Few things carry more stigma in the United States than death and hospice. Death is familiar in oncology, yet providers may not discuss it with patients until their cancer has progressed to the point that medical intervention is no longer an option. With the American Cancer Society estimating more than 600,000 American deaths from cancer in 2022, it’s time to change our practice.

On November 18, 2022, the U.S. Food and Drug Administration approved a Monday-Wednesday-Friday dosing option for asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®). Under the alternative regimen, patients receive 25 mg/m² intramuscularly on Monday and Wednesday mornings and 50 mg/m² intramuscularly on Friday afternoons. It also is approved at a dose of 25 mg/m² intramuscularly every 48 hours.

When the U.S. Food and Drug Administration approved tebentafusp-tebn (Kimmtrak®) in January 2022 as an orphan drug for unresectable or metastatic uveal melanoma in adults, it became the first—and only, at the time of this reference sheet’s publication—drug approved for the indication.

In her first report as National Cancer Institute director, Monica M. Bertagnolli, MD, laid out her eight core principles to guide the agency’s work in reformulating clinical trials and strengthening cancer research during the Clinical Trials Advisory Committee meeting in November 2022.

On November 10, 2022, the U.S. Food and Drug Administration (FDA) approved brentuximab vedotin (Adcetris®) plus doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide for pediatric patients aged two years and older with previously untreated, high-risk classical Hodgkin lymphoma. This is the first pediatric approval for brentuximab vedotin.

On November 14, 2022, the U.S. Food and Drug Administration granted accelerated approval to mirvetuximab soravtansine-gynx (Elahere®) for adult patients with folate receptor alpha–positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, as detected with an FDA-approved test, who received one to three prior systemic treatment regimens. Mirvetuximab soravtansine-gynx is a FR alpha–directed antibody and microtubule inhibitor conjugate. FDA also approved the VENTANA FOLR1 (FOLR-2.1) RxDx Assay (Ventana Medical Systems, Inc.) as a companion diagnostic device to identify patients for the indication.

Growing evidence suggests that the gut microbiome, a diverse and complex mix of microorganisms and their metabolites, is closely linked to the immune system, and researchers are studying whether modulating the gut microbiome affects cancer immunotherapy treatment outcomes. In particular, probiotics—which are flora typically obtained through dietary sources such as yogurt and fermented foods or via supplemental forms—are gaining prominence as a potential strategy to modulate the gut microbiome during cancer treatment.

Before poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors were approved for ovarian cancer, traditional treatment consisted of surgical cytoreduction and platinum-based chemotherapy with a taxane, with or without bevacizumab, depending on stage and type. With the surgery-chemotherapy combination, 70%–75% of patients had recurrence and overall five-year survival rates were 29%, indicating a need for additional therapies.

My passion for biomarkers lies in research, specifically clinical trials. The incorporation of biomarkers in oncology clinical trials has been an important advancement in research, and we’ve seen the effect on improving patient outcomes. Identification of pathogenic variants is essential to prescribing personalized therapy for patients with cancer.

Biomarkers, also called molecular markers or signature molecules, can help clinicians characterize alterations in tumors through the detection of specific DNA, RNA, protein, or metabolomic profiles. These pieces of the cancer puzzle are part of precision oncology that the cancer care team can use to assess patients’ cancer risk and prognosis or monitor disease progression. Biomarkers are also a key factor in determining and tailoring treatment methods and their likelihood of success.

Four academic institutions will create centers of excellence dedicated to telehealth in cancer care to help healthcare providers increase its use in oncology practice, thanks to $23 million in National Cancer Institute (NCI) funding. The awards are part of NCI’s Telehealth Research Centers of Excellence initiative, which is supported by President Joe Biden’s Cancer Moonshot initiative.

On October 31, 2022, the U.S. Food and Drug Administration alerted patients, caregivers, and healthcare providers of a tracheostomy tube shortage, including Bivona tracheostomy tubes manufactured by ICU Medical, because of difficulty obtaining required raw materials. FDA said it is working with manufacturers and other stakeholders to help resolve supply challenges and support the devices’ availability.

On October 31, 2022, the U.S. Food and Drug Administration recommended that healthcare providers discuss alternative options for magnetic resonance imaging–guided breast biopsy procedures with patients if a facility is unable to perform it because of a shortage of Philips Invivo MRI breast biopsy grid plates and other Philips Invivo MRI disposables. 

Many of our patients are individuals who haven’t developed cancer but might have a concerning family history of the disease. We rely on healthcare providers like oncology nurses to identify individuals with concerning cancer histories and refer them to genetic counselors for a complete risk assessment, including genetic testing when appropriate, to determine their risk and recommend proactive measures to reduce it.

On October 25, 2022, the U.S. Food and Drug Administration granted accelerated approval to teclistamab-cqyv (Tecvayli®), the first bispecific B-cell maturation antigen–directed CD3 T-cell engager, for adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

On October 21, 2022, the U.S. Food and Drug Administration approved tremelimumab (Imjudo®) in combination with durvalumab for adult patients with unresectable hepatocellular carcinoma.

