Biosimilars, Oral Agents, and Drugs Targeting Genetic Mutations Are Creating a Paradigm Shift in Cancer Treatment
New treatment options continue to emerge for diseases that until recently had limited, if any, treatment choices. Nurses are seeing more changes in the way treatment regimens come together, biosimilars are presenting viable options for patients, and genetic mutations, as opposed to disease sites, are at the forefront of drug development.
What Does the Research Say About Genetic Testing and Underserved Populations?
Underserved communities largely have low rates of cancer genetic testing. Although the reasons vary, they can include lack of referrals, no or underinsurance, prohibitive cost, lack of trust, lack of knowledge, discrimination issues, or competing health needs.
How Do You Address Unanticipated Genomic Testing Results?
Genomic testing—identifying variants, like mutations, in tumor cells to inform patient treatment options—occasionally comes with unanticipated results that clinicians have to address with their patients. Clinicians and patients alike are often hopeful that tumor genomic testing will identify a personalized cancer treatment. Indeed, many patients have benefited from being candidates for new targeted therapies identified through genomic testing.
Testing in the Era of Precision Oncology
Every cancer diagnosis is as individualized and unique as the person receiving it. From family history to societal and economic background to a patient’s genetic make-up and composition, cancer affects each person with cancer differently. Initiatives like precision medicine are based in data that suggest that a personalized disease should have its own personalized treatment. As a subset of precision medicine, precision oncology assesses a patient’s unique genetic profile to help align targeted therapies to hit the right cancer subtypes.
Epigenetic Cervical Cancer Test May Be More Accurate Than Pap or HPV Tests
An S5 methylation test detected 100% of grade 2 cervical intraepithelial neoplasms or worse, compared to a 50% detection rate for Pap or human papillomavirus (HPV) tests, according to the results of a recent study reported in the International Journal of Cancer.
BRCA Is Not the Only Common Mutation for Breast and Ovarian Cancer
Multigene testing for hereditary breast and ovarian cancer has increased the detection predisposition genes beyond BRCA1 and BRCA2, according to study findings presented at the San Antonio Breast Cancer Symposium on December 7, 2018.
Trastuzumab Remains Standard HER2+ Breast Cancer Therapy Despite Cardiac Risks
Trastuzumab can improve disease-free survival (DFS) and overall survival (OS) in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Although some studies suggest that short-term treatment (less than one year) may reduce cardiac toxicity and cost without compromising outcomes, the results of a new study presented at the disagree.
On-Treatment Genetic Testing Improves Accuracy of Tumor Response Prediction
Genetic testing during treatment can improve accuracy of response and outcome prediction compared to other prognostic tests, according to results from a study assessing on-treatment changes in gene expression in patients receiving chemotherapy. Researchers from Oikonomidou O Institute of Genetics and Molecular Medicine in Edinburgh, United Kingdom, presented the findings at the .
Genetics Plays a Role in Treatment Response for Relapsed or Refractory Multiple Myeloma
No molecular-informed personalized therapies are currently available for patients with relapsed/refractory multiple myeloma (MM); however, cytogenetics and next-generation sequencing (NGS) can identify molecular abnormalities to provide guidance for more targeted therapy. Tarek Assi, MD, of Gustave Roussy Cancer Campus in Villejuif, France, discussed his research team’s findings that tumor genotyping is associated with higher response rates and prolonged duration of therapy at the ASH Annual Meeting on December 1, 2018.
FDA Approves Larotrectinib for Solid Tumors With NTRK Gene Fusions
On November 26, 2018, the U.S. Food and Drug Administration (FDA) granted accelerated approval to larotrectinib for adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation, that are either metastatic or where surgical resection is likely to result in severe morbidity, and who have no satisfactory alternative treatments or whose cancer has progressed following treatment.
Biosimilars and Gene Therapy Are Making Great Strides in Cancer Care
As researchers learn more about how combination therapy combats drug resistance and lessens the changes of tumor evasion of the immune system, immune checkpoint inhibitors are receiving approval for a broader range of indications. However, recent U.S. Food and Drug Administration (FDA) approvals have centered around hematologic malignancies and the emergence of two new biosimilars.
How Patients Can Benefit From Hereditary Cancer Support
My story, like many of your patients, is unfortunately not that uncommon: I’m a motherless daughter. I lost my mom to breast cancer when I was 26 years old; she lost her mother to the disease before she graduated high school. The BRCA1 mutation has been passed down in my family, and I, too, carry the mutation. Even though it was expected, I was devastated and desperately looking for resources to help manage my cancer risk. It was scary not knowing where to turn. I needed to know that I wasn’t alone.
