FDA Approves Nivolumab for Resected Esophageal or GEJ Cancer
On May 20, 2021, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) for patients with completely resected esophageal or gastroesophageal junction (GEJ) cancer with residual pathologic disease who have received neoadjuvant chemoradiotherapy.
The Case of the Weight Loss Wishes
Craig was diagnosed with colorectal cancer after a routine colonoscopy and subsequent colectomy. He meets with Lacey, the oncology nurse, to discuss managing the side effects of his FOLFOX chemotherapy. Lacey notes that Craig’s age is 71, weight is 255 lbs., and body mass index (a body fat ratio based on weight and height) is 38. Craig describes his activity level as “walking to the mailbox and exercising my fingers on the remote control. This cancer treatment will help me knock off some of this extra weight.”
Nursing Considerations for Melanoma Survivorship Care
Breast, prostate, colorectal, and melanoma are the most common primary cancer sites among 58% of survivors. Advancements in immunotherapy and targeted therapies have significantly increased treatment options for a disease that once had very limited treatment options, markedly improving overall five-year survival rates for patients with melanoma. Yet survival rates vary depending on extent of disease (local versus metastatic) and ethnic minority disparities. Although the overall (all stages combined) five-year survival rate for White patients with melanoma is 93%, the rate drops to 87% for Hispanics and to just 23% for those with distant melanoma.
Larotrectinib and Other Tumor-Agnostic Targeted Therapies Are Leading Cancer Care Into the Next Frontier
In 2018, the cancer drug larotrectinib quietly became a milestone along the evolving path to approaching cancer therapy: it was the first agent approved to treat a genetic variant, not a specific type of cancer or disease site. And as oncology treatment science progresses, many predict that it won’t be the last—it’s already been joined by pembrolizumab and entrectinib as tumor-agnostic therapies. The key to curing cancer may be hidden in the disease’s genetic code rather than its location in the body.
Genetic Disorder Reference Sheet: BRCA1 and BRCA2 Hereditary Cancers
BRCA1- or BRCA2-associated hereditary breast and ovarian cancer is the most common form of hereditary breast and ovarian cancer. The prevalence of BRCA1 and BRCA2 pathogenic variants in the general population is estimated at 1 in 400–500 people, although it increases to 1 in 40 for those of Ashkenazi Jewish ancestry, which is linked to three founder pathogenic variants (BRCA1 c.68_69delAG, BRCA1c.5266dupC, and BRCA2 c.5946delT).
FDA Grants Accelerated Approval to Pembrolizumab for HER2-Positive Gastric Cancer
On May 5, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab (Keytruda®) in combination with trastuzumab and fluoropyrimidine- and platinum-containing chemotherapy for first-line treatment of patients with locally advanced unresectable or metastatic HER2-positive gastric or gastroesophageal junction (GEJ) adenocarcinoma.
How to Handle Even the Worst Radiation Therapy Side Effects
Some of the most painful side effects of cancer and its treatment occur with radiation therapy. Although patients may find the effects emotionally devastating, nurses can help take a proactive management approach by preparing patients for what’s ahead. Annette Quinn, RN, MSN, from the University of Pittsburgh Hillman Cancer Center, outlined the most common but distressing side effects and tips for managing them during a session held on April 29, 2021, for the 46th Annual ONS Congress™.
Time in Nature Is Time Well Spent
“Nature alone cures,” Florence Nightingale instructed her fellow nurses in Notes on Nursing—and we’ve continued to follow that principle, creating a healing environment for our patients that involves fresh air and sunlight. That same environment can promote health in nurses as well.
FDA Grants Accelerated Approval to Loncastuximab Tesirine-Lpyl for Large B-Cell Lymphoma
On April 23, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to loncastuximab tesirine-lpyl (Zynlonta™), a CD19-directed antibody and alkylating agent conjugate, for adult patients with relapsed or refractory large B-cell lymphoma, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from low grade lymphoma, and high-grade B-cell lymphoma, after two or more lines of systemic therapy.