After more than 93% of patients maintained nadir serum asparaginase activity in the therapy’s clinical trials, on June 30, 2021, the U.S. Food and Drug Administration approved asparaginase erwinia chrysanthemi (recombinant)–rywn (Rylaze^TM) for use as a component of a multiagent chemotherapeutic regimen for treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma in adult and pediatric patients who have developed hypersensitivity to E. coli-derived asparaginase.

Our understanding of cancer has come a great ways over the past few decades, and some of the progress can be traced back to the 1950’s film Challenge: Science Against Cancer, explained David Cantor, PhD, researcher at the Instituto de Desarrollo Económico y Social, Buenos Aires Argentina, adjunct professor in the School of Public Health at the University of Maryland, College Park, in a July 2022 essay for the National Library of Medicine.

Sexual dysfunction is one of the most common side effects of cancer treatment, yet oncology professionals often under address patients’ sexuality and sexual dysfunction concerns. Providers cite lack of time, training, and resources as barriers to initiating important discussions about sexual side effects, and studies show that patients’ age and prognosis are additional hindering factors.

Biologic agents or chemotherapies can trigger hypersensitivity reactions, which occur when a patient’s immune system identifies an agent as an antigen and initiates a complex reaction involving sensitization of T lymphocytes and macrophages, production of antibodies, and release of histamine. Developing and implementing a hypersensitivity kit containing all necessary medications and associated protocols allows nurses to immediately implement management when reactions occur.

Nurses’ consistent and correct use of genomics terminology is critical to reduce confusion and provide safe genomics care to patients and their families, especially when explaining the meaning of genomic tests or findings.

Using the National Institutes of Health Symptom Science Model and Nursing Science Precision Health Model helps oncology nurses to recognize symptoms more promptly in patients with ovarian cancer and provide precision interventions that address racial disparities and foster equity in symptom-focused, patient-centered care, Mahoney and Pierce reported in the October 2022 issue of the Clinical Journal of Oncology Nursing.

Human epidermal growth factor receptor 2 (HER2) proteins are involved in normal cellular growth and are found on the surface of all breast cells. Approximately 20% of breast cancers are HER2 positive, meaning they have high levels of HER2 protein, and those cancers typically grow and metastasize more quickly than other types of breast cancer.

Bringing the first agent to market for the indication, on August 5, 2022, the U.S. Food and Drug Administration (FDA) approved fam-trastuzumab deruxtecan-nxki (Enhertu®) for patients with unresectable or metastatic HER2-low breast cancer based on results from the DESTINY-Breast04 trial that demonstrated improved progression-free and overall survival. FDA also gave fam-trastuzumab deruxtecan its fourth approval on August 11, 2022, for unresectable or metastatic HER2-activating non-small cell lung cancer (NSCLC).

Medication administration is a high-risk process that requires critical thinking, efficient decision-making, attention to detail, and a foundational knowledge of basic pharmacology. The process is not a single task but a cascade of events that include handling, ordering, preparing, dispensing, administering, and monitoring. Although nurses’ involvement varies at each phase, the risk for errors always exists, and consequences can have a lifelong impact on patients, families, and healthcare workers. Nurses can use the following strategies in their responsibility as the last line of defense for safe medication administration.

On September 27, 2022, the U.S. Food and Drug Administration reported Eugia US, LLC’s, voluntary recall of AuroMedics acyclovir sodium injection 500 mg per 10 ml (50 mg/ml) single-dose vial to the consumer level because of reported presence of a dark red, brown, and black particulate inside the vial.

On September 30, 2022, the U.S. Food and Drug Administration granted accelerated approval to futibatinib (Lytgobi®) for adult patients with previously treated, unresectable, locally advanced or metastatic intrahepatic cholangiocarcinoma harboring fibroblast growth factor receptor 2 gene fusions or other rearrangements.

On September 21, 2022, the U.S. Food and Drug Administration (FDA) granted regular approval to selpercatinib (Retevmo®) for adults with locally advanced or metastatic non-small cell lung cancer (NSCLC) with a rearranged during transfection (RET) gene fusion and accelerated approval for adults with locally advanced or metastatic solid tumors with a RET gene fusion that progressed on or following prior systemic treatment or who have no satisfactory alternative treatment options.

On September 20, 2022, the U.S. Food and Drug Administration (FDA) approved the use of sodium thiosulfate (Pedmark®) to reduce the risk of ototoxicity associated with cisplatin in pediatric patients aged 1 month and older with localized, nonmetastatic solid tumors.

Monitoring early-stage testicular cancer survivors for disease recurrence after surgery using either magnetic resonance imaging or fewer computed tomography scans is just as effective as more frequent intervals, researchers reported in study findings published in the Journal of Clinical Oncology.

On September 15, 2022, the U.S. Food and Drug Administration reported Baxter Healthcare Corporation’s recall of Clearlink basic solution set with Duovent because of reports of leaks. FDA identified it as a class I recall, the most serious type of recall, where use of the set may cause serious injuries or death.

