Immunotherapy Summit: Proceedings and Identified Priorities for Safe Administration and Care.

BACKGROUND: Oncology nurses play a significant role in ensuring optimal care coordination for patients receiving immunotherapies. OBJECTIVES: The Oncology Nursing Society hosted an immunotherapy summit in March 2018. Summit attendees identified and prioritized several critical resource needs to best support oncology nurses administering immunotherapies and caring for patients receiving these therapies. METHODS: Priorities address care coordination; immunotherapy-specific education for healthcare professionals, patients, and their caregivers; and appropriate assessment, intervention, and documentation to contribute to the science of immunotherapies. FINDINGS: This article summarizes summit proceedings and priorities for safe administration and care related to immunotherapies.

Immunotherapy Administration: Oncology Nursing Society Recommendations
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As the use of immunotherapeutic agents increases in single-agent and multimodality treatment regimens, oncology nurses face the challenge of administering and caring for patients receiving new and unique agents. Oncology Nursing Society clinical staff and clinical nurses collaborated to produce a set of recommendations to educate nurses involved with the monitoring of patients receiving immunotherapy on administration procedures and safe handling of these agents to ensure patient and staff safety and to reduce risk of error. The recommendations are meant to provide clinical nurses with a framework on which to build policies and procedures for administering new treatment modalities.
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Checkpoint Inhibitors: Common Immune-Related Adverse Events and Their Management
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BACKGROUND: Immunotherapy, specifically the use of checkpoint inhibitors, offers patients with cancer an alternative to chemotherapy, targeting different pathways to destroy cancer cells. The side effects of immunotherapies, as well as their impact on normal tissue, need to be assessed and managed based on their mechanisms of action. OBJECTIVES: This article presents an overview of immune-related adverse events (AEs). 
. METHODS: Common immune-related toxicities, as well as rare and refractory toxicities, are reviewed. 
. FINDINGS: Immunotherapy treatment is an option for many patients with cancer, and nurses must understand the distinct side effect profile of these agents. Prompt identification and expert management are the cornerstones of success when dealing with immune-related AEs, and oncology nurses play a key role in improving patient care.

Toxicity Management: Development of a Novel and Immune-Mediated Adverse Events Algorithm
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BACKGROUND: Novel immunotherapy and biologic agents are being developed with the potential to improve outcomes and reduce long-term toxicities among individuals with hematologic malignancies. These emerging drugs affect neoplastic cells and the surrounding microenvironment, causing unique immune-mediated toxicities.
. OBJECTIVES: The aim was to develop an algorithm for clinical staff to manage unique toxicities associated with next-generation immunotherapies indicated in the hematologic population, using a system-focused approach.
. METHODS: Data were collected using specific toxicities based on the four major novel biologic classes. Immune-mediated adverse events were reported across studies. Based on published literature, institutional experience, and group consensus, a novel algorithm for managing immune-mediated toxicities was created.
. FINDINGS: The development of this treatment algorithm provides a more streamlined approach for managing common but unique toxicities and improves safety, compliance, patient outcome, and quality of life with novel immuno-oncologic agents.

Efecto de la inmunoterapia con el bacilo de Calmette-Guérin sobre la capacidad migratoria e invasiva del cáncer escamoso de cabeza y cuello en un modelo in vitro 3D / Effect of immunotherapy with bacillus Calmette-Guérin on migratory and invasive capacity in a 3 D head and neck squamous cell carcinoma model

El cáncer escamoso de cabeza y cuello se caracteriza por su tendencia a la invasión local y a distancia, además de una alta predisposición a la aparición de segundas neoplasias. El proceso de invasión y metástasis es complejo y tiene múltiples etapas. Las metaloproteinasas de matriz 2 y 9, se sobreexpresan en el cáncer escamoso de cabeza y cuello donde actúan degradando la membrana extracelular favoreciendo así la invasión tumoral y la metástasis. El bacilo de Calmette-Guérin (BCG) ha sido usado como inmunomodulador en el tratamiento de algunos tipos de cáncer con buenos resultados. El propósito de este estudio es determinar el efecto de la activación inmune mediada por el BCG sobre la migración e invasión usando un modelo in vitro 3 D de cultivos de células tumorales de faringe cocultivadas con células mononucleares de sangre periférica en contacto o no con el BCG. Para determinar la expresión de las metaloproteinasas y p53 se realizó Western blot y para la migración e invasión, kits comerciales. Los resultados muestran disminución en la expresión de metaloproteinasas, p53 y en la migración en el grupo BCG (AU)

Head and neck squamous cell carcinoma is characterized by local invasion and a propensity for dissemination to cervical lymph nodes and recurrence. Cancer cell invasion and metastasis represent complex, multistep process. The remodelling of ECM by MMPs is one of the most crucial steps for cancer progression. MMP-2 and MMP-9, are over expressed in head and neck squamous cell carcinoma where they act to degrade the basement membrane thus promoting tumor invasion and metastasis. Bacillus Calmette-Guérin (BCG) has been used as an immunomodulator in treating some cancers with good results. The purpose of this study is to determine the effect of BCG immune activation in migration and metastasis using in vitro 3 D cultures pharyngeal tumor cells were co-cultured with previously isolated peripheral blood mononuclear cells, in experimental groups or cultured alone. MMPs and p53 was determinate by Western blot and the invasion-migration using commercial assays. Our results showed decreasing expression of MMPs, p53 and significantly reduced migration in BGC group (AU)

Mothers' "liquid gold": a quality improvement initiative to support early colostrum delivery via oral immune therapy (OIT) to premature and critically ill newborns.