FDA Grants Accelerated Approval to Dostarlimab-Gxly for dMMR Endometrial Cancer
On April 22, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to dostarlimab-gxly (Jemperli), an anti-PD-1 antibody, for adult patients with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer, as determined by an FDA-approved test, that has progressed on or following treatment with a prior platinum-containing regimen.
HER2 Status Has Implications for Breast Cancer Treatment and Nursing Care
Breast cancer is classified by several factors, including the presence of human epidermal growth factor receptor 2 (HER2), a type of growth-promoting protein found on the surface of cells. All breast cells have HER2 receptors, but some breast cancers have more HER2 receptors than normal, which may promote tumor growth. About 60% of breast cancers have some level of HER2 expression, and approximately one in five patients has high levels of the HER2 protein, which is considered HER2-positive.
Research Shows That Better Cancer Care Requires Listening—to Both Patients and Clinicians
Oncology nursing research has a powerful impact on quality care and positive patient outcomes, but the science must be grounded in clinical context because researchers’ ultimate goal is to disseminate their findings to clinicians to facilitate practice change, ONS’s 2021 Distinguished Researcher Christopher Friese, PhD, RN, AOCN®, FAAN, of the University of Michigan and Rogel Cancer Center, said during his session for the 46th Annual ONS Congress™ on April 22, 2021.
FDA Announces Several New Recalls of BD Alaris Pump Module Model 8100 Because of Key and Bezel Problems
On April 16, 2021, the U.S. Food and Drug Administration (FDA) reported Care Fusion 303, Inc.’s, recall of the BD Alaris Pump Module 8100 because the device may experience stuck or unresponsive keys during operation. FDA identified it as a class I recall, the most serious type of recall, where use of the devices may cause serious injuries or death.
The Case of the Transgender Considerations for Cancer Screening
Sally, a nurse practitioner in a cancer survivorship clinic, is preparing to discuss screening and surveillance guidelines with Jonah, a 32-year-old survivor of Hodgkin lymphoma. Sally reviews Jonah’s patient history form and notes that Jonah uses he and him pronouns. His gender identity is male and sex assigned at birth was female. Jonah’s surgical history includes gender-affirming surgery on chest tissue (also known as top surgery), and his current medications include supplemental testosterone. Jonah also specifies that he is transmasculine—an umbrella term used to indicate that Jonah feels a connection with masculinity.
FDA Approves Nivolumab in Combination With Chemotherapy for Metastatic Gastric Cancer and Esophageal Adenocarcinoma
On April 16, 2021, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) in combination with fluoropyrimidine- and platinum-containing chemotherapy for advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma.
FDA Grants Accelerated Approval to Sacituzumab Govitecan for Advanced Urothelial Cancer
On April 13, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to sacituzumab govitecan (Trodelvy®) for patients with locally advanced or metastatic urothelial cancer who previously received a platinum-containing chemotherapy and either a programmed death receptor-1 or a programmed death-ligand 1 inhibitor.
Nursing Management of Adverse Events From Enfortumab Vedotin Therapy for Urothelial Cancer
Once patients stop responding to platinum-based chemotherapy for locally advanced or metastatic urothelial cancer, their treatment options had been somewhat limited: PD-1/PD-L1 inhibitors were effective in only 13%–29% of patients and taxanes in only 11%–13%. When the antibody drug conjugate enfortumab vedotin was approved in late 2019, it offered new hope for patients and providers, with clinical trials reporting a 44% objective response rate.
Involve the Entire Cancer Care Team to Effectively Implement Guidelines
Only 19% of strategies to implement clinical practice guidelines are fully effective and the majority (43%) are not effective at all, according to the findings from a clinical review in the European Union. Effective guideline implementation requires teamwork, interprofessional engagement, and selecting the most appropriate tool for the job.
