Urologic malignancies affect thousands of people annually, resulting in significant morbidity and mortality. The landscape for treatment of advanced bladder and renal cell carcinomas has changed significantly over the last several years, with new options ranging from immune checkpoint inhibitors (ICIs), antibody drug conjugates (ADCs), FGFR inhibitors (FGFRIs), and combination therapies, among others.
The expansion of treatment options for patients with bladder cancer and renal cell carcinoma has resulted in longer overall survival though, unfortunately, none of these options is curative. A review of new treatments and management strategies for bladder and renal cancers was presented at the 2023 ONA Summit Live Virtual Meeting.
Given the rapidly developing therapeutic options for these cancers, it is imperative that oncology nursing professionals remain up to date with all the different components of these treatments including mechanisms of action, toxicity profiles (both most common side effects and more rare, but serious adverse events); management of adverse events; patient selection and options for treatment sequencings; and recognition of disparities in care.
Overlapping complexities in treatment selection, sequencing of agents, and management of adverse events may contribute to clinicians’ lack of comprehensive knowledge of patient characteristics and newer guidelines recommendations. Although the development of new treatment options is promising, clinicians must also include patient goals of care, quality of life values, and preferences into the treatment decision making process.
The most common subtype of bladder cancer is urothelial carcinoma, and the most common subtype of renal cell carcinoma is clear cell; treatment of rarer subtypes of either cancer are outside the scope of this presentation. Many potential risk factors for these malignancies have been identified, though pinpointing an exact cause is often challenging. Cigarette smoke is a risk factor for both bladder and renal cell carcinomas.
Advanced bladder cancer is treated with platinum-based chemotherapy for those who meet eligibility criteria. In the last few years, immunotherapy agents have come to play an important role in treatment after chemotherapy or initially, for patients who are ineligible to receive chemotherapy. These agents may be used in the maintenance setting (eg, avelumab), in the first-line setting for platinum-ineligible patients (eg, pembrolizumab), and in subsequent lines of treatment.
Erdafitinib (an FGFRI) and enfortumab vedotin (an ADC) may be used in the second- or third-line space, depending on patient characteristics. Sacituzimab is approved for use in the third-line setting. All of these medications, regardless of mechanism of action, have unique and somewhat complicated toxicity profiles, which may be unfamiliar to some clinicians. Patient and caregiver education plays a key component in ensuring prompt reporting of any adverse event that occurs, to initiate a toxicity management plan.
Options for treating metastatic renal cell carcinoma were relatively limited until the introduction of tyrosine kinase inhibitors (TKIs), ICIs, and combination therapies. While the therapeutic options are more expansive, the data on sequencing are limited. In addition, management of adverse events associated with monotherapy are challenging, but pose an even greater challenge in combination with ICIs.
Oncology nursing professionals are well poised to provide exceptional care to patients with urologic malignancies by staying abreast of new therapeutic options, toxicity management, and patient and caregiver education.
Mary Dunn is an adult nurse practitioner at University of North Carolina at Chapel Hill, Department of Urology and Department of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.
Dunn MW. Updates in the management of bladder and renal cancers: new options, new hope. Oral presentation at: 2023 ONA Summit Live Virtual Meeting; March 17-19, 2023.
This article originally appeared on Oncology Nurse Advisor