{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 419: Pharmacology 101: Immunomodulators","description":"\u201cUntil immunomodulators, patients [with myeloma] did not have a great overall survival rate. But when we introduced lenalidomide, we started seeing our patients have life expectancies between five and seven years\u2014which was unheard of prior to these immunomodulators going forward. I think it\u2019s promising and allows patients to have quality of life versus therapy of life,\u201d ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS\u00ae, TCTCN\u2122, oncology clinical specialist at ONS, during a conversation about immunomodulators. Music Credit: \u201cFireflies and Stardust\u201d by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 12, 2027. Daniel Verina is on the speakers' bureau for Johnson & Johnson, GlaxoSmithKline, and Pfizer. 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 about the use of immunomodulators to treat cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast\u2122 episodes: Pharmacology 101 series Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses Episode 386: Interprofessional Navigation and the Oral Anticancer Medication Care Compass Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy ONS Voice articles: Maintain Oral Adherence With ONS Guidelines\u2122 Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations Sexual Considerations for Patients With Cancer Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles Oncology Nursing Forum articles: Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study Facilitators of Multiple Myeloma Treatment: A Qualitative Study ONS book: Multiple Myeloma: A Textbook for Nurses (third edition) ONS Symptom Intervention resource: Peripheral Neuropathy Risk Evaluation and Mitigation Strategies (REMS) Lenalidomide Pomalidomide Thalidomide International Myeloma Foundation: Using Immune Therapy to Fight Multiple Myeloma International Myeloma Society Multiple Myeloma Research Foundation: Treatments for Multiple Myeloma 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 \u201cWe definitely want the diagnosis of multiple myeloma before initiating these drugs. We\u2019re going to look at serum protein electrophoresis. We want to make sure that we know the patient has serum free light chains and myeloma proteins to really confirm their disease. Plus, a bone marrow biopsy.\u201d TS 7:21 \u201cEach immunomodulator has slightly different side effects. Thalidomide\u2019s biggest side effects are constipation, weakness, fatigue, somnolence, peripheral neuropathy, mood swings, hand tremors, and depression. With each generation, less of the side effects actually occurred. Most of lenalidomide\u2019s side effects, not discounting the deep vein thrombosis, are pancytopenia\u2014the neutropenia, the anemia, and the thrombocytopenia. [The side effects] are very similar in pomalidomide.\u201d TS 15:40 \u201cThe REMS program is critical for oral immunomodulator therapies\u2014thalidomide, pomalidomide, and lenalidomide. It was developed due to the risk of developing embryofetal toxicities. ... It is mandatory testing and counseling, so all females of reproductive potential must have two negative pregnancy tests prior to starting the therapy and then monthly pregnancy tests while on the therapy alone. Again, they must use two forms of effective contraceptives or abstain from heterosexual sex four weeks prior, during, and after. And the same thing for men. I focus on that because males may say, \u2018I have a vasectomy.\u2019 These therapies tend to bind to the semen. So, males must still use a latex or synthetic condom during any sexual contact with a female of reproductive potential, even if they did have a vasectomy.\u201d TS 18:31 \u201cThe capsule itself cannot be chewed, crushed, or opened. I bring that up because as healthcare professionals, we have educated our patients. If it\u2019s difficult to swallow capsules or tablets, we\u2019ve always said to them, \u2018Oh, don\u2019t worry, just crush it into applesauce or open it up and sprinkle it on your mashed potatoes.\u2019 But because of this embryofetal toxicity, I advise my patients not to open the capsule. If they can\u2019t swallow it for any reason, they have a sore throat or they\u2019re just unable to, then [we tell them] to hold the therapy and then call us.\u201d TS 22:49 \u201cWe spoke about three generations already, but there\u2019s actually a fourth generation [of immunomodulators]. They\u2019re called cereblon E3 ligase modulators(CELMoDs). They\u2019re still in clinical trials but really showing promise in the therapy of myeloma. They\u2019re showing very good affinity to cereblons, just like the immunomodulators do. I think, in all cancer therapies, as newer generations come out or newer therapies move forward, some of the older generations might move aside, but they get integrated later on. So I don\u2019t think [immunomodulators] will disappear totally, but they will probably be modified.\u201d TS 36:39 ","author_name":"The ONS Podcast","author_url":"http:\/\/onsvoice.libsyn.com\/website","html":"