger staff who aren’t used to seeing patients this sick, ‘even if that patient doesn’t survive, what an honor for us to be a part of their journey,’” she tells Oncology Nursing News®. For this episode of The Vitals, Jackson, an oncology and bone marrow transplant clinical nurse specialist and unit director at UCLA Medical Center, recalls the story of a patient with acute lymphoblastic leukemia (ALL) who relapsed following treatment with induction chemotherapy and whose disease did not respond to blinatumomab (Blincyto). The team chose to give this patient an off-the-shelf CD22-directed CAR T-cell therapy—which was successful, until the patient ultimately relapsed 6 weeks later.  Jackson emphasizes how, in addition to his physical symptoms, this patient was burdened by worry for his family. As the primary breadwinner in a family with a 2-year-old daughter, he was stressed about how to continue caring for his family. Moreover, he grappled with a language barrier prevented the patient from understanding the complexity of the treatments that the team was prescribing for him. Therefore, Jacksons’ team had to find innovative ways to ensure that the patient, and his family, felt well supported throughout his treatment.  “The biggest challenge we had was [ensuring] his understanding of how sick he really was, the complexity of the treatment, and that he wouldn’t be able to go back to work right away,” she says. Episode Notes: This was a 29 year old male that was diagnosed with Philadelphia chromosome–negative ALL. Time stamp TS 2:13 Given that it’s a clinical trial [product], we don’t always know [what to expect]. We know with the FDA approved products, the 2 biggest factors we need to monitor patients for is cytokine release syndrome and neurotoxicity. These were the things we were watching for. TS 5:38 We did a lot of work with our social worker, he was Mixteca Alto, an indigenous population within the Mexican community, and we wanted to make sure we had the appropriate interpreters. TS 8:09 The Vitals Podcast:  ASH Data Offer Treatment Direction for Oncology Nursing Professionals Oncology Nursing Stories: Acupuncture Helps Thyroid Cancer Survivor Taper Opioid Use Oncology Nursing Stories: Pregnancy After Lymphoma Chemoradiation Oncology Nursing News® Online Articles Blinatumomab Plus Consolidation Chemotherapy Significantly Reduces Risk of Death in MRD-Negative B-Cell ALL FDA Approves Blinatumomab for Patients with Acute Lymphoblastic Leukemia and Minimal Residual Disease The Shifting Dynamics of Social Support After a Cancer Diagnosis Video Interview Verina on Tackling Neurological Toxicities From CAR T-Cell Therapy Expert Weighs in on Future of CAR T-Cell Therapy Treatment Directions Oncology Nursing News® Publication Features Preparing Patients for CAR T-Cell Therapy With Confidence The Future of CAR T-Cell Therapy: Will Off-the-Shelf Options Soon Enter the Playing Field? Navigator Offers Strategies to Support Non-English Speaking Patients References Stock W, Luger SM, Advani AS, et al. A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403. Blood. 2019;133(14):1548-1559. doi:10.1182/blood-2018-10-881961 Phase 1/2 study of UCART22 in patients with relapsed or refractory CD22+ B-cell acute lymphoblastic leukemia (BALLI-01). ClinicalTrials.gov. Updated September 27, 2022. Accessed March 3, 2023. https://clinicaltrials.gov/ct2/show/NCT04150497