 
Kristi Rosa joined MJH Life Sciences in 2016 and has since held several positions within the company. She helped launch the rapidly growing infectious disease news resource 

. Prior to working at the company, she served as lead copywriter and marketing coordinator at The Strand Theater. Email: krosa@onclive.com

The outlook for HER2-positive breast cancer has significantly improved over the past few years, with the emergence of targeted therapies that have been shown to vastly improve patient outcomes. Moreover, recent FDA approvals in the adjuvant setting have added to the armamentarium, explained Vik Gorantla, MD.

In December 2017, the FDA approved pertuzumab (Perjeta) in combination with trastuzumab (Herceptin) and chemotherapy as an adjuvant treatment for patients with HER2-positive breast cancer who were at high risk for recurrence. The decision was based on data from the phase III APHINITY trial, in which the pertuzumab combination demonstrated a 3-year invasive disease-free survival (iDFS) rate of 94.1% compared with 93.2% seen in those who were given trastuzumab/placebo plus chemotherapy.

“Trastuzumab really changed the landscape of treatment for patients with HER2-positive breast cancer. We have done well in this patient population, but now, we want to see if we can do better,” Vik Gorantla, MD, said. “Pertuzumab has been approved in the metastatic setting and in the neoadjuvant setting, so logically, it makes sense to see if we can use it in the adjuvant setting to get even better results. Can we do better?”

The FDA also approved neratinib (Nerlynx) for the extended adjuvant treatment of patients with early stage, HER2-positive breast cancer following postoperative trastuzumab in July 2017.

: Could you share insight on the APHINITY trial and how this study’s results have informed your practice?

 on Breast Cancer, Gorantla, a clinical assistant professor at University of Pittsburgh Medical Center, Hillman Cancer Center, discussed ongoing developments in the adjuvant setting for patients with HER2-positive breast cancer.

: This clinical trial was started in 2011; it was an international trial with more than 500 centers and 4800 women who were randomized 1:1 to receive pertuzumab, trastuzumab, and chemotherapy versus trastuzumab plus chemotherapy and placebo. The primary endpoint was iDFS. The secondary endpoint was overall survival (OS) and the trial was adequately powered to meet this objective. The science was good science—it was a well-run and well-defined study.

Is the duration of the pertuzumab regimen up for debate, or is it strictly 1 full year?

What would you say are the unanswered questions with the APHINITY trial?

Again, randomization was performed, and, of course, the data were presented in 2017 and showed that the study met its primary endpoint by a couple of percentage points; it was statistically significant. The benefit was really seen in node-positive patients and also in potentially estrogen receptor (ER)— and progesterone receptor (PR)–negative patients; that’s where we saw the most benefit, and that is the population for which we most probably will be using this drug.

It’s strictly 1 year at this point. But again, it has been a very controversial subject. Was the benefit really worth it? There has been a lot of debate about it. Again, it was a well-designed study; it met its primary endpoint. The FDA has approved the regimen. Now, patient selection is going to be the key. Personally, I think patients who have ER-/PR-negative, node-positive disease are the patients who I would recommend this regimen for.

What do we do for patients who have residual disease? What do we do for those who received neoadjuvant therapy with docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP)? Those are the questions that are unanswered. Again, the OS data are still maturing; it has only been 4 years since the data have come out.

Another question has to do with the long-term implications. If you were exposed to pertuzumab and if the disease comes back, what are you going to do? If you expose them again to pertuzumab, does prior exposure to pertuzumab affect your outcome when you add on pertuzumab later?

Moving forward, what is the biggest challenge that you would like to see addressed?

What is needed to drive subsequent progress in this patient population?

Of course, now, we live in a world where we have to look at the cost of therapy. Cost is not only physical and emotional toxicities, but also financial toxicities—the cost of the drug. That’s another aspect that we are looking at very closely now. When we talk about physical toxicities, overall, the biggest issue with this drug was really the diarrhea&mdash;approximately a 7% increase in diarrhea compared with trastuzumab&mdash;but it can be easily managed.

