{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 403: Pharmacology 101: Checkpoint Inhibitors","description":"\u201cBecause the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That\u2019s one of our biggest questions that we ask, usually every consult that we\u2019re seeing with solid tumor. \u2018Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?\u2019 And then also patients who have undergone organ transplants. Now, interestingly, this does include stem cell transplants,\u201d Kelsey Finch, PharmD, BCOP, oncology pharmacist practitioner at Columbus Regional Health in Indiana, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS\u00ae, manager of oncology nursing practice at ONS, during a conversation about checkpoint inhibitors. Music Credit: \u201cFireflies and Stardust\u201d by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 20, 2027. Kelsey Finch has disclosed a speakers bureau relationship with AstraZeneca. This financial relationship has been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center\u2019s Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to checkpoint inhibitors in the treatment of cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast\u2122 episodes: Pharmacology 101 series Episode 273: Updates in Chemotherapy and Immunotherapy Episode 174: Administer Pembrolizumab Immunotherapy With Confidence Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment ONS Voice articles: Here\u2019s Why Oncology Nurses Are Pivotal in Managing Immune-Related Adverse Events Make Subcutaneous Administration More Comfortable for Your Patients Nursing Considerations for ICI-Related Myocarditis Oncology Nurses Navigate the Changing Landscape of Immuno-Oncology Postdischarge ICI Patient Education Eliminates Hospital Readmissions Shorter Administration Times Still Require High-Acuity Care ONS Voice oncology drug reference sheets: Dostarlimab-Gxly Nivolumab and Hyaluronidase-Nvhy Nivolumab and Relatlimab-Rmbw Pembrolizumab and Berahyaluronidase Alfa-Pmph Retifanlimab-Dlwr Toripalimab-Tpzi ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Cancer Immunotherapy (second edition) ONS course: ONS\/ONCC\u00ae Chemotherapy Immunotherapy Certificate\u2122 Clinical Journal of Oncology Nursing articles: Immune Checkpoint Inhibitor\u2013Related Myocarditis: Recognition, Surveillance, and Management Immune Checkpoint Inhibitor Therapy: Key Principles When Educating Patients Triple M Syndrome: Implications for Hematology-Oncology Advanced Practice Providers ONS Huddle Cards: Checkpoint Inhibitors Immunotherapy ONS Learning Libraries: Genomics and Precision Oncology Learning Library Immuno-Oncology Learning Library Drugs@FDA package inserts National Comprehensive Cancer Network homepage OncoLink: All About Immunotherapy To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode \u201cBefore immune checkpoint blockade, the two-year overall survival rate in metastatic melanoma was hovering around 10%. After these agents came to market, depending on the trial and the agents used, that number actually increased to about 50%\u201365%. So, five times the amount of patients were actually living at the two-year mark. Not surprisingly, studies then exploded across several tumor types, leading to approvals in all sorts of cancers, mostly in the solid tumor. But there are a couple hematologic as well. Lung cancer, kidney cancer, head and neck, Hodgkin lymphoma, hepatocellular, the list goes on. So, it\u2019s really just transforming the stage IV setting across all tumors, specifically from uniformly fatal prognosis to one where durable responses and long-term survival is also possible.\u201d TS 3:03 \u201cThere are four different mechanisms officially being used in therapies that are approved by the U.S. Food and Drug Administration (FDA). Those are cytotoxic T-lymphocyte\u2013associated protein 4, programmed cell death protein 1, and programmed cell death ligand 1, which I\u2019m counting as two different mechanisms, even though they somewhat work together. And lymphocyte-activation gene 3 is the fourth one that\u2019s in there. So, all these mechanisms impact the T cell in our immune system. The T cell is traditionally responsible for protecting our body from harmful things like bacteria, viruses, and cancer. When the tumor binds to cytotoxic T-lymphocyte\u2013associated protein 4 receptors, that happens on the T cell itself. And that inhibits the activation of the T cells, essentially allowing that tumor to then live. So when developing medications that block this receptor, they noted an added benefit that it actually increased the T-cell proliferation as well as keeping that T cell active. So not only are we not blocking the T cells, we\u2019re making them more productive.\u201d TS 5:38  \u201cIf you have a chance of any sort of tissue rejection, specifically with allogeneic stem cell transplants or where we see that focusing on it, there\u2019s a little bit of controversy, mixed bag on opinions as far as autologous stem cell transplants. But it\u2019s best to at least exercise a little bit of caution. If they have a chance of organ rejection, is that worth the risk of the therapy that we\u2019re looking to give? And then, patients with HIV, any sort of immunologic concerns at baseline that we could potentially worsen.\u201d TS 14:37 \u201cAs a rule of thumb, with immune checkpoint blockade, regardless of what mechanism you\u2019re looking at, if something in your body can get inflamed, that can wind up as an adverse event. So, whenever I talk to my patients, the key word is anything ending in \u2018-itis.\u2019 ... The most common adverse events that we end up seeing are dermatitis and hypothyroidism. Immune checkpoint blockade can cause both hyper- and hypothyroidism. Very often, we actually start in the hyper- and then end up, for lack of better words, burning out the thyroid, ultimately leading to a sustained hypothyroidism.\u201d TS 18:34 \u201cThe half-life of immune checkpoint inhibitors is usually around 30 days, meaning that once these agents are given, the drug will be in the patient\u2019s system for up to five months. Specifically, it will probably build month to month, so often we don\u2019t even see a lot of our adverse events until month three or four. Usually, when we\u2019re that far into treatment, we\u2019re not looking for new adverse events in things like chemotherapy. But these drugs do build over time.\u201d TS 24:28 \u201cAs far as safe handling is concerned, these agents are not chemotherapy. That makes drug compounding and administration pretty straightforward. When looking at the follow-up care, the most important thing, in my opinion, is to engage in meaningful dialogue with your patients. A lot of the side effects can be nonspecific. So, really listening to the patient and evaluating changes in their lifestyle, I think it\u2019ll get you far. We usually hark in on the new, worsening, or persistent whenever we\u2019re talking to patients because they\u2019ll be looking for things as well. So, just having a dialogue of how their life has changed can certainly help.\u201d TS 26:17 ","author_name":"The ONS Podcast","author_url":"http:\/\/onsvoice.libsyn.com\/website","html":"