The Case of the Targeted Therapy Toxicity
Tyrone is a 74-year-old man with a history of acute myeloid leukemia (AML), type 2 diabetes, and hypertension who was admitted to the hospital after lab results revealed 40% circulating blasts in his peripheral blood that was concerning for relapsed disease. He was diagnosed with AML three years ago and achieved remission after treatment with a hypomethylating agent.
Nursing Considerations for Head and Neck Cancer Survivorship Care
Despite accounting for only 3% of all cancer survivors, patients with head and neck cancers often require significant support and survivorship care. And oncology nurses can expect survivorship to grow with recent improvements in prognosis and treatment options, such as with reductions in human papillomavirus-related oropharyngeal cancers, which tend to affect young people and offer improved long-term survival rates.
FDA Approves Sacituzumab Govitecan for Triple-Negative Breast Cancer
On April 7, 2021, the U.S. Food and Drug Administration (FDA) granted regular approval to sacituzumab govitecan (Trodelvy®) for patients with unresectable locally advanced or metastatic triple-negative breast cancer who received two or more prior systemic therapies, at least one of which for metastatic disease.
FDA Approves New Cetuximab Dosing Regimen for Colorectal Cancer and Squamous Cell Carcinoma
On April 6, 2021, the U.S. Food and Drug Administration (FDA) approved a new dosage regimen for cetuximab (Erbitux®) of 500 mg/m2 via IV infusion for 120 minutes every two weeks for patients with KRAS wild-type, epidermal growth factor receptor-expressing colorectal cancer or squamous cell carcinoma of the head and neck.
FDA Issues Safety Communication for ADM Products Used in Implant-Based Breast Reconstruction
On March 31, 2021, the U.S. Food and Drug Administration (FDA) issued a safety communication informing patients, caregivers, and healthcare providers that certain acellular dermal matrix (ADM) products used in implant-based breast reconstruction may have a higher chance for complications or problems.
FDA Approves Isatuximab-Irfc for Multiple Myeloma
On March 31, 2021, the U.S. Food and Drug Administration (FDA) approved isatuximab-irfc (Sarclisa®) in combination with carfilzomib and dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three prior lines of therapy.
FDA Approves Idecabtagene Vicleucel as the First Cell-Based Gene Therapy for Adult Patients With Multiple Myeloma
On March 27, 2021, the U.S. Food and Drug Administration (FDA) approved idecabtagene vicleucel (Abecma), for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. This is the first FDA-approved cell-based gene therapy for multiple myeloma.
Zydus Pharmaceuticals Inc. Issues Voluntary Nationwide Recall of Acyclovir Sodium Injection
On March 25, 2021, the U.S. Food and Drug Administration shared Zydus Pharmaceuticals Inc.’s notice of its voluntary recall of four lots of acyclovir sodium injection 50 mg/ml, supplied in 10 ml and 20 ml vials, after receiving reports of crystallization in the product.
The Case of the Cord Blood Match
Zhang is a 67-year-old man who had no history of medical concerns until he was hospitalized for pneumonia. A complete blood count taken during his workup for pneumonia showed pancytopenia, and a biopsy confirmed a diagnosis of acute myeloid leukemia. After multiple rounds of induction therapy, Zhang's bone marrow biopsy showed minimal residual disease and he entered remission. His oncologist recommends an allogeneic hematopoietic stem cell transplant as soon as possible because of the disease's aggressive nature, but he has no match in the registry.
Infection Prevention for Oncology Nurses
Regardless of care setting, oncology nurses must be vigilant about creating a safe environment for and educating patients about the importance of infection prevention. Patients with cancer are at increased risk for viral, bacterial, and fungal infections, but the extent depends on cancer type and treatment.
Genetic Disorder Reference Sheet: CHEK2 Gene Pathogenic Variants
The CHEK2 (checkpoint kinase 2) tumor suppressor gene provides cells with instructions for making a protein known as CHK2, which becomes active when the cell’s DNA is damaged or strands of it break. CHEK2 halts cell division and enables either cell repair or destruction. Without a properly functioning CHEK2 gene, cells lose a key restraint on their growth which may lead to uncontrolled cells and possibly malignancy. CHEK2*1100delC is the most common pathogenic variant and most prevalent in European populations.
