In November 2022, HER2-directed therapies made headlines in breast cancer as did innovations to help individuals who are often overlooked in oncology care.
Each month, Oncology Nursing News® takes a look back at our most popular stories. This month, new data highlighted the potential value that HER2-directed targeted therapy can offer patients who have metastatic breast cancer that has progressed following and has spread to the brain. This information is especially useful for regions that do not have access to newer drugs with better blood brain barrier penetration, according to study authors.
New ways to help individuals with cancer who have less access to care continued to grab the attention of nurses. A contributor highlighted the importance of making cancer screening accessible for people with disabilities and a feature story from our print publication on how to better support caregivers. This month, we also featured a presentation from the 40th Annual CFS® on the importance of proper immune-related adverse event (irAE) management.
Lastly, one of our newest features, the Oncology Drug Crash Course sheet, provides a helpful overview of an agent approved across multiple indications and details what nurses need to know about adverse effects and any handling nuances. In November 2022, 3 nurses weigh in on what other oncology nurses need to know with the HER2-directed targeted therapy, fam-trastuzumab deruxtecan-nxki (Enhertu).
5. Aggressive HER2-Targeted Therapy May Have a Role Following Disease Progression in Patients With Breast Cancer and Brain Metastases
According to a retrospective analysis of real-world evidence which was reported in JCO Global Oncology, aggressive HER2-targeted therapy may still be effective in patients with HER2-positive breast cancer who have experienced disease progression after HER2-directed therapy and who have brain metastases.
The findings showed that patients with disease progression and brain metastases achieved a median progression-free survival of 8 months (95% CI, 6.2-9.8) and a median overall survival (OS) of 14.0 months (95% CI, 10.8-17.2). The estimated 2-year OS rate was 25% (95% CI, 16.7%-34.4%).
Patients with HER2-positive metastatic breast cancer and brain metastases face poor prognoses, write investigators. However, these findings suggest that targeted therapy may play a useful role, even following disease progression. The authors added that these data may be useful to inform decision-making for patients who live in regions where newer HER2-directed therapies may be limited and real-world evidence surrounding local and systemic therapies are crucial.
4. Improvements in Accessibility to Cancer Screenings Are Needed for Individuals With Disabilities
Approximately 15% of the world’s population lives with a disability, writes Rebecca Kronk, PhD, MSN, CRNP, ANEF, FAAN, CNE, associate dean for academic affairs professor, Duquesne University School of Nursing. Moreover, in the United States, the Center for Disease Control has reported that 1 in 4 adults has at least 1 disability.
In oncology, there needs to be recognition of that disparities that people with disabilities, who have been described as the largest minority group in the world, face. It is imperative that nurses and other health care professionals acknowledged how disparities can affect preventative screenings and, more importantly, become part of the solution by helping to make early detection and cancer treatment more accessible for those living with disabilities.
3. Maximizing Potential of Immunotherapy Requires Appropriate irAE Management
Immunotherapy represents a very powerful force in the world of cancer treatment, according to Melinda S. Weber, DNP, APN, AOCN-C. This treatment modality has drastically improved outcomes for many patients across cancer subtypes.
However, because immunotherapy is linked to a unique and powerful mechanism of action, it is also associated with intense adverse effects which need appropriate management.
In a presentation during the Nursing track at the 40th Annual CFS®, Weber who is the director of care transformation and a charge APN in the Skin and Sarcoma Division at John Theurer Cancer Center at Hackensack University Medical Center Weber, touched on the marked success of the treatment in the field in melanoma and outlined the tenets of early recognition, appropriate grading, and best management practices for irAEs.
2. Caring for the Caregiver: Practical Tips for Oncology Nurses
Those caring for an adult with cancer face substantial stress. Giving care, either voluntarily or not, impacts the psychical, social, and emotional health of a caregiver, and can influence their employment and financial stability.
In this feature story, Ellen Tichich, MFA, MSN, RN-BC, spoke with caregiver Debbie Legault, and Michelle Mollica, PhD, MPH, RN, OCN; and Sharon Cavone, BSN, RN, OCN, about practical ways that oncology nurses can help caregivers feels supported.
1. Oncology Drug Crash Course: Fam-Trastuzumab Deruxtecan-Nxki (Enhertu)
Alyssa Hall, FNP-BC, AOCNP, Donna Thomas, BSN, RN, OCN, Kellie Zeichner, BSN, RN, OCN, provide an in-depth look at trastuzumab deruxtecan, including the approved indications and safety considerations, in a downloadable fact sheet.
Trastuzumab deruxtecan is a HER2-directed antibody and topoisomerase inhibitor conjugate composed of 3 components: a humanized anti-HER2 IgG1 monoclonal antibody, a topoisomerase inhibitor, and a tetrapeptide-based cleaver. After it binds to HER2 on the tumor cells, trastuzumab deruxtecan undergoes internalization and intracellular linker cleavage by lysosomal enzymes. Once released, the membrane-permeable deruxtecan causes DNA damage and apoptotic cell death.
After demonstrating significant efficacy as a third-line treatment for patients with metastatic HER2-positive breast cancer, trastuzumab deruxtecan has gained approval from the FDA for 5 indications and is under investigation across solid tumors.