Early breast milk, known as colostrum ("liquid gold") provides immune benefits to infants, offering potential risk reduction for nosocomial infection (NI) and necrotizing enterocolitis (NEC), a serious gastrointestinal emergency. Provision of colostrum is recognized as oral immune therapy (OIT) and is valuable to all NICU infants unable to feed orally. A quality improvement project was initiated by the multidisciplinary NICU Quality Care Council at London Health Sciences Centres-Victoria (LHSC-VH) to obtain mothers' colostrum for early OIT. The initiative was driven by the Canadian EPIQ (Evidence-based Practice for Improving Quality) group as a means of reducing the rates of NEC and NI, two major morbidities in the NICU. The overall aim was to facilitate the availability of OIT to preterm and critically ill neonates as soon as possible after birth.

Inmunoterapia alérgica desde Atención Primaria de Salud / Allergen immunotherapy from Primary Health Care

La vacuna o inmunoterapia es el único tratamiento etiológico y específico de las enfermedades alérgicas capaz de modificar su curso natural.El objetivo de este artículo es mostrar una actualización en la administración de la inmunoterapia alérgica (subcutánea y sublingual) en el ámbito de la Atención Primaria de Salud, así como en las recomendaciones generales para el paciente con alergia. Para ello se llevó a cabo una revisión de la literatura.No se han encontrado diferencias sobre la modificación de pautas y la actuación en caso de reacciones adversas. Además se ha de valorar la inmunoterapia sublingual, la cual se está posicionando como forma segura y eficaz en el tratamiento de la enfermedad alérgica. Esta vía de administración presenta una buena tolerancia, comodidad de administración y escasez de efectos secundarios en los pacientes alérgicos (AU)

Vaccines or immunotherapy is the only causal and specific treatment of allergic diseases able to modify the natural course of allergic disease.The aim of this paper is to show an update on the administration of allergenim munotherapy (subcutaneous and sublingual) in the field of PrimaryHealth Care, as well as general recommendations for patients with allergy. To this end a review of the literature was carried out.No differences were found on the modification of regimen patterns or actions to be taken in adverse reactions. In addition, sublingual immunotherapy has to be assessed, which is positioning it self as a safe and effective method in the treatment of allergic disease. This route of administration affords a good tolerance, ease of administration and lack of side effects in allergic patients (AU)

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Dendritic cells: emerging roles in tumor immunotherapy.

The purpose of this article is to examine the use of myeloid dendritic cells (DCs) as immunotherapy in the treatment of cancer. DCs can be stimulated either from circulating blood or bone marrow progenitor cells using cytokines, particularly granulocyte macrophage-colony-stimulating factor (GM-CSF) (e.g., sargramostim, Leukine). GM-CSF has been shown to promote maturation, mobilization, and antigen presentation of DCs in vivo or ex vivo as a therapeutic cancer vaccine. Once stimulated, DCs can present tumor antigen to naive T cells to initiate an immune response. In addition to myeloid-related DC stimulation, antitumor properties of GM-CSF include direct cytotoxicity, antiangiogenesis properties, and potential upregulation of antibody-dependent cellular cytotoxicity. Oncology nurses need to be knowledgeable regarding new therapies. Using knowledge gained through reading professional journals and self-education, nurses can inform patients of new therapies, which may increase patients' hope.

The nurse educator role in otolaryngic allergy.

Otolaryngic allergy is a subspecialty demanding the standards of excellence for otolaryngic nursing described by the American Nurses Association (1994). This article provides a review of basic immunology, environmental control measures, pharmacotherapy, and immunotherapy and explores the nurse educator role in the care of otolaryngic allergy patients.

Biological advances for new treatment approaches.

OBJECTIVES: To review malignant cell characteristics, which serve as the basis for the development of molecular, targeted cancer therapies. To provide an introduction and overview of new targeted agents, including monoclonal antibodies, enzyme inhibitors, antiangiogenic agents, gene therapy, and vaccines. DATA SOURCES: Published scientific papers, review articles, and book chapters. CONCLUSION: Through new understandings and theories of how cancer cells survive, thrive, and metastasize, researchers have created new targeted therapies for cancer treatment to minimize the harmful systemic effects of traditional therapy. IMPLICATIONS FOR NURSING PRACTICE: As with any new therapeutic modality, scientific rationale and mechanism of action must be appreciated by health care staff to build a solid foundation for patient education and to provide astute management of acute and latent effects.

Trends in cancer therapy: role of monoclonal antibodies.

OBJECTIVES: To discuss the scientific rationale for the use of monoclonal antibodies in cancer treatment and distinguish the unique characteristics of selected monoclonal antibodies. DATA SOURCES: Published scientific papers, abstracts, review articles, and book chapters. CONCLUSION: The continued discovery of intrinsic antigens/epitopes specific to malignant cells and the science of immune cell activation demonstrates the durability of monoclonal antibodies as mainstream immunotherapy. IMPLICATIONS FOR NURSING PRACTICE: With the success of monoclonal antibodies used in clinical practice, oncology nurses need to continue to increase their knowledge and competency. Monoclonal antibodies target tumor-associated antigens in both solid and hematologic tumors. It is imperative that nurses be familiar with specific aspects of each antibody infusion they administer.

Cancer vaccines.

OBJECTIVE: To provide a review of cancer vaccines, how they work, and the current state of the science underlying these treatments. DATA SOURCES: Research studies, review articles, book chapters, personal communications. CONCLUSION: Vaccines have been studied in a variety of malignancies; however, melanoma has provided the best tumor model for vaccination. Clinical trials continue to investigate the optimal vaccine, route, and immunization schedule. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must grasp a widening array of therapeutic options for cancer patients. The educational needs of the patient will be better met through a thorough understanding of basic concepts of newer cancer therapies.

Immunotherapy: a novel treatment for Non-Hodgkin's lymphoma.

OBJECTIVES: To provide an