What happens when the disease comes back? This is a disease that relapses in the visceral organs, especially in the brain. What do we do in those patients? We need drugs that have better blood-brain barrier penetration. We have had lapatinib in the past and there are some data for neratinib and potentially ado-trastuzumab emtansine (T-DM1; Kadcyla).

We need to balance toxicity and benefit—that’s really the crux of it. [We need] better understanding of the biology and better understanding of the pathways. Additionally, we are only targeting 2 epitopes, if you think about it: trastuzumab targets one epitope, while pertuzumab targets another one. Are there other ways of doing this? What about the regions of HER1, HER3, HER4&mdash;is there any role there? That would be something to look at.

von Minckwitz G, Procter MJ, De Azambuja E, et al. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. 

. 2017;377(2):122-131. doi: 10.1056/NEJMoa1703643.

Articles

Vik Gorantla, MD, discusses ongoing developments in the adjuvant setting for patients with HER2-positive breast cancer.

Adjuvant Options Expand in HER2+ Breast Cancer, But Questions Remain

Epoetin alfa-epbx (Retacrit), the biosimilar to epoetin alfa (Procrit/Epogen) has been launched in the United States at a significant discount, according to Pfizer, the developer of the injectable.

 The shipment of the biosimilar to wholesalers throughout the United States began on November 12, 2018.

“We are delighted to introduce our third biosimilar in the United States,” said John P. Kennedy, general manager of US Biosimilars at Pfizer Essential Health, in a recent statement. “Pfizer is committed to fostering a sustainable marketplace for biosimilars and advocates for policies that bring these important medicines to patients and physicians as quickly as possible.”

Prior to this announcement, on May 15, 2018, the FDA approved the biosimilar to be used as a treatment for anemia caused by chronic kidney disease, chemotherapy, or the use of zidovudine in patients with HIV infection.

Epoetin alfa-epbx is also indicated for use prior to and following surgery to decrease the likelihood that patients will need a red blood cell transfusion due to blood loss from surgery.

The manufacturer of the biosimilar, Hospira, a Pfizer company, submitted the biologics license application (BLA) based on data yielded from the 2 single-center, randomized, open-label EPOE-12-02 and EPOE-14-01 studies.

The first study was designed to establish the pharmacokinetics (PK) and pharmacodynamics (PD; reticulocyte count) of the biosimilar following a single subcutaneous dose of 100 u/kg in healthy participants (n = 81). The investigators compared the biosimilar data with that of epoetin alfa.

Investigators found that the biosimilar met the prespecified acceptance criteria for similarity, the geometric mean of AUC

 (1.03 mIU-h/mL; 90% CI, 0.97-1.09), and C

 (1.09 mIU-h/mL; 90% CI, 1.01-1.18). The same was true of PD for AUEC

The second study, EPOE-14-01, aimed to determine the drug’s PK and PD (hemoglobin level) after multiple doses of subcutaneous 100 u/kg of the biosimilar 3 times weekly for the duration of 4 weeks in health participants (n = 129). Again, these data were compared with data associated with epoetin alfa.

This study also met prespecified acceptance criteria for PD similarity of geometric mean of hemoglobin level AEUC 

The FDA’s Oncologic Drugs Advisory Committee voted 14 to 1 in favor of the approval of the BLA for the biosimilar in May 2017. At that time, the committee reported that the analytical similarity data supported the conclusion that, overall, epoetin alfa-epbx was “highly similar to US-licensed Epogen/Procrit, notwithstanding minor differences in clinically inactive components.” They added that “there were no clinically relevant differences” in the data associated with PK, PD, safety, efficacy, and immunogenicity between the two drugs.

