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Course: Oncology Nursing

Topic: Targeted Therapies in Cancer Treatment Part 1

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Module Goals

Learners will be able to:

Describe the role of targeted agents in the treatment and palliation of cancer.
Define the classification of targeted therapies.
Describe the factors influencing the selection of targeted therapies for cancer.
Compare and contrast the methods for administering targeted therapies.
Summarize the future directions in therapies on various health domains.

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What is Targeted Therapy?

American Cancer Society, 2021

“Targeted therapy is a type of cancer treatment that uses drugs designed to "target" cancer cells without affecting normal cells”

Block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer
Are sometimes called "molecularly targeted drugs” or "molecularly targeted therapies”

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Chemotherapy vs Targeted Therapy

Chemotherapy

Toxic to most cells
Can damage the normal cells as well as killing cancer cells
Kills mature cancer cells

American Cancer Society,2021

Targeted Therapy

Affects cancer cells
Usually does not affect normal cells
Blocks cancer cells from copying themselves
(stops a cancer cell from dividing and making new cancer cells)

American Cancer Society,2021

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Role of Targeted Agents

American Cancer Society, 2021

The actions of targeted drugs:

Block or turn off chemical signals that tell the cancer cell to grow and divide.
Change proteins within the cancer cells so the cells die.
Stop making new blood vessels to feed the cancer cells.
Trigger the immune system to kill the cancer cells
Carry toxins that destroy cancer cells but not normal cells.

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Role of Targeted Therapies

Actions of targeted therapies depend on the agent it contains
The roles of targeted therapies include:

Enhancement of the individual's immune system.
Alteration of the environment in which cancer cells grow.
Increase the vulnerability of cancer cells to the body's immune system.
Alteration in the pathway where normal cells transform to malignant cells.
Prevention of metastasis of cancer cells.
Enhance the repair of normal cells damaged by treatment.
Facilitate the delivery of toxic therapies to cancer cells.

EdCan Cancer Australia, 2021

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Role of Targeted Therapies (continued)

The therapeutic and supportive roles of targeted therapy in cancer control include:

Curative, when used in the primary or adjuvant setting.
Improves treatment response by improving disease free survival when used in conjunction with conventional therapies.
Control or stabilize disease in advanced cancers in the palliative care setting.
Maintain or enhance quality of life.
Minimize the severity of toxicities associated with other therapeutic treatments.

Edcan Cancer Australia, 2021

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Critical Thinking Question

An oncologist is planning to start a targeted therapy on a client to minimize the effects on the normal cells of the client. What are the different roles of target agent? (Select all that apply)

Change the protein within in cancer cells causing the cancer cells to die
Block or turn off the chemical signal that tells cancer cell to grow
Stop making new blood cells which feed the cancer cells
Trigger your immune system to kill the cancer cells

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Classification of Targeted Therapies

Angiogenesis inhibitors: block the formation of new blood vessels that feed and nourish the cancer cells.

Example: bevacizumab (used for many different cancers)

Monoclonal antibodies that deliver toxin molecules:

deliver molecules by themselves or molecules with drugs into or onto the cancer cell to kill it

Examples: alemtuzumab (certain chronic leukemias), trastuzumab (certain breast cancers), cetuximab (certain colorectal, lung, head and neck cancers)

American Cancer Society, 2021

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Classification of Targeted Therapies (continued)

Proteasome inhibitors: These disrupt normal cell functions causing the cancer cells die. Example: bortezomib (multiple myeloma)¹
Signal transduction inhibitors: These disrupt cell signals so that they change the actions of the cancer cell¹. Example: imatinib (certain chronic leukemias)
Hormone therapies: slow or stop the growth of hormone-sensitive tumors, which require certain hormones to grow²

American Cancer Society, 2021)
EdCan Australia, 2021

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Classification of Targeted Therapies (continued)

Gene expression modulators: Modify the function of proteins that play a role in controlling gene expression.

Apoptosis inducers: Cause cancer cells to undergo a process of controlled cell death.

Immunotherapies: Trigger the immune system to destroy cancer cells. Some monoclonal antibodies bind to certain immune cells to help these cells better kill cancer cells.

Edcan Australia, 2021

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Factors Influencing Selection of Targeted Therapy

National Cancer Institute-2021

Types of cancer:

Tumor tissue must be tested to determine whether an appropriate target is present:

If no mutation is present then the therapy is not appropriate.

Patients may be a candidate for a targeted therapy when:

Cancer did not respond to other therapies
Cancer has spread
Cancer is inoperable

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Critical Thinking Question

Among all the cancer patients in an oncology ward who which one would be the right clients for the targeted therapy? (Select all that apply)

A client who got tissue tested and found no mutation
A client who did not respond to another therapy
A client whose cancer has spread
A client with inoperable tumors

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Methods for Administering Targeted Therapies

American Cancer Society, 2019

Intravenous Routes:

IV push: the drugs can be given quickly through the catheter from a syringe over a few minutes.
IV infusion: a typical infusion may last from a few minutes to a few hours. The flow is usually controlled by an electronic machine called an IV pump.

Central Venous Catheter (CVS)
Oral: Pills, Capsules, Liquids and swallowed like other oral medicines.

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Principles of Administering Targeted Therapies

Biopharmaceuticals are protein-based agents and refrigeration is often required.
Biopharmaceuticals cannot tolerate extreme temperature when transported in car boots and aeroplane baggage holds.
When lyophilised product is reconstituted the vial should not be shaken, and the solution should be directed down the side of the vial and not onto powder.
Do not shake as this may cause foaming and can denature the protein.
Biopharmaceuticals are not all compatible with all plastic syringes and intravenous tube.

Australian Government, Cancer Australia, 2021

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What a nurse would do?

A nurse in a oncology unit is to begin the targeted therapy on a client who has metastatic cancer of lungs. What should the nurse do when administering a targeted therapy? (Select all that apply)

Refrigeration of targeted drugs
When lyophilised product is reconstituted the vial should not be shaken
When lyophilised product is reconstituted the vial should be shaken
Check the compatibility of agents with intravenous tubing

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Future Directions in Therapies

A broad range of strategies at both the preclinical and clinical stages of investigation are currently being explored.
Strategies fall into three broad categories:

Recapitulating organ and tissue structure via scaffold fabrication, 3D bioprinting, and self assembly.
Integrating grafts with the host via vascularization and innervation
Altering the host environment to induce therapeutic responses, particularly through cell infusion and modulating the immune system.

Mao & Mooney, 2015

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References

American Cancer Society, 2021. How Targeted Therapies Are Used to Treat Cancer. Retrieved from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy/what-is.html

American Cancer Society, 2019. Methods of getting targeted therapy. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy/targeted-therapy-things-to-know.htm

Australian Government, Cancer Australia, 2021. Principles of administration of targeted therapy. Retrieved from:https://www.edcan.org.au/edcan-learning-resources/supporting-resources/targeted-therapies/administration-principles

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References:

Australian Government Cancer Australia, 2021. Targeted Therapies in Cancer Treatment.Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/targeted-therapies/overview-of-targeted-therapies

lmao, A. S., & Mooney, D. J. (2015). Regenerative medicine: Current therapies and future directions. Proceedings of the National Academy of Sciences of the United States of America, 112(47), 14452–14459. https://doi.org/10.1073/pnas.1508520112

National Cancer Institute, 2021. Targeted Cancer Therapies. Retrieved from: https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet#how-is-it-determined-whether-a-patient-is-a-candidate-for-targeted-therapy

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