On September 8, 2022, the U.S. Food and Drug Administration reported that cancers, including squamous cell carcinoma and various lymphomas, may develop in the capsule that forms around breast implants.

On September 2, 2022, the U.S. Food and Drug Administration approved durvalumab (Imfinzi®) in combination with gemcitabine and cisplatin for adult patients with locally advanced or metastatic biliary tract cancer.

On August 26, 2022, the U.S. Food and Drug Administration approved pemigatinib (Pemazyre®) for adults with relapsed or refractory myeloid or lymphoid neoplasms with fibroblast growth factor receptor 1 rearrangement.

On August 24, 2022, the U.S. Food and Drug Administration approved ibrutinib (Imbruvica®) for pediatric patients aged less than 1 year with chronic graft-versus-host disease after failure of one or more lines of systemic therapy. Formulations include capsules, tablets, and oral suspension.

When Opdualag^TM (nivolumab and relatlimab-rmbw), a fixed-dose combination therapy that consists of two distinct monoclonal antibodies, received FDA approval on March 18, 2022, for the treatment of unresectable or metastatic melanoma for adult and pediatric patients 12 years of age or older, it became the first approved combination therapy that includes two distinct immunotherapy agents in a single infusion. Relatlimab-rmbw is also the first approved lymphocyte activation gene-3–blocking antibody.

On August 11, 2022, the U.S. Food and Drug Administration (FDA) granted accelerated approval to fam-trastuzumab deruxtecan-nxki (Enhertu®) for adult patients with unresectable or metastatic non-small cell lung cancer (NSCLC) whose tumors have activating human epidermal growth factor receptor 2 (HER2) variants, as detected by an FDA-approved test, and who have received a prior systemic therapy. This is the first drug approved for HER2-variant NSCLC.

On August 10, 2022, the U.S. Food and Drug Administration (FDA) granted regular approval to capmatinib (Tabrecta®) for adult patients with metastatic non-small cell lung cancer whose tumors have a mutation leading to mesenchymal-epithelial transition exon 14 skipping, as detected by an FDA-approved test.

To raise awareness and better educate patients and providers about biosimilars’ potential in clinical care, the U.S. Food and Drug Administration (FDA) added three new fact sheets to its healthcare provider resources in July 2022.

On August 5, 2022, the U.S. Food and Drug Administration (FDA) approved darolutamide (Nubeqa®) tablets in combination with docetaxel for adult patients with metastatic hormone-sensitive prostate cancer.

On August 5, 2022, the U.S. Food and Drug Administration (FDA) approved fam-trastuzumab deruxtecan-nxki (Enhertu®) for use in adult patients with unresectable or metastatic HER2-low (IHC 1+ or IHC 2+/ISH‑) breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within six months of completing adjuvant chemotherapy.

Multiple endocrine neoplasia type 2 is an autosomal dominant disease that occurs because of germline pathogenic variants in the rearranged during transfection (RET) proto-oncogene. The RET gene was isolated in 1993 and pathogenic variants affect 1–10 per 100,000 people. Approximately 50% of cases are de novo.

Research and practice changes funded through healthcare legislation have influenced today’s care delivery across all settings: hospitals, clinics, and even homes. And with their constituents laser-focused on health in today’s pandemic society, legislators have never made that happen so quickly.

After clinical trial results demonstrated a four-month improvement in overall survival compared to best standard care, in March 2022 the U.S. Food and Drug Administration approved lutetium lu 177 vipivotide tetraxetan (Pluvicto^TM) to treat prostate-specific membrane antigen–expressing metastatic castration-resistant prostate cancer.

On July 20, 2022, the U.S. Food and Drug Administration (FDA) reported Smiths Medical’s recall of its Medfusion 3500 and 4000 syringe infusion pumps because of software malfunctions. 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.

Diarrhea is a distressing condition that significantly affects patients’ quality of life and social functioning. Characterized by passage of more than three unformed stools in 24 hours, in cancer it can be caused by chemotherapy, radiotherapy, laxatives and antibiotics, enteral feeding, malabsorption syndromes, colectomy, or several types of malignant tumors. Diarrhea has also been reported in long-term cancer survivors. Standard treatment options such as opiate agonists and adsorbents are associated with side effects that may increase a patient’s symptom burden.

Emerging evidence has consistently shown that flushing central venous catheters with normal saline is comparable to heparin flushes in the adult care setting, leading to updated guideline recommendations that include saline as an alternative. But to date, only two studies have evaluated the two options in pediatric patients, the older of which found increased complications when used in children with leukemia or lymphoma. Is normal saline an acceptable alternative in that population?

On June 30, 2022, the U.S. Food and Drug Administration issued a drug safety communication for duvelisib (Copiktra^®) after results from a clinical trial showed a possible increased risk of death associated with the agent, which is approved for the treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL who have received at least two prior therapies. The clinical trial results also associated duvelisib with a higher risk of serious side effects, including infections, diarrhea, lung and intestinal inflammation, skin reactions, and elevated liver enzymes.