Not long afterwards, however, the FDA issued a complete response letter to Hospira expressing concerns regarding manufacturing the biosimilar at the company’s facility based in McPherson, Kansas. Particular issues identified by the FDA included: in-process specifications, failure to follow procedures developed to prevent contamination of products, and lack of appropriate sampling plans for analytical and inspection activities.

However, Pfizer emphasized that these concerns were not specifically related to epoetin alfa-epbx, and, in an attempt to address the FDA’s concerns, the company submitted a corrective and preventative action plan in March 2017.

Epoetin alfa-epbx will now be introduced to the market at a substantial discount at a Wholesale Acquisition Cost (WAC) of $11.03 per 1000 units/mL, which is 57.1% below the WAC of Procrit ($25.72 per 1000 units/mL), and 33.5% below the WAC of its reference product, Epogen ($16.58 per 1000 units/mL).

Epoetin alfa-epbx has been granted 2 unique assigned Q codes from the Centers for Medicare and Medicaid Services: Q5105 for End-Stage Renal Disease (ESRD) and Q5106 for non-ESRD. Under the hospital outpatient prospective payment system, epoetin alfa-epbx qualifies for pass-through status.

Pfizer. Pfizer introduced biosimilar Retacrit (epoetin alfa-epbx) injection in the US at a substantial discount. Published November 14, 2018.

Pfizer. Pfizer’s biosimilar RETACRIT® (epoetin alfa-epbx) approved by U.S. FDA. Published May 15, 2018. https://bit.ly/2Pd4J3L. Accessed November 14, 2018.

Epoetin alfa-epbx (Retacrit), the biosimilar to epoetin alfa (Procrit/Epogen) has been launched in the United States at a significant discount.

Epoetin Alfa Biosimilar Launched in United States at Discounted Cost

The pan-HER TKI neratinib (Nerlynx) demonstrates efficacy as an adjuvant therapy for patients with HER2-positive breast cancer; however, the associated adverse events (AEs) provide some patient selection challenges, explained Mohammed Rahman, MD.

“I think all-in-all, it’s an attractive treatment. The only downside of it is gastrointestinal toxicity—the diarrhea rate in the ExteNET trial was almost 90%, but more importantly, grade 3 diarrhea was close to 39% or 40%,” said Rahman. “However, if doctors are very aggressive with antidiarrheal management, these [events] can be managed easily and effectively. We can actually get the numbers down with various remedies to maybe single-digit figures in terms of grade 3 diarrhea toxicity.”

The FDA approved neratinib (Nerlynx) in July 2017 to prevent recurrence in patients with early-stage HER2-positive breast cancer who had completed at least 1 year of adjuvant therapy with trastuzumab (Herceptin).

The regulatory decision was based on data from the multicenter, double-blind, phase III ExteNET trial, which enrolled 2840 women with early-stage HER2-positive breast cancer who within 2 years of completing adjuvant trastuzumab, were randomized to receive either neratinib (n = 1420) or placebo (n = 1420) for the duration of 1 year.

The primary outcome for the trial was invasive disease-free survival (iDFS), which was defined as time between randomization date to the first occurrence of invasive recurrence, distant recurrence, or death from any cause within 2 years and 28 days of follow-up. After 2 years, investigators reported a 94.2% iDFS in patients who received neratinib versus 91.9% in patients who received placebo (HR, 0.66; 95% CI, 0.49-0.90;

 = .008). Five-year follow-up data showed an iDFS rate with neratinib of 90.2% (95% CI, 88.3-91.8) versus 87.7% (95% CI, 85.7-89.4) with placebo.

Patients who received neratinib were also more likely to experience severe diarrhea compared with those who received placebo; diarrhea was the most common AE that led to discontinuation of treatment. Due to the high rate of AEs among other factors, patient selectivity is key, Rahman added.

What are the key findings from the ExteNET trial?

 State of the Science Summit™ on Breast Cancer, Rahman discussed ongoing efforts to optimize the use of neratinib in patients with HER2-positive breast cancer.

