Targeted Therapies in Lung Cancer: Management Strategies for Nurses and Practitioners

Chapter 1. Introduction
Marianne Davies & Beth Eaby-Sandy

Chapter 2. Introduction to Mutation Testing
Vanna Dest, Kathryn Medow

Chapter 3. Nursing Considerations with EGFR inhibitors in NSCLC
Michelle Turner

Chapter 4. Nursing Considerations with ALK and ROS1 inhibitors in NSCLC
Beth Eaby-Sandy

Chapter 5. BRAF in Non-Small Cell Lung Cancer
Helen Shih

Chapter 6. Mechanisms of acquired resistance to targeted therapy in NSCLC: Role of Repeat Biopsy and Nursing Considerations
Emily Duffield

Chapter 7. The Impact and Toxicity of Checkpoint Inhibitors in Management of Lung Cancer.
Stephanie Crawford Andrews, Marianne Davies

Chapter 8. The Role of Anti-Angiogenic Agents (VEGF)
Melinda Oliver and Elizabeth S. Waxman

Chapter 9. Nursing Considerations for Patients Treated with Targeted Therapies
Kelly E. Goodwin, Marianne Davies

This book aims to educate nurses and advanced practice providers (APP's) about known mutations, availability of targeted therapy and the management of patients with non-small cell lung cancer (NSCLC). It will educate nurses and practitioners about the scope of therapy to assure safe and effective lung cancer treatment. In this era of personalized medicine, nurses and APP's are responsible for guiding patients from diagnosis through treatment. This starts with the identification of patients that can benefit from these therapies, the key role of biopsy acquisition (ie. what to test, when and how often) and treatment selection based on the mutation identified. Readers will learn about the mechanisms of action, administration, potential adverse side effects and unique management strategies for these targeted agents.

Lung cancer continues to be the leading cause of cancer death in the United States and worldwide. Recent advances in the identification of specific oncogenic mutations that drive cancer development, growth and metastasis have led to major paradigm shifts in lung cancer treatment. Sophisticated methods are required to identify specific mutations at the time of diagnosis. This book explains how molecularly targeted therapies have been developed that target these drivers.

To date, several tyrosine kinase inhibitors have been approved to target the epidermal growth factor receptor (EGFR), EML4-ALK ,ROS1 and BRAF. Most recently, immune checkpoint inhibitors have been approved with some indication that efficacy may be enhanced for patients who overexpress PD-L1. While some driver mutations have been identified, there is ongoing investigation into additional mutations. In the case of driver mutations, lung cancers will develop resistance to therapy. This book provides nurses and APP's with the mechanisms of resistance that have been identified such as T790 mutation and many others in the EGFR mutation, and shows how the next level of drug development is focused on identifying mechanisms of resistance and development of new agents that overcome these mutations. 

With this book in hand, nurses and practitioners will be able to navigate patients through this ever expanding field of lung cancer treatment.

Dr. Marianne Davies is a graduate of Russell-Sage College (BSN), Yale University School of Nursing (MSN-Oncology Clinical Nurse Specialist and Post-Masters-Acute Care Nurse Practitioner) and MGH Institute of Health Professions (DNP & Certificate of Teaching and Learning). She is an Assistant Professor of Nursing at the Yale School of Nursing, teaching in the Masters and Doctoral programs and coordinator of the Oncology Nurse Practitioner Concentration. She has a joint appointment at the Yale Comprehensive Cancer Center. She has been an Oncology Nurse Practitioner in Thoracic Medical Oncology for several years. Her areas of specialization are clinical trials of immunotherapy agents, targeted therapies and new drug development. Her specific concentration is the management of toxicities associated with immune and targeted therapeutics. She has authored several articles in peer reviewed journals as well as book chapters. She speaks nationally and internationally on the topics of lung cancer, treatment and management strategies. She is a member of the Advanced Practitioner Society for Hematology and Oncology (APSHO), Oncology Nursing Society (ONS), International Association for the Study of Lung Cancer (IASLC), International Thoracic Oncology Nursing Forum (ITONF), Society for Immunotherapy of Cancer (SITC) and Association of Community Care Centers Institute for Clinical Immuno-Oncology (ICLIO).

Beth Eaby-Sandy is an oncology nurse practitioner working in the Abramson Cancer Center at the Hospital of the University of Pennsylvania. She has been in oncology fort 20 years, and has specialized in thoracic oncology as a nurse practitioner for the past 16 years. She serves as associate editor for the JADPRO journal, and is a reviewer for the Supportive Care in Cancer journal. She has published in several peer-reviewed nursing and medical journals as well as book chapters. She is an active member of IASLC and ITONF, serving on committees for both organizations, and a member of APSHO and SITC. She also speaks nationally and internationally on the topics of lung cancer and supportive care for oncology treatments.