FDA Approves Pembrolizumab for Esophageal or GEJ Carcinoma
On March 22, 2021, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for use in combination with platinum- and fluoropyrimidine-based chemotherapy for patients with metastatic or locally advanced esophageal or gastroesophageal junction (GEJ) (tumors with an epicenter 1–5 cm above the gastroesophageal junction) carcinoma who are not candidates for surgical resection or definitive chemoradiation.
FDA Advises Healthcare Professionals Not to Use BD’s ChloraPrep™ 3 ml Applicators
On March 19, 2021, the U.S. Food and Drug Administration (FDA) issued an advisory to healthcare professionals not to use ChloraPrep 3 ml applicators manufactured by BD (Becton, Dickinson and Company) because of the risk of microbial contamination. The product was distributed globally and is labeled with “CareFusion, El Paso, TX.”
Management Strategies for Cutaneous Toxicity From EGFR Inhibitors
Epidermal growth factor receptor (EGFR)-targeted therapy is effective for several solid tumor malignancies, primarily non-small cell lung cancer with EGFR mutation and metastatic colorectal cancer. Although the agents spare patients from typical side effects seen with more conventional cytotoxic chemotherapies, such as nausea or vomiting, they do have a unique side-effect profile, including potentially dose-limiting cutaneous toxicity.
FDA Approves Tivozanib for Relapsed or Refractory Advanced Renal Cell Carcinoma
On March 10, 2021, the U.S. Food and Drug Administration (FDA) approved tivozanib (Fotivda®), a kinase inhibitor, for adult patients with relapsed or refractory advanced renal cell carcinoma following two or more prior systemic therapies. FDA approved the application three weeks ahead of its goal date.
FDA Grants Accelerated Approval to Axicabtagene Ciloleucel for Relapsed or Refractory Follicular Lymphoma
On March 5, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to axicabtagene ciloleucel (Yescarta®) for adult patients with relapsed or refractory follicular lymphoma after two or more lines of systemic therapy.
FDA Approves Lorlatinib for ALK-Positive Metastatic NSCLC
On March 3, 2021, the U.S. Food and Drug Administration (FDA) granted regular approval to lorlatinib (Lorbrena®) for patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are anaplastic lymphoma kinase (ALK)-positive, as detected by an FDA-approved test. FDA also approved the Ventana ALK (D5F3) CDx Assay as a companion diagnostic for lorlatinib.
Nursing Considerations for Colorectal Cancer Survivorship Care
As the third most common cancer among both men and women, colorectal cancer is a reality for the more than 1 million people in the United States who are living with or have a history of the disease. Advancements in early detection and treatment have improved outcomes, but many survivors experience late and long-term side effects that may vary in duration, intensity, and impact on their quality of life. Clinicians must tailor each survivorship care plan for a patient’s cancer type, stage, treatment received, psychosocial implications, and side effects or toxicities. Studies have shown that experiencing long-term side effects and symptoms can reduce survivors’ quality of life.
FDA Grants Accelerated Approval to Melphalan Flufenamide for Relapsed or Refractory Multiple Myeloma
On February 26, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to melphalan flufenamide (Pepaxto®) in combination with dexamethasone for adults with relapsed or refractory multiple myeloma who received at least four prior lines of therapy and whose disease is refractory to at least one proteasome inhibitor, one immunomodulatory agent, and one CD-38–directed monoclonal antibody.
Self-Care Is Essential When Working Remotely
Did you ever imagine that you could do your job remotely? I did not, but that’s what I’m doing right now. Working remotely has become the new normal for certain professional roles, including some in nursing. An estimated 31% of new hires since March 2020 work from home. In February 2020, the Centers for Disease Control and Prevention released social distancing guidelines and recommended the use of telehealth for patient visits. In March 2020, telehealth visits increased 154% compared to March 2019. Working at home has affected both healthcare workers and patients.