 Neratinib is a pan-HER TKI, which blocks pan HER domains on the cancer cells—specifically, HER2, HER1/EGFR, and HER4.

What it showed was the use of neratinib after completion of trastuzumab in the adjuvant setting. If we extend it by 12 months, the iDFS is extended by an absolute 2.4%. Now, if you look at subgroup analyses, if the patients were hormone receptor (HR)—positive, their iDFS showed an absolute difference of almost 4.4%.

It was interesting that further subclassification showed that if neratinib was started as early as possible in a fit patient with HER2-positive, estrogen receptor (ER)—positive breast cancer, who has not shown evidence of progression of disease and who has had their HER2 testing done at a central location, the absolute benefit from this treatment was more than 7%. In the setting of adjuvant HER2-positive breast cancer—which is a disease that still has about a 26% recurrence in the first 10 years&mdash;that is a very provocative result and oncologists in the United States should take that seriously.

Is neratinib’s use in the adjuvant setting impacted at all by pertuzumab’s indication in both the neoadjuvant and adjuvant settings?

The other important thing that is coming out of the neratinib data—not just in the ExteNET trial, but other trials, such as I-SPY 2 or NEfERT-T&mdash;is [that it penetrates] the central nervous system (CNS). As this is a small molecule TKI, it seems to be very effective, and there is a 50% reduction in the formation of CNS metastases.

That is an open question because neratinib and pertuzumab have similar toxicity profiles; they both cause diarrhea. Therefore, it is very difficult for patients to complete pertuzumab and then you tell them, “Well, I’m going to give you a drug that’s going to cause diarrhea.”

But, it goes back to residual disease burden. If you have a very high-grade tumor that was large at outset, and after neoadjuvant trastuzumab, trastuzumab/pertuzumab, or trastuzumab/pertuzumab/chemotherapy, there’s still a large tumor remaining in the breast or there are several positive nodes, then that is the definition of residual disease burden and it becomes a high disease burden. In those patients, you know that they are not going to do as well, so you want to do the best and most for them. That is when neratinib will come into the equation—when a disease burden is high.

Is there anything else that you want to emphasize in terms of patient selection and what the trial informs?

The other thing about neratinib that we saw was that it needs to be started sooner rather than later; the patients who started much later after 1 year or 2, didn’t seem to benefit. The ER-positive patients will benefit, and obviously, so will the HER2-positive patients. Starting it as soon as possible will benefit them. Overall, I believe that the pertuzumab and neratinib relationship will pan out as more data come out.

The patient selection was based upon HER2 positivity in high-risk patients. Again, it goes back to residual disease at the time of surgery. The other important question that somebody asked me was, “What about genomic profiling?” We are still using clinical criteria. What about the genomic criteria? What about next-generation sequencing?

That is kind of a whole new arena that we may have to venture into because not only do we want to make decisions on the basis of clinical high risk, but we need to make decisions on genomic high risk.

What would you like to remind physicians working in the space?

One of the things that attracts me is the CNS penetration. In some of the recent trials, it shows that instances of brain metastases may be reduced as low as 50% with neratinib; that’s very attractive for us in terms of recurrent HER2-positive breast cancer because these patients are living long. Hence, the natural disease has changed, and they are developing brain metastases in the later part of their disease process. Therefore, a drug that does penetrate CNS and takes care of brain metastases would be a very attractive proposal.

We need to look out for the HER2-positive, ER-positive patients with a lot of disease burden. In those patients, it will be easy to influence them and present these data. As I mentioned in my presentation, we took anthracycline on board for an absolute benefit difference of just over 2%, and taxanes were [a benefit of] around 2%.

Here comes a drug that has 2.4% in all-comers, 4.4% in a HR-positive cohort, and then it goes up to over 7% if you get a central HER2 testing and start the drug earlier rather than later. The 7.4% is sellable as long as physicians are very diligent about treating the diarrhea and helping patients get through their treatment.

