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    Pneumonitis With Immunotherapy Treatment
    Immunotherapy

    Pneumonitis With Immunotherapy Treatment

    Pneumonitis is inflammation of the lung parenchyma; although rare, it can be fatal. Nishino et al. found that the overall incidence of pneumonitis with PD-1 inhibitor monotherapy was 2.7% for all-grade and 0.8% for grade 3 or higher pneumonitis. Naidoo et al. reported an approximate 5% incidence of all-grade pneumonitis, although the incidence of all-grade pneumonitis is higher with combination immunotherapy (up to 10%). The incidence is more common with higher grades in PD-1 inhibitors (versus PD-L1 inhibitors), but it occurs less often with anti-CTLA4 monoclonal antibodies. 

    September 23, 2019
    Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy
    Advanced practice nursing (APN)

    Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy

    Dermatologic toxicity is the most common side effect secondary to immunotherapy. The majority of dermatologic adverse events are mild to moderate rashes on the truck of the body and upper extremities, pruritis, and vitiligo. The most common is maculopapular rash with erythematous macules, papules, and/or plaques that can sometimes be scaly; pruritis is also frequent but often underreported and undertreated and may affect quality of life.

    July 25, 2019
    Manage Immunotherapy-Related Diarrhea and Colitis
    Advanced practice nursing (APN)

    Manage Immunotherapy-Related Diarrhea and Colitis

    Although immunotherapy has a unique set of toxicities compared to traditional chemotherapy, in general, grade 3 or 4 toxicities are rare—with the exception of grade 3 diarrhea and colitis. The mechanisms by which immune-related diarrhea and colitis occur are not clear. However, T-cell activation leads to high levels of CD4 T-helper cell cytokines and cytolytic CD8 T-cell tissue infiltration. Some research suggests that depleting regulatory T cells also induces autoimmunity.

    June 06, 2019
    How APRNs Can Manage Immunotherapy-Related Hypophysitis in Patients With Cancer
    Advanced practice nursing (APN)

    How APRNs Can Manage Immunotherapy-Related Hypophysitis in Patients With Cancer

    Immunotherapy may place patients at risk for distinctive toxicities that differ from traditional chemotherapy. One example is endocrine dysfunction, including hypophysitis, hypo- or hyperthyroidism, type 1 diabetes, and primary adrenal insufficiency. 

    April 25, 2019
    How APRNs Can Manage Immunotherapy-Related Hypothyroidism in Patients With Cancer
    Advanced practice nursing (APN)

    How APRNs Can Manage Immunotherapy-Related Hypothyroidism in Patients With Cancer

    Immunotherapy has a unique set of toxicities in comparison to traditional chemotherapy. Endocrine dysfunction, including hypo- or hyperthyroidism, hypophysitis, type-1 diabetes, and primary adrenal insufficiency, may occur. Advanced practice RNs (APRNs) have a role in monitoring and treating patients for endocrine-related toxicities.

    February 21, 2019
    Take a Closer Look at Immune Checkpoint Inhibitors
    Immunotherapy

    Take a Closer Look at Immune Checkpoint Inhibitors

    One way that cancer has been able to evade the immune system is through overexpression of immune checkpoint proteins (immune inhibitory pathway), which allow cancer cells to be considered “self” instead of foreign and block T-cell action. Immune checkpoint proteins cytotoxic T-lymphocyte–associated 4 (CTLA-4) and programmed cell death protein (PD-1) are receptors that are expressed on the surface of cytotoxic T cells. Immune checkpoint inhibitors prevent those receptors from binding to their natural ligands, disrupting the immune inhibitory pathway. See Table 1 for a list of approved agents and indications.  

    December 25, 2018

    To discuss the information in this article with other oncology nurses, visit the ONS Communities.

    To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org.

    Wendy Vogel MSN, FNP, AOCNP®
     
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