Journal of the Advanced Practitioner in Oncology最新文献

HER2 is overexpressed and/or amplified in approximately 20% of breast cancers. It is a clinically aggressive subtype; however, the introduction of targeted therapies has greatly improved survival rates. At JADPRO Live 2022, presenters discussed recent updates to clinical practice for HER2-positive metastatic breast cancer, and how to interpret emerging evidence on HER2-low data. They also highlighted best practices for monitoring and managing side effects for patients on these therapies.

Managing infection in patients with neutropenia is a difficult challenge, as fever is often the only clinical symptom. At JADPRO Live 2022, Kyle C. Molina, PharmD, BCIDP, AAVHIP, of the University of Colorado Hospital, discussed the epidemiology and pathophysiology associated with febrile neutropenia in patients with cancer. He reviewed appropriate treatment settings and empiric antimicrobial regimens for a patient and how to formulate a plan to safely de-escalate and target therapy for patients with febrile neutropenia.

During JADPRO Live 2022, Kirollos Hanna, PharmD, BCPS, BCOP, briefed advanced practitioners on key FDA approvals from late 2021 to late 2022. He described mechanisms of action that are unique across some malignancies, as well as mechanisms of action that clinicians can utilize through an expanded indication or across other solid malignancies. Finally, he discussed safety profiles and what advanced practitioners can and should do in monitoring across solid tumors.

Multiple primaries are defined as more than one synchronous or metachronous cancer in the same individual. They can pose challenges to clinicians, as the goal is to find an anticancer therapy strategy that covers both cancer types without increased toxicity or drug interactions, and does not negatively impact a patient's overall outcome. At JADPRO Live 2022, presenters tackled this complicated topic by reviewing diagnostic criteria, epidemiology, and risk factors, demonstrating the prioritization of treatment, and discussing the role of the advanced practitioner in collaborative, interdisciplinary management of the patient with multiple primary tumors.

At JADPRO Live 2022, Jonathan Treem, MD, of the University of Colorado Palliative Care, explained medical aid in dying in order to prepare advanced practitioners to feel confident to counsel a patient who inquiries about aid in dying. He explained the law and protocol for participation, the history, ethics, and data behind the intervention, and steps for what is required. Finally, Dr. Treem discussed ethical considerations that may arise as patients and clinicians consider these types of interventions.

The treatment paradigm for metastatic non-small cell lung cancer has changed significantly since the advent of targeted therapy. During JADPRO Live 2022, presenters focused on important updates to clinical practice guidelines, data from recent clinical trials of biomarkers and their respective targeted therapies, and best practices for monitoring and managing side effects associated with targeted therapies for metastatic non-small cell lung cancer.

This special issue of JADPRO includes summaries of select educational sessions presented at JADPRO Live 2022.

Therapeutic options for patients with multiple myeloma have multiplied in the past decade. However, multiple myeloma remains an incurable disease, and relapsed/refractory myeloma is characterized by genetic and cytogenetic alterations that drive resistance and result in progressively shorter durations of remission to each subsequent therapy. At JADPRO Live 2022, presenters discussed the multifactorial process for choosing the right therapy for a particular patient and strategies to manage unique treatment complications associated with novel treatment modalities used for patients with relapsed/refractory multiple myeloma.

Oncology drug development historically has followed a path of sequential phase I, II, and III clinical trials using traditional trial designs, with the goal of achieving regulatory approval. These studies are often conducted with inclusion criteria that limit enrollment to a single tumor type or tumor site of origin, excluding other patients who might also respond. Increased use of precision medicine targeting biomarkers or specific oncogenic mutations has led to novel clinical trial designs that can evaluate these therapies in a less limited fashion. Master protocols such as basket trials, umbrella trials, and platform trials can, for example, evaluate histology-specific therapies targeting a common oncogenic mutation across multiple tumor types or screen for the presence of multiple different biomarkers rather than a single one. In other cases, they can lead to more rapid evaluation of a drug and evaluate targeted therapies in tumor types for which they are not yet currently indicated. As the use of complex biomarker-based master protocols increases, advanced practitioners must understand these novel trial designs, their advantages and disadvantages, and how their use may advance drug development and maximize the clinical benefits of molecular precision therapy.

In the popular biomarker-focused session at JADPRO Live 2022, presenters paired biomarkers with tumor types for which their expression is most commonly used to determine targeted therapy, identified key assays used to measure common biomarkers, and reviewed recommendations and guidelines for biomarker testing.