What is sitting at the crux of subsequent progress in patients with early-stage HER2-positive breast cancer?

Again, the diarrhea comes as a tsunami; they say in the first 24 hours to the first week, and then tails off over a period of 30 days. However, [patients should be treated] upfront with loperamide and add colestipol, because then the rate of grade 3 diarrhea goes down to 11%. Then, there’s budesonide, which is an oral, nonabsorbable steroid, which is available. Therefore, if you had a plan in place, this drug can be quite easily given.

We are evolving. The secret lies in the genomic profiling of these tumors. Does neratinib save all the patients? It doesn’t. That means you are still missing patients who need more potent treatment. I believe it comes down to mutations at a subcellular level of genomics; that’s where we are going to get the most “bang for our buck.”

Martin M, Holmes FA, Ejlertsen B, et al. Neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): 5-year analysis of a randomized, double-blind, placebo-controlled, phase 3 trial.

2017;18(12):1688-1700. doi: 10.1016/S1470-2045(17)30717-9.

Mohammed Rahman, MD, discusses ongoing efforts to optimize the use of neratinib in patients with HER2-positive breast cancer.

Neratinib Promising for Early-Stage HER2+ Breast Cancer, But Has Caveats

The FDA has accepted a supplemental new drug application (sNDA) for review for avatrombopag (Doptelet) as a treatment for patients with chronic immune thrombocytopenia (ITP) who have had an inadequate response to prior treatment, according to Dova Pharmaceuticals, the developer of the second-generation, oral thrombopoietin receptor agonist.

The application for avatrombopag was based on findings from the phase III Amendment 02 trial, which met its primary and first secondary efficacy endpoints—number of weeks with a platelet count ≥50 x 10

/L in the absence of rescue therapy and the proportion of patients with platelet counts ≥50 × 10

/L on day 8, respectively—with high statistical significance (

 <.0001). Under the Prescription Drug User Fee Act, the FDA will render a decision on the application by June 30, 2019.

“Chronic ITP affects approximately 60,000 adults in the United States and despite the currently available therapies, which include 2 other thrombopoietin receptor agonists, there remains an important unmet need,” Lee F. Allen, MD, PhD, chief medical officer of Dova, said in a statement. “Acceptance of this sNDA is another significant milestone for Dova, and an important step towards addressing this underserved patient population and expanding the applications for Doptelet as a treatment for thrombocytopenia.”

Results from the Amendment 02 trial were published in the 

 In the study, investigators aimed to demonstrate that the efficacy of avatrombopag plus standard of care was superior to placebo plus standard of care for adult patients with ITP who had received at least 1 previous ITP treatment, as measured by cumulative number of weeks of platelet response over 6 months with once-daily treatment.

The trial, which was conducted from February 6, 2012, to April 9, 2015, included a core study and an extension phase. Forty-nine of the 100 patients who were screened by investigators met the eligibility criteria for the trial. These patients were randomized to either receive avatrombopag (n = 32) or placebo (n = 17).

For the core study, the duration of exposure was longer in the avatrombopag arm, with 26/32 (81.3%) of the patients receiving the avatrombopag over 18 weeks, 17/32 (53.1%) over 26 weeks, and 2/32 (6.3%) over 30 weeks. Only 3/17 (17.6%) of patients in the placebo arm were exposed to study medication over 18 weeks, and only 1 patient was exposed for longer than 26 weeks. In the combined core study and extension, the mean duration of exposure to avatrombopag was 43.9 weeks, with the longest exposure to the medication being 75.7 weeks.