NINR Study Identifies Genes for Fatigue in Cancer Treatment
Radiation therapy can be an incredibly draining form of treatment for patients with cancer. Side effects such as fatigue can be debilitating for many before, during, and after treatment. Because symptom management is a crucial component to cancer care and central role of oncology nursing, ensuring that patients are able to mitigate their symptoms and side effects can help improve their quality of life. Recently, a team at the National Institute of Nursing Research (NINR) identified certain genes associated with fatigue in men being treated for prostate cancer.
Genomics Is Revolutionizing Cancer Care Now and For the Future
As precision oncology continues to expand, so does the ability to use less-toxic targeted therapies. James Chen, MD, assistant professor of biomedical informatics and assistant professor of internal medicine at the division of medical oncology at Ohio State University in Columbus, described his work with genomics in cancer care and the challenges in precision medicine at the 43rd Annual Congress in Washington, DC.
Why Pretesting Counseling Is Critical in the Age of Consumer Genetic Tests
On March 6, 2018, 23andMe—an at-home genetic testing company—announced their direct-to-consumer genetic test (DTCGT) would include DNA results for the three common founder BRCA mutations commonly seen in people with Ashkenazi Jewish ancestry. This was big news because DNA results for the BRCA mutations had been previously available on the 23andMe panel report until the U.S. Food and Drug Administration removed them in 2013.
New Gene-Based Tests Screen and Monitor for Bladder, Endometrial, and Ovarian Cancers
Researchers have developed two new gene-based tests that detect DNA mutations that lead to bladder, endometrial, and ovarian cancers. The tests, which are not yet U.S. Food and Drug Administration approved, could be used to identify a new or relapsed cancer earlier, when it is easier to treat.
Study Gives a Better Understanding of ARID1A Mutations in Colorectal Cancer
A component of the SWI/SNF chromatin remodeling complex, AT-rich interactive domain 1A (ARID1A), regulates gene expression. Data on the characteristics and associated clinicopathologic features of ARID1A in colorectal cancer (CRC) are limited, even though its mutations are reported in a variety of other cancers. In study findings presented at the 2018 American Society of Clinical Oncology Annual Meeting, researchers explained an increased understanding of the ARID1A mutation in CRC.
BRCA Mutations Point to Hereditary Breast and Ovarian Cancer Syndrome
Although all cancers have a genetic basis, a subset result from an inherited (i.e., germline) mutation that puts a person at increased risk for certain cancers. Unfortunately, the signs of hereditary cancer are often overlooked or misunderstood. Here’s what oncology nurses need to know about BRCA mutations, one of the more common mutations you’ll see in practice.
Understanding Genomics and Using Precision Medicine to Advance Cancer Survival
During the American Association for Cancer Research/ONS Bench to Bedside session at the 43rd Annual Congress in Washington, DC, Victor Velculescu, MD, PhD, of Johns Hopkins University School of Medicine, and Maura Kadan, RN, MSN, of Personal Genome Diagnostics, dissected the science behind precision oncology, including an understanding of genetic alterations, the use of immunotherapy, and how to advance survival with these clinical breakthroughs.
NIH Wants 1 Million Americans to Contribute to New Pool of Gene Data; FDA Takes Action Against Misleading Companies Marketing to Kids; Conservative Groups Hope to Release New Obamacare Replacement This Month
With hopes for more than 1 million participants, the National Institutes of Health (NIH) has launched the All of Us initiative, a radical precision medicine campaign to amass a collective gene pool data repository. The NIH is aiming to shrink our differences and expand on the similarities found in our genetic data. For some, compiling genetic data of an entire country’s citizens may sound very reminiscent of Big Brother from the book 1984. But the amount of information that could be shared and learned from such a massive health database is remarkable.
FDA Approves Dabrafenib Plus Trametinib for Adjuvant Treatment of Melanoma With BRAF V600E or V600K Mutations
On April 30, 2018, the U.S. Food and Drug Administration (FDA) granted regular approval to dabrafenib (Tafinlar ®) and trametinib (Mekinist®) in combination for the adjuvant treatment of patients with melanoma with BRAF V600E or V600K mutations, as detected by an FDA-approved test, and involvement of lymph node(s), following complete resection.
How DNA Revolutionized Oncology Care
April 25, 2018, marks National DNA Day. Why the hype? National DNA Day commemorates the successful completion of the Human Genome Project in 2003, and the discovery of DNA's double helix in 1953. Without DNA, understanding the diseases and treatments for cancer would be nearly impossible. Genetics and genomics play huge roles in treating malignancy, and it’s crucial to the care of patients with cancer for oncology nurses to understand genetics and genomics.