FDA Approves Cemiplimab-Rwlc for NSCLC With High PD-L1 Expression
On February 22, 2021, the U.S. Food and Drug Administration (FDA) approved cemiplimab-rwlc (Libtayo®) for the first-line treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who are not candidates for surgical resection or definitive chemoradiation and whose tumors have high PD-L1 expression (tumor proportion score ≥ 50%) as determined by an FDA-approved test, with no estimated aberrations to glomerular filtration rate, anaplastic lymphoma kinase, or receptor tyrosine kinase (encoded by the ROS1 gene).
Be Alert for Axillary Adenopathy After COVID-19 Vaccination
Nearly 60 million people in the United States and almost 200 million around the world have received the COVID-19 coronavirus vaccine as of mid-February 2021, and the numbers will continue to grow as more doses come to market and other manufacturers’ versions receive emergency use authorizations. As more people get vaccinated, some of the expected side effects are being observed in clinical practice and have implications for cancer care.
FDA Approves Trilaciclib to Reduce Chemotherapy-Induced Myelosuppression
On February 12, 2021, the U.S. Food and Drug Administration (FDA) approved trilaciclib (Cosela™) as the first therapy in its class to reduce the frequency of chemotherapy-induced myelosuppression in adults receiving certain types of chemotherapy for extensive-stage small cell lung cancer. Trilaciclib inhibits cyclin-dependent kinase 4/6 (CDK 4/6) enzymes to prevent bone marrow damage.
Inclusion in National Repository Helps Move ONS Guidelines™ Evidence to Practice
When they launched in 2020, oncology nurses recognized the first five ONS Guidelines™ for cancer treatment-related symptoms and adverse events as the evidence-based standard for patient care. Now, the ECRI Guidelines Trust, a national evaluation organization, has given them that distinction as well, including all of ONS’s current guidelines in its repository.
FDA Approves Cemiplimab-Rwlc for Locally Advanced and Metastatic Basal Cell Carcinoma
On February 9, 2021, the U.S. Food and Drug Administration (FDA) approved cemiplimab-rwlc (Libtayo®) for use in patients with locally advanced basal cell carcinoma previously treated with a hedgehog pathway inhibitor (HHI) or for whom an HHI is not appropriate. FDA also granted accelerated approval to cemiplimab-rwlc for patients with metastatic BCC previously treated with an HHI or for whom an HHI is not appropriate.
FDA Approves Lisocabtagene Maraleucel for Relapsed or Refractory Large B-Cell Lymphoma
On February 5, 2021, the U.S. Food and Drug Administration (FDA) approved lisocabtagene maraleucel (Breyanzi®) for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma not otherwise specified—including DLBCL arising from indolent lymphoma—high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B.
Nursing Considerations for Lymphoma Survivorship Care
As treatments have advanced and patients and providers have more options, cure and survivorship rates for lymphomas are improving: five-year survival rates for Hodgkin and non-Hodgkin lymphoma are 86% and 71%, respectively. Despite good results from treatment, research indicates that lymphoma survivors carry a significant amount of late and chronic effects. Even in a complete remission, late effects of treatment present a burden for patients' physical and psychosocial well-being.
FDA Grants Accelerated Approval to Tepotinib for Metastatic NSCLC
On February 3, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to tepotinib (Tepmetko®) for adult patients with metastatic non-small cell lung cancer (NSCLC) harboring mesenchymal-epithelial transition exon 14 skipping alterations.
Oncology Drug Reference Sheet: Tafasitamab-Cxix
Tafasitamab-cxix (Monjuvi®) received accelerated approval from the U.S. Food and Drug Administration in July 2020 in combination with lenalidomide for adults with relapsed or refractory diffuse large B-cell lymphoma.