Data showed that avatrombopag was superior to placebo in the cumulative number of weeks of platelet response with a significantly longer duration of a platelet count ≥50 × 10

/l in the absence of rescue therapy versus placebo (median: 12.4 vs. 0.0 weeks; mean: 12.0 vs. 0.1 weeks; 

 < .0001). Additionally, a greater platelet response rate was observed for patients who received avatrombopag at day 8 versus those who received placebo (21/32; 65.6% and 0/17, 0.0%, respectively; 

Results also showed that 5 of the 15 patients who were on concomitant ITP medication in the avatrombopag arm reduced their use of this medication from baseline, while none of the 8 patients who received placebo were able to do so (33.3% vs. 0%, respectively; 95% CI, 9.48-57.19). However, this was not found to be statistically significant due to the small number of patients who had been using concomitant ITP medications at baseline.

Four patients in the avatrombopag arm experienced grade 3 treatment-emergent adverse events (TEAEs), such as epistaxis, petechiae, headache, and platelet count reduction. Two grade 4 TEAEs were also reported in the core study; one patient experienced a cerebrovascular accident who discontinued study treatment and the other experienced worsening ITP not deemed to be associated with the mediation. The most commonly reported TEAEs in the avatrombopag arm were headache, contusion, upper respiratory tract infection, arthralgia, epistaxis, fatigue, gingival bleeding and petechiae.

Avatrombopag was deemed to be well tolerated with a safety profile comparable with placebo when adjusted for treatment exposure. The safety data yielded in the trial proved consistent with phase II studies and 6-month studies that evaluated other thrombopoietin receptor agonists, with headaches being the most frequently reported AE.

Avatrombopag was initially approved by the FDA as a treatment for thrombocytopenia in adults with chronic liver disease who are scheduled to undergo a medical or dental procedure.

Dova Pharmaceuticals, Inc. Dova Pharmaceuticals announces FDA acceptance of supplemental new drug application for DOPTELET (avatrombopag) for the treatment of chronic immune thrombocytopenia (ITP). Published November 5, 2018. https://bit.ly/2D5WejX. Accessed November 8, 2018.

Jurczak W, Chonjnowski K, Mayer J, et al. Phase 3 randomization study of avatrombopag, a novel thrombopoietin receptor agonist for the treatment of chronic immune thrombocytopenia [published online September 7, 2018]. 

The FDA has accepted a supplemental new drug application for review for avatrombopag (Doptelet) as a treatment for patients with chronic immune thrombocytopenia who have had an inadequate response to prior treatment.

FDA Accepts sNDA for Avatrombopag in ITP

With continuous advances in the lung cancer space, multidisciplinary collaboration and education are needed to ensure that the best treatment plan is selected for each particular case and that patients do well throughout treatment.

Nurses and nurse practitioners often establish relationships with patients before a diagnosis is even confirmed, and they continue to support patients throughout their journey by helping inform the development of an appropriate treatment plan and then ensuring that associated side effects are managed effectively, said Mary Pasquinelli, MS, APRN.

“Often, as a nurse practitioner, I will see that patient throughout their course of treatment and then the oncologist and I work with that patient together to see the patient when they have scans or if they have progression of disease,” Pasquinelli said. “Otherwise, I do a lot of the symptom management and diagnose, prescribe, and treat for any of the side effects.”

With the introduction of new therapies such as checkpoint inhibitors, physicians, including those outside of the oncology space, need to be made aware of how side effects associated with new approaches differ from those experienced with standard of care. Nurses often help communicate that information to ensure the best possible care for patients.

: Nurses are sometimes the first point of contact for patients with suspected lung cancer. Can you speak to the importance of this?

 State of the Science Summit™ on Non—Small Cell Lung Cancer in Chicago, Illinois, Pasquinelli, a nurse practitioner from the University of Illinois at Chicago (UIC) and director of the lung cancer screening program at UIC, discussed the pivotal role of nurses in lung cancer care.

: Patients come in to our institutions through multiple ways, different referrals. At our hospital, we have the lung cancer screening patient and I will see all the patients that have a Lung-RADS 4 that could be suspicious of lung cancer. I also have a lung nodule clinic, and so, I may see patients in the pulmonary clinic where the patient has a high suspicion of cancer. Then we talk about these patients in the multidisciplinary tumor board and decide which way to biopsy the patient or if we should do more imaging.

