Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice.

In recent years oral mucosal injury has been increasingly recognized as an important toxicity associated with mammalian target of rapamycin (mTOR) inhibitors, including in patients with breast cancer who are receiving everolimus. This review addresses the state-of-the-science regarding mTOR inhibitor-associated stomatitis (mIAS), and delineates its clinical characteristics and management. Given the clinically impactful pain associated with mIAS, this review also specifically highlights new research focusing on the study of the molecular basis of pain. The incidence of mIAS varies widely (2-78%). As reported across multiple mTOR inhibitor clinical trials, grade 3/4 toxicity occurs in up to 9% of patients. Managing mTOR-associated oral lesions with topical oral, intralesional, and/or systemic steroids can be beneficial, in contrast to the lack of evidence supporting steroid treatment of oral mucositis caused by high-dose chemotherapy or radiation. However, steroid management is not uniformly efficacious in all patients receiving mTOR inhibitors. Furthermore, technology does not presently exist to permit clinicians to predict a priori which of their patients will develop these lesions. There thus remains a strategic need to define the pathobiology of mIAS, the molecular basis of pain, and risk prediction relative to development of the clinical lesion. This knowledge could lead to novel future interventions designed to more effectively prevent mIAS and improve pain management if clinically significant mIAS lesions develop.

Nursing Roles in Cardiac Safety: Romidepsin in Patients With T-Cell Lymphoma.

PURPOSE/OBJECTIVES: To provide information to help nurses mitigate cardiac risks among patients receiving romidepsin (Istodax®), a histone deacetylase (HDAC) inhibitor approved by the U.S. Food and Drug Administration for the treatment of relapsed/refractory cutaneous and peripheral T-cell lymphoma. 
. DATA SOURCES: Clinical studies of romidepsin represented the primary data sources. Supporting references included class information on HDAC inhibitors, as well as data regarding the impact of electrolyte imbalances and antiemetic treatment on electrocardiogram (ECG) data.
. DATA SYNTHESIS: Cardiac concerns during treatment with romidepsin are multifactorial. Electrolyte deficiencies, which are associated with ECG abnormalities and dysrhythmias, are common among patients with T-cell lymphoma. In addition, clinically insignificant changes in the corrected QT interval reported with romidepsin are primarily attributable to concomitant use of prophylactic antiemetics and likely exaggerated by transient increases in heart rate. 
. CONCLUSIONS: Data support the cardiac safety of romidepsin while cautioning about the need for nurses' vigilance regarding consistent electrolyte supplementation, appropriate antiemetic selection, and heart rate monitoring. 
. IMPLICATIONS FOR NURSING: By recognizing drug-related and non-drug-related influences on cardiac safety during treatment with romidepsin, as well as other anticancer agents, nurses can identify risks, report them, and recommend appropriate interventions, which, ultimately, facilitates improved patient outcomes.

Nursing Implications of Chemotherapy Agents and Their Associated Side Effects in Patients With Pancreatic Cancer.

BACKGROUND: Survival for patients with advanced (locally advanced unresectable and metastatic disease) pancreatic cancer is very poor; however, several advances in treatment have been made during the past several years. Gemcitabine (Gemzar®)-based regimens, FOLFIRINOX, and nab-paclitaxel (Abraxane®)-based regimens have demonstrated efficacy in patients with advanced pancreatic cancer. Understanding the unique safety profile of each of these regimens is crucial in helping nurses identify symptoms, develop patient education strategies, and ultimately improve outcomes. OBJECTIVES: This article aims to provide background information on and nursing implications of the treatment of patients with advanced pancreatic cancer by exploring the mechanism of action and efficacy and safety profiles of standard treatment regimens. METHODS: Key trials of standard treatment regimens used in the treatment of advanced pancreatic cancer were examined with respect to efficacy outcomes and the most commonly observed adverse events. Symptom identification and management strategies are discussed from the nursing perspective. FINDINGS: The current standard treatment options for patients with advanced pancreatic cancer have differences in efficacy and safety profiles. Nurses should educate themselves on these differences, particularly on associated adverse events and their management.