Targeted Therapies for Non-Small Cell Lung Cancer: Expert Responses to Frequently Asked Questions

Ms. Knoop is a clinical nurse specialist and supervisor at the Vanderbilt-Ingram Cancer Center Information Program in Nashville, Tennessee, where she provides information to healthcare professionals and consumers about cancer clinical trials and services. She received her master of science in nursing from the Vanderbilt University School of Nursing and serves there as an adjunct faculty member. Ms. Knoop has more than 25 years of oncology nursing experience. She frequently lectures on the topics of molecularly targeted cancer therapies, cancer clinical trials, and supportive care. Ms. Knoop is coeditor of the Oncology Nursing Society publication Oncology Supportive Care Quarterly.

Teresa J. Knoop, MSN, RN, AOCN^®, reported a financial interest/relationship or affiliation in the form of: Consultant, Bristol-Myers Squibb Company, Genentech BioOncology, and Amgen, Inc.; Speakers' Bureau, Amgen, Inc., and Genentech BioOncology.

Selected Targeted Therapy Mechanisms of Action

Therapies targeting the tyrosine kinases epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) have become a mainstay of treatment for many patients with metastatic non-small cell lung cancer. Because of their unique mechanisms of action, the side effects associated with EGFR and VEGF inhibitors differ from those characteristic of standard cytotoxic chemotherapy agents. This presentation will explain the science of cell signaling and illustrate, in 3-D video animation, how these specific targeted agents influence aberrant cell signaling. The goal is to demystify the concept of targeted therapies and help nurses integrate knowledge of these therapeutic agents into their individual clinical practices thereby optimizing sideeffect management.

Breast Cancer Survivorship Pyschological Support Update

In recent years, cancer survivorship issues have received greater attention and research interest as the number of cancer survivors increases in the United States, and the cancer advocacy movement gains in strength. Cancer survivorship is defined as a continuum from the time of diagnosis to the end of life. It has been conceptualized as a progression through three phases or “seasons” of survival incorporating: (1) surviving the treatment and its side effects, (2) beginning to return to normal life while being monitored for recurrence, and (3) long-term adjustment, when the cancer experience is viewed as an episode in a full life. In 2004, the most recent year with complete Surveillance, Epidemiology, and End Results (SEER) data, there were 10.1 million cancer survivors; of these, more than 2.4 million were breast cancer survivors. Family members, friends, and caregivers of the woman diagnosed with breast cancer are also considered to be cancer survivors.

Psychosocial distress, at varying levels of severity, accompanies the cancer experience. There are calls to consider distress the sixth vital sign; it would then be routinely monitored along with pulse, blood pressure, respiration, temperature, and pain. Periods of highest distress for the woman with breast cancer are associated with transition points in treatment. Completion of treatment may be a cause of increased anxiety rather than joy. There are many potential barriers to meeting the psychosocial needs of women with breast cancer after active treatments ends. The Institute of Medicine of the National Academies has released several reports during recent years describing strategies to acknowledge and meet these needs, declaring that provision of psychosocial services should be a standard of care for survivors of cancer. Oncology nurses play a key role in assessing the patient, family members, and caregivers for signs of distress. In so doing, an atmosphere of compassion and trust is created such that the breast cancer survivor feels free to share psychosocial concerns and have them addressed by appropriate specialists if necessary.

Dr. Sandler is an associate professor of medicine in the Division of Hematology/Oncology at Vanderbilt University Medical Center, Nashville, Tennessee. He also serves as the medical director of the Thoracic Oncology Program and the director of the Vanderbilt-Ingram Cancer Center Affiliate Network. He received his doctor of medicine from Rush Medical College, Chicago, and completed his fellowship at Yale University School of Medicine, New Haven, Connecticut. His primary research interests include small and non-small cell lung cancers as well as sarcoma. Dr. Sandler has written more than 200 articles, book chapters, reviews, and abstracts involving the pharmacology and clinical activity of chemotherapy and novel targeted agents. He is also an active member of the American Society of Clinical Oncology and the Eastern Cooperative Oncology Group, in which he serves as the cochair of the Thoracic Committee.

Alan Sandler, MD, reported a financial interest/relationship or affiliation in the form of: Consultant, Amgen, Inc., Genentech BioOncology, Bristol-Myers Squibb Company, and Enzon Pharmaceuticals, Inc.; Speaker's Bureau, Genentech BioOncology; Contracted Research, Genentech BioOncology, Bristol-Myers Squibb Company, Eli Lilly and Company, sanofi-aventis U.S., Pfizer, Inc., and Amgen, Inc.

NSCLC Targeted Therapy Clinical Research Update

Chemotherapy has played an integral role in combating lung cancer and long-term survival has rarely been achieved. Increased understanding in the biological processes of cells has led to the development of targeted agents, which have yielded mixed results in the treatment of non-small cell lung cancer. Combinations of these targeted agents are being studied and hold promise. This presentation will focus on the results of key clinical trials of both platinum-based chemotherapy and targeted agents.

Update on Clinical Trials of Antiangiogenesis Agents in Breast Cancer/Metastatic Breast Cancer Treatment Update

Metastatic breast cancer (MBC) remains a largely incurable disease. However, survival rates continue to increase as advances in the understanding of the biology of tumorigenesis are made. Angiogenesis plays a major role in tumor formation and therefore, agents targeting this process, including the monoclonal antibody bevacizumab, are particularly successful at treating tumors. In addition, the introduction of the monoclonal antibody trastuzumab has dramatically improved outcomes for women with human epidermal growth factor receptor 2 (HER2)-positive MBC and reaffirmed the value of targeting specific cellular proteins as a means of controlling disease. This has led to the development of a plethora of new agents for the treatment of HER2-positive breast cancer in the metastatic setting, though optimal chemotherapy regimens are still under investigation.

Ms. Paolilli is a clinical nurse specialist for the Thoracic Oncology Service at Memorial Sloan- Kettering Cancer Center (MSKCC) in New York City. She is also editor of PEPID RN ONS, a pointof- care reference program developed by the Oncology Nursing Society and PEPID. She has worked in thoracic oncology nursing for more than 10 years. Ms. Paolilli received her master’s degree in nursing from Pace University in New York City. She has presented on various lung cancer topics, including mesothelioma, chemotherapy administration, and small cell lung cancer. Ms. Paolilli is a member of the Oncology Nursing Society and is the recipient of the Excellence in Communication award from her peers at MSKCC.

Diane E. Paolilli, RN, MSN, AOCN^® reported a financial interest/relationship or affiliation in the form of: Speakers' Bureaus, Genentech BioOncology.

Nursing Management of Patients With NSCLC Receiving Targeted Therapies

As the use of targeted therapies continues to expand in the treatment of patients with non-small cell lung cancer (NSCLC), oncology nurses need to be increasingly familiar with optimal side-effect management. This presentation will focus on strategies for controlling adverse events commonly encountered with targeted therapies (eg, diarrhea, rash, hypertension) without compromising disease management. The oncology nurse’s role in providing effective early intervention, performing ongoing assessment, providing patient education, and encouraging adherence to treatment will be highlighted.