Role of Nurses in the Multidisciplinary Management of RCC

Chung-Han Lee, M.D.: Ms. Virdee, can you speak a little about the role that nurses play in the multidisciplinary management of patients with kidney cancer?

Kiran Virdee, R.N., BSN, CCRN: Yes. Thank you, Dr. Lee. Nurses play a critical role in the multidisciplinary management of patients with RCC [renal cell carcinoma]. They’re usually the first point of contact when patients have questions or concerns regarding their treatment. Nurses provide thorough education on the medication regimens that we prescribe. The education includes how often to take the medication, how to take the medication, their treatment cycles and most important, what adverse events to monitor at home. It’s critical to make sure patients receiving care for RCC understand to call the office and review any adverse events that may occur.

Nurses also help facilitate the management of these adverse effects by doing multiple follow-up phone calls with patients. We have to call patients who may live far away to reach out to them and see how they’re doing with the interventions we provide, and sometimes have them come in for further evaluation if necessary. Aside from the medical standpoint, nurses are also there for patients and their family members from the initial diagnosis through treatment. They’re able to provide referrals to social workers for family concerns and practical concerns.

We also talk about reaching out to support groups. Nurses are able to have patients connect with psychiatrists should there be any concern for depression or anxiety with their disease and treatment. Nurses also help patients connect with financial assistance programs. The medications sometimes come at a higher cost, so we try to help patients in any way we can. In general, nurses wear many hats while providing care for our patients. We’re front and center. As a nurse, it’s important to remember that each patient experience is unique. One patient’s response to treatment may not be the same as the next. It’s important to have open communication with the patients so they can call and reach out if they have any concerns.

Chung-Han Lee, M.D.: Thank you so much. Cancer care is very much a team sport. Between the patient end, nursing end and physician end, it’s a collaboration of everyone, in addition to the patient’s relative support group. Everyone comes together to try to optimize the outcomes. Deciding on the treatment is the first step of the journey. It’s critical to make sure we can properly give treatment and that we’re balancing all the risks and benefits throughout and making adjustments as necessary. As the treatments develop, we’re going to learn a lot about the different efficacies and toxicities that might come about.

Looking into the future, we have been very fortunate to have multiple regimens FDA approved. There are a couple of fairly exciting clinical trials looking at what we call triplet combinations. These are using three drugs instead of the two drugs that we’ve been using to see whether an addition of a third drug could be beneficial. For example, there’s the COSMIC-313 clinical trial. Like Ms [Meryl] Uranga, who had ipilimumab-nivolumab up front, it looks at whether adding a tyrosine kinase inhibitor [TKI] with a treatment like ipilimumab-nivolumab can work even better than doing more of a sequencing approach, which she had before. That trial is looking at the combination of ipilimumab-nivolumab with a TKI called cabozantinib and comparing that with ipilimumab-nivolumab alone.

Another trial that’s quite interesting and promising is looking at the addition of a third agent to a combination, like lenvatinib plus pembrolizumab. There’s a triplet looking at quavonlimab, which is an anti-CTLA4, and another immunotherapy drug in a triplet combination, so two immunotherapy drugs in combination with lenvatinib. Or there’s the addition of belzutifan. Belzutifan is a very novel agent that isn’t FDA approved for clear cell kidney cancer. But we’re all very excited about it because it addresses one of the key transcription factors that are necessary for kidney cancer to develop. We’re using that in combination with lenvatinib plus pembrolizumab to see whether addressing this key pathway within kidney cancer pathogenesis can be beneficial. This is a very exciting field in which we’re hoping to understand more about the science to improve patient outcomes.

Transcript edited for clarity.