Over the past two decades, the treatment of metastatic non-small cell lung cancer has dramatically evolved with the introduction of targeted therapies and immunotherapy. These advancements require predictive molecular tests to determine which treatments are suitable for patients. Biomarker testing has become vital in lung cancer care, enabling personalized diagnosis and treatment by identifying specific genetic variants. 

The rapid advancements in oncology treatments—with new approvals in therapies like small molecules, biologics, biosimilars, and cellular therapies coming nearly every month—can be challenging for any nurse to keep up with, let alone truly understand the nuances of those approvals. As new discoveries unfold, the U.S. Food and Drug Administration (FDA) oversees the lengthy and multifaceted journey a drug or biologic takes from the laboratory to the patient. The ultimate goal of the many steps is to balance providing access to the latest treatments with ensuring patient safety.

Mei is a 67-year-old patient who recently underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking. Her surgical specimens were sent for pathology review and germline biomarker testing. Based on the findings, Mei was diagnosed with stage IIIC, high-grade serous epithelial ovarian cancer with a BRCA1 pathogenic germline variant.

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.

The urinary system, including the bladder, ureters, urethra, and renal pelvis, is lined with urothelial tissue. Urothelial carcinoma is the predominant histologic type of cancer in that system, and 90% of tumors are located in the bladder. With more than 81,400 new cases and nearly 18,000 deaths estimated for 2020, bladder cancer is the fifth most prevalent type of cancer in the United States.

This is the third in a series detailing some of the general factors to consider around patient adherence to oral medications, and ways to support patients receiving neratinib.

This is the third in a series detailing some of the general factors to consider around patient adherence to oral medications, and ways to support patients receiving neratinib.

AS is a 58-year-old woman who was diagnosed at age 55 with a right infiltrating ductal carcinoma of the breast, identified as grade III, ER and PR positive, and HER2 positive. She had bilateral mastectomy, and tumor size was noted to be 2.8 cm. She had a positive sentinel lymph node. She was staged at IIB (pT2, pN1, M0). Her left breast was noted to have usual ductal epithelial hyperplasia and a 1.2 cm fibroadenoma. AS’s genetic testing revealed a BRCA1 mutation (BRCA1 c.3748G>T [p.Glu1250*]), which may confer an increased risk for breast cancer in the range of 46%–87%, and 39%–63% risk for ovarian cancer by age 70. As her patient history shows, she has some risk factors for nonadherence, including no support at home and some financial issues. Throughout her care, the team worked to communicate and prepare AS to help ensure adherence as much as possible.

The cancer treatment landscape has shifted with the emergence of new, targeted therapies. Development and use of oral oncolytics, targeted cancer therapies that can be taken by patients orally in their own homes, has increased in recent years. This increase is due in part to research in extra- and intracellular signaling pathways. By interfering with or blocking these signals, targeted drugs have become standard agents in cancer therapy. Oral oncolytics currently account for about 25% of the oncology pipeline of drugs in clinical development, and experts project that oral oncoloytic use will continue to rise.

Lung cancer is the second most common cancer in both men and women (after skin cancer) and is the leading cause of cancer death among both men and women. Histology has become an important determinant in choosing therapy for various types of cancer, including non-small cell lung cancer. Currently, biomarker testing is the standard of care in lung cancer; with biomarker testing, patients likely to respond to targeted therapy can be identified. As the number of targeted agents continues to increase, so does the demand for continued biomarker testing and adequate tumor tissue samples.

Large-volume (≥ 3 ml) intramuscular (IM) injections may not be administered often, and oncology nurses can be unfamiliar with best practices. A study found that only 32% of gluteal injections were administered into the desired IM target. This could lead to the drug being administered subcutaneously or near major nerves and blood vessels, potentially decreasing the treatment’s efficacy.