Labs Differ Widely in BRCA Testing Protocols
An international survey of 86 genetic testing labs showed inconsistent protocols and standards for analyzing the BRCA1 or 2 cancer susceptibility genes and their variations. The results were reported in NPJ Genomic Medicine.
NIH Completes In-Depth Genomic Analysis; Senate Panel Unveils Draft Opioid Bill; Teenagers Struggle to Quit Vaping
Researchers for the PanCancer Atlas, a genomic data set reference tool, recently completed an analysis of molecular and clinical information from more than 10,000 different tumors spanning more than 33 cancer types. The PanCancer Atlas is the result of nearly a decade’s worth of work associated with the Cancer Genome Atlas—a multi-institutional program driven by the National Human Genome Research Institute and the National Cancer Institute (NCI). The results of the analysis were published as a set of 27 papers.
FDA Authorizes Direct-to-Consumer Test for BRCA Cancer Gene
Genetic testing is becoming more recognized among the general public, due in part to news reports and celebrity endorsements. Now, people are seeking to understand cancer risks and prevention measures through genetic information. There are many companies that ask for a mere mouth swab and deliver insight into a person’s DNA. As this becomes more commonplace, those with familial predisposition to cancer will look for ways to understand their own genetic results. Recently, the U.S. Food and Drug Administration (FDA) approved an at-home test identifying some—but not all—breast cancer genes.
Oncology Nurses Play Key Role in Genetics Education, Testing for Patients
Identifying genetically predisposed women with breast cancer who could benefit from risk assessment and genetic counseling is an important competency for oncology nurses. However, a recent study published in the Journal of Clinical Oncology (JCO) reported that fewer than 50% of newly diagnosed patients with breast cancer who should have been given formal genetic counseling actually received the appropriate genetic testing.
Newly Approved Cancer Treatments Indicate Growing Role of Genomics and Oral Therapies
It is becoming more commonplace for nurses to find orders for agents with which they are unfamiliar or quite possibly have never administered. Following is a summary of the latest new U.S. Food and Drug Administration (FDA) approvals or indications to keep you up to date in your practice. Of note, this summary contains the approval of yet another biosimilar in trastuzumab-dkst and rolapitant for chemotherapy-induced nausea and vomiting, which includes a safety alert. Early experiences with rolapitant, a NK-1 inhibitor, indicated a risk of hypersensitivity reactions.
Oncology Nurses Can Help Patients Understand At-Home Genetic Testing
Direct-to-consumer genetic testing (DTCGT) has entered the prime-time stage. It’s difficult to watch TV without seeing ads touting the simplicity of DTCGT and what it can tell you, and it even made Oprah’s 2017 Favorite Things List.
What Oncology Nurses Need to Know About Pharmacogenomics
A subset of precision medicine, pharmacogenomics, is also growing exponentially, especially in oncology. Currently, 165 drugs or combinations are influenced by pharmacogenetics, and 58 of those are specific to oncology/hematology.
NIH Funds Precision Research for Childhood Cancer; Will Congress Lift Medicaid Ban for Opioid Epidemic?; FDA-Approved Breast Cancer Test May Impact Oncology Nurses
Cancer treatments aren’t one-size-fits-all, and they differ greatly depending on age. As the leading cause of disease-related death for children, pediatric cancers pose a critical threat to this population. According to the National Institutes of Health (NIH), one reason pediatric cancer mortality rates persist is because there’s “limited knowledge” related to the biological mechanisms affecting childhood cancers. NIH-funded studies are breaking ground and uncovering new information about the genomics of pediatric cancers.
The Case of the Cancer Genetics Referral
Christina is a 29-year-old African American woman with a strong family history of breast and ovarian cancers and a personal history of benign ovarian fibroids. She was referred to your office because of a suspicious lump in her left breast. Because of her family history, Christina is especially worried. You are concerned that Christina could have a hereditary family cancer syndrome, and you know that a comprehensive family history must be obtained.
NIH: A Look Back at 2017 in Research
To plan for a strong future, one must understand the past. Reviewing the previous year’s accomplishments is always a good policy for reflection and improvement. It can help remind us of the accomplishments achieved in 12 short months. Such was the case at the National Institutes of Health (NIH), as director Francis Collins addressed the research achievements for 2017 in his opening blog.
FDA Clears Genomic Profiling Tests for Cancer Treatment
Former National Institutes of Health (NIH) Director, Harold Varmus, when asked about cancer treatment, once said, “One of the major advances we’ve had as a result of cancer research is deep recognition of the complexity of cancer. It’s not one disease, it’s lots of different diseases. Every single cancer is different when you look at it on a genetic level.”