Often, I have a relationship with these patients before they actually get diagnosed with cancer and then I’m there when they get diagnosed and I talk with them. One thing that I think is very important is that when we give a diagnosis, we also have a plan for them. They’re not getting called over the phone to get a diagnosis, where they don’t know what’s going to happen next. We give the diagnosis and we talk about a plan right there. We have our lung navigator with us, so he can help that patient get scheduled for the next appointments.

What are some ways that nurse practitioners serve as advocates for their patients?

Often, I do have a relationship with our patients before they come. Sometimes they will call in wanting to get a second opinion, or they’re a new patient, and either I will reach out to them or to a lung navigator just to get some information. Then they kind of know who we are before they come through our door.

We work collaboratively with the physician, but I often see the patient by myself when they’re in the clinic getting their chemotherapy—independent of the physician. But if there is a change of therapy or if there’s a question, I always have the oncologist there in the clinic so that I can discuss the case with them. I see the patients independently as long as they’re doing well.

I’m doing a lot of the symptom management, ensuring that they’re doing okay if they have any symptoms and working to resolve the symptoms. Also, I pull in resources, as needed; we distress screen every patient for anxiety and depression and we also have a screen for supportive care.

As developments are made in the field, what should nurses and physicians know about the side effects associated with new treatments?

Many of our patients live in low resource areas and they have a lot of barriers to care and problems with food and security or housing and security, so when I realize that this patient—through our screening and our interviewing&mdash;has some issues, I immediately am able to access social work, our palliative care team, other resources, and support groups, to help that patient right at the beginning so that those resources and support help them throughout their whole care continuum.

There have been a lot of wonderful new advancements in lung cancer therapy although there are also some new challenges, too. We have all of these new checkpoint inhibitors, immunotherapy drugs, but they also have a big side effect profile that is different from chemotherapy.

It’s really important for physicians, nurse practitioners, and even our infusion nurses, to really understand the side effects of these medications because even though the symptom is the same, how you’re going to treat them might be different. For instance, our lung cancer patients are often short of breath but when they have shortness of breath—is this a pneumonia that’s starting up or is this pneumonitis from the checkpoint inhibitors? You really need to know your patient well, know the symptoms, and be able to work them up appropriately because the treatment is different.

Also, with the checkpoint inhibitors, I often speak to other physicians outside of oncology—the primary care physicians&mdash;because of our lung cancer screening program, and I tell them a lot about the side effects. They often know the side effects of chemotherapy&mdash;those are pretty well-known&mdash;but they don’t know the side effects of immunotherapy and for our primary care providers, we’re often comanaging these patients; often, our patients not only have lung cancer, but they have diabetes, heart failure, or hypertension.

What should the nursing community remember when caring for patients with lung cancer?

It’s important for our primary care providers to understand the side effects of immunotherapy because we’re going to be comanaging them together. I do a lot of awareness and education within our clinic and outside of our clinic.

Everybody is different; we have no case that is exactly the same. Each of these cases has a person behind them and it’s so important to treat that patient holistically—not just their cancer, but also mind, body, and spirit&mdash;and to be sure that that person has the resources and support to do well throughout their treatment.

Also, it’s important for nurses and nurse practitioners to be sure that they’re being collaborative with their whole team, to be sure that we have the best outcomes and the best support for our patients.

Mary Pasquinelli, MS, APRN, discusses the pivotal role of nurses in lung cancer care.

Kristi Rosa

Articles

Adjuvant Options Expand in HER2+ Breast Cancer, But Questions Remain

Epoetin Alfa Biosimilar Launched in United States at Discounted Cost

Neratinib Promising for Early-Stage HER2+ Breast Cancer, But Has Caveats

FDA Accepts sNDA for Avatrombopag in ITP

Nurses Play Pivotal Role in Patient Journey Through Lung Cancer Continuum