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GLAONS Survey of Oncology Nurses Reveals Knowledge Gap Regarding Novel Treatment Options

In September 2022, i3 Health conducted a survey of 157 oncology nurses at the Greater Los Angeles Oncology Nursing Society (GLAONS) 6th Annual Oncology Care Summit to assess nurses' familiarity with and desire to understand novel oncology treatment options, including chimeric antigen receptor (CAR) T-cell therapies, cyclin-dependent kinase (CDK)4/6 inhibitors, immune checkpoint inhibitors, poly-ADP ribose polymerase (PARP) inhibitors, and antibody-drug conjugates.

CAR T-cell therapy has been shown to produce significant antitumor responses in patients with hematologic malignancies. CAR T-cell therapy works via a process in which white blood cells are extracted from the patient in a procedure known as leukapheresis. Once the T cells are separated from the white blood cells, the CAR gene is added to create the CAR T cell and is administered to the patient, enabling the CAR T cells to bind to the cancer cells and destroy them.

Out of the 157 oncology nurses surveyed at the GLAONS Oncology Care Summit, only 56 (36%) reported being very familiar with CAR T-cell therapies, such as axicabtagene ciloleucel, idecabtagene vicleucel, lisocabtagene maraleucel, brexucabtagene autoleucel, and tisagenlecleucel; 22 (14%) reported knowing the approved uses of these therapies; 64 (41%) only knew the names of these therapies; and 15 (10%) had never heard of them. Of the 157 nurses asked, 119 (76%) reported that they would like to receive further education on CAR T-cell therapy to enhance their oncology nursing practice.

CDK4/6 inhibitors are a novel therapeutic option for patients with hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative advanced breast cancer. These agents function by halting the cell cycle at the G1-to-S cell cycle checkpoint, blocking a cell division signaling cascade that is overexpressed in HR-positive/HER2-negative disease.

Regarding CDK4/6 inhibitors, such as abemaciclib, ribociclib, and palbociclib, only 33 oncology nurses surveyed (21%) reported being very familiar with them; 12 (8%) knew the approved uses of these inhibitors; 80 (51%) only knew the names of these inhibitors; and 32 (20%) had never heard of them. Of the 157 nurses asked, 122 (78%) reported wanting to receive further education on CDK4/6 inhibitors to enhance their practice.

Immune checkpoint inhibitors have many approvals in treatment of different cancers, including breast, bladder, cervical, colon, and lung, among others. These treatments work by blocking the binding of checkpoint proteins to their partner protein, allowing T cells to remain active and destroy cancer cells. Understanding how immune checkpoint inhibitors work is valuable for enhancing oncology nursing practice.

When asked about their familiarity with immune checkpoint inhibitors, such as pembrolizumab, nivolumab, dostarlimab, durvalumab, atezolizumab, ipilimumab, cemiplimab, and avelumab, only 48 (31%) of the nurses were very familiar with them, 36 (21%) knew their approved uses, 60 (38%) only knew the names of them, and 13 (8%) had never heard of them. Of the 157 nurses asked, 112 (78%) reported wanting to receive further education on immune checkpoint inhibitors to enhance their practice.

PARP proteins are found in cells where they help damaged cells repair themselves. PARP inhibitors disable these PARP proteins in the cell so that they do not activate in cancer cells, therefore allowing the cancer cell to die rather than be repaired. This novel treatment option is mainly used in cancers with possible BRCA mutations, such as breast, ovarian, and prostate cancer; BRCA mutations cause cells to have a damaged repair system, so with PARP inhibitors, the cancer cells present cannot repair themselves. It is vital that clinicians understand this evolving treatment option, as new PARP inhibitors are in trials to evaluate their efficacy in lung, pancreatic, head and neck, esophagus, cervical, kidney, and bladder cancer.

Concerning the oncology nurses' familiarity with PARP inhibitors, such as olaparib, niraparib, rucaparib, and talazoparib, 45 (29%) reported being very familiar with them, 19 (12%) knew the approved uses of them, 66 (42%) knew only the names of them, and 27 (17%) had never heard of them. When asked if they would like to receive further education on PARP inhibitors, 116 nurses (74%) reported being interested in more information to better enhance their practice.

Antibody-drug conjugates are an innovative type of treatment for cancers, with 10 current approvals by the FDA and over 90 in development worldwide via clinical trials. They work by stably linking monoclonal antibodies to a small molecule drug, creating the antibody-drug conjugate. In comparison to other treatment options and chemotherapy, antibody-drug conjugates are known to kill cancer cells without damaging healthy cells. Understanding antibody-drug conjugates as a novel treatment option is important not only for the successful management and treatment of different cancers, but also for the potential implications in other diseases in which new antibody-drug conjugates are currently in development now.

When surveyed about their familiarity with antibody-drug conjugates, such as brentuximab vedotin, enfortumab vedotin, trastuzumab deruxtecan, and belantamab mafodotin, 49 nurses (31%) were very familiar with them, 25 (16%) knew the approved uses of them, 68 (43%) knew only the names of them, and 15 (10%) had never heard of them. When asked about wanting to receive further education on antibody-drug conjugates, 117 (75%) nurses expressed interest to better enhance their practice.

Resources

i3 Health (2022). 2022 GLAONS Survey Data. Data on file.

American Cancer Society (2023). Key statistics for breast cancer. Available at: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html

American Cancer Society (2022). CAR T-cell therapy and its side effects. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/car-t-cell1.html

National Cancer Institute (2022). Immune checkpoint inhibitors. Available at: https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/checkpoint-inhibitors#how-do-immune-checkpoint-inhibitors-work-against-cancer

Cancer Research UK (2023). PARP inhibitors. Available at: https://www.cancerresearchuk.org/about-cancer/treatment/targeted-cancer-drugs/types/PARP-inhibitors

Pettinato MC (2021). Introduction to antibody-drug conjugates. Antibodies (Basel), 27;10(4):42. DOI:10.3390/antib10040042

Cortesi L, Rugo HS, & Jackisch C (2021). An overview of PARP inhibitors for the treatment of breast cancer. Target Oncol, 16(3):255-282. DOI:10.1007/s11523-021-00796-4

Corti D, Purcell LA, Snell G, et al (2021). Tackling COVID-19 with neutralizing monoclonal antibodies. Cell, 10;184(12):3086-3108. DOI:10.1016/j.cell.2021.05.005


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