Immune checkpoint inhibition is a form of immunotherapy that blocks checkpoint proteins on immune cells, boosting the body's immune response against cancer cells. Checkpoint inhibitors such as pembrolizumab (Keytruda®, Merck), nivolumab (Opdivo®, Bristol-Myers Squibb), atezolizumab (Tecentriq®, Genentech), durvalumab (Imfinzi®, AstraZeneca), cemiplimab (Libtayo®, Regeneron Pharmaceuticals, Inc.), ipilimumab (Yervoy®, Bristol-Myers Squibb), and avelumab (Bavencio®, EMD Serono and Pfizer) have demonstrated remarkable antitumor activity in multiple types of cancer, including non-small cell lung cancer, skin cancers, kidney cancer, bladder cancer, head and neck cancers, and Hodgkin lymphoma. However, since these agents may allow the immune system to attack normal organs in the body, they can be associated with potentially serious adverse events. Oncology nurses must be aware of these therapies and appropriate management of immune-related adverse events in order for their patients to achieve optimal outcomes.
In April of 2019, i3 Health conducted a survey of 66 oncology nurses at the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California, in order to assess nurses' familiarity with immune checkpoint inhibitors and their confidence in managing immune-related adverse events.
Although half of respondents (50.0%) indicated that they were "highly familiar" with nivolumab and pembrolizumab, fewer indicated they were "highly familiar" with ipilimumab (28.8%), durvalumab (21.2%), atezolizumab (15.2%), avelumab (7.6%), and cemiplimab (3.0%). Less than half of respondents indicated that they felt "highly confident" in managing immune-related adverse events, including diarrhea (37.9%), vomiting (35.0%), nausea (33.3%), fatigue (30.3%), rash (27.3%), and pneumonitis (26.0%). Less than one quarter of respondents indicated high levels of confidence in managing pruritus (22.7%), colitis (22.7%), cough (22.7%), headache (21.2%), loss of appetite (20.0%), enterocolitis (15.2%), hepatotoxicity (15.2%), and thyroiditis (12.1%).
"As nurses, we know there is a laundry list of side effects and adverse reactions for each medication we administer. When dealing with biotherapies, we know that these adverse events are often intensified," said Sandra Ruesch, MSN, RN, CEN, SPEN, SANE-A, Lead Nurse Planner at i3 Health. "Patients quickly look to their nurses to provide essential information about these medications, and it is our role as nurses to be aware of immune-related adverse events so that we are able to recognize and mitigate these effects as well as educate our patients on what may potentially occur while they are receiving these therapies."
The majority of respondents (84.8%) indicated they would like to receive education on immune checkpoint inhibitors to enhance their oncology nursing practice.