Cancer Immunotherapy Update
Nurses play a pivotal and strategic role in immunotherapy treatment. By understanding how the treatment process works and the possible adverse effects, nurses can help better educate patients. Nurses can also assist their patients in setting reasonable expectations and clarifying treatment goals. Learn more about immunotherapy in this article.
Because cancer treatment (surgery, radiation, and chemotherapy) frequently fails, researchers began asking why patients’ immune systems do not respond to cancer cells like they do to bacteria and viruses. Under normal conditions, T lymphocytes (T-cells) bind to a tumor cell via programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) receptors and then send signals that recruit antigen-presenting cells (APCs) that attach to the T-cells via the cytotoxic T lymphocyte antigen-4 (CT-LA-4) binding arm. Next, a series of cytokines (such as gamma interferon, interleukin 12 and B7) work to kill the T-cell and the tumor cell through apoptosis (cell death). Cancer tumor cells, however, block T-cells from binding to dendritic cells, allowing the cancer to escape detection by the patient’s immune system.
The U.S. Food and Drug Administration (FDA) has approved several immunotherapy agents to treat cancer. They help the immune system recognize tumor cells, prevent immune system tolerance of tumor cells, and manipulate translational proteins in the tumor microenvironment. However, these drugs come with accompanying toxicities (immune-related adverse effects). This article focuses on two recently approved treatments—immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy—their immune-related adverse effects, and treatment options. By understanding how these treatments work and their possible adverse effects, nurses can better educate patients and intervene quickly when necessary.
Key Learning Outcomes
- Describe how immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy work.
- Discuss adverse effects related to immune checkpoint inhibitors.
- Discuss adverse effects related to CAR T-cell therapy.
Victoria L. Anderson, MSN, CRNP, FAANP is a senior nurse practitioner in the Laboratory of Clinical Immunology and Microbiology, Immunopathogenesis Section at the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) in Bethesda, Maryland.
Leslie Smith, MSN, RN, AOCNS, APRN-CNS is a clinical nurse specialist in oncology, blood and marrow transplant at the NIH Clinical Center Nursing Department in Bethesda, Maryland.