Latinas With BRCA1 or 2 Mutations Are More Likely to Choose Surgery
The uptake of prophylactic surgeries among Latinas with germline BRCA mutations may be slightly lower than what has been reported in non-Hispanic whites but higher than in African Americans, a group of U.S. researchers said. They presented their findings on Saturday, December 10, during a poster session at the San Antonio Breast Cancer Symposium.
Enrichment of Mucin Gene Family Shown in Breast Cancer Diagnosed During Pregnancy
The first study on the mutational landscape of breast cancer diagnosed during pregnancy (BCP) using whole-genome sequencing found that BCP is associated with a higher number of putative driver mutations, including mutations in mucin genes. Researchers presented their findings on Thursday, December 7, during a poster session at the San Antonio Breast Cancer Symposium.
FDA Grants Marketing Approval to FoundationOne CDx In Vitro Diagnostic
On November 30, 2017, the U.S. Food and Drug Administration granted marketing approval to the FoundationOne CDx, a next generation sequencing based in vitro diagnostic to detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type.
Study Finds How Smoking Contributes to Epigenetics of Lung Cancer
Although cigarette use has long been linked to lung cancer, scientists have not understood how the earliest changes in lung cells developed. In a study published in Cancer Cell, researchers showed how cigarette smoke sensitized airway cells to genetic mutations that are known to cause lung cancers.
The Case of the Slow-to-Manifest Side Effects
Mary, age 60, has been diagnosed with stage IIB ovarian cancer. Because she has a strong family history of various cancers, Mary is tested for Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC).
Her test is positive, and she is told she is at increased risk for developing cancers associated with HNPCC: ovarian, breast, prostate, kidney, endometrial, pancreatic, prostate, and liver.
Why Oncology Nurses Need to Embrace Genetics
Genetics in clinical oncology nursing practice permeates all aspects of care from prevention and detection to treatment decisions to long-term survivorship care. Each of these areas often overlap, and oncology nurses need a solid genetics understanding to provide optimal care.
Researchers Map More Than 760 Cancer-Dependent Genes
In an effort to build a comprehensive catalog of genetic causes of cancer, researchers from Harvard and Massachusetts Institute of Technology’s Broad Institute as well as Dana-Farber Cancer Institute have identified more than 760 genes that cells from multiple types of cancer depend on for growth and survival. The findings were published in Cell.
Sanders Gains Support for Single-Payer Health Care Push; GOP Senators Put Forth Graham-Cassidy Healthcare Bill; New Toolkit Helps Nurses Integrate Genomics in Cancer Care
Senator Bernie Sanders (I-VT) recently gave an interview for The Nation to discuss his announcement and subsequent push for a single-payer healthcare system in the United States. During his 2016 presidential bid, Sanders campaigned for universal health care and gained significant support from the public. However, many on Capitol Hill were still unsure of a “Medicare-for-all” plan. Despite the initially tepid response, Sanders recently outlined a new single-payer healthcare bill he plans to introduce, and he’s gaining surprising support from several senators in Washington, DC.
FDA Approves First Single NGS Test to Detect Multiple RAS Mutations
On June 29, 2017, the U.S. Food and Drug Administration (FDA) granted marketing approval to the Praxis Extended RAS Panel (Illumina, Inc.), a next generation sequencing (NGS) test to detect certain genetic mutations in RAS genes in tumor samples of patients with metastatic colorectal cancer (mCRC). The test is used to aid in the identification of patients who may be eligible for treatment with panitumumab (Vectibix®, Amgen, Inc.).
Genomic Information Helps Guide Successful Therapies for Each Patient
The healthcare landscape is changing more rapidly than ever, and daily discoveries in genomics are leading to truly individualized care. During a session at the 42nd Annual Congress in Denver, CO, David Solit, MD, Geoffrey Beene Chair and director of the Marie-Josée and Henry R. Kravis Center for Molecular Oncology at Memorial Sloan Kettering Cancer Center (MSKCC), reviewed cutting-edge genomics science, its role in precision medicine, and innovative genomics programs at his institution. Solit leads a research program that seeks to identify new drug targets using genomic profiling.
Local Organizations Can Make a Big Difference in Cancer Care
I have the privilege of managing and being the sole provider in a unique program. I work in the Hereditary Cancer Program at Saint Louis University Cancer Center, where I provide risk assessment services and education about genetic testing to individuals and families in the region. It’s an amazing nursing role, and I can truly help people prevent cancer and manage their risk.
More Women Undergo BRCA Testing, but Not High-Risk Patients
BRCA gene testing is on the rise for women who do not meet the referral requirements based on family history, researchers reported in study findings published in the American Journal of Preventive Medicine. At the same time, many high-risk women do not obtain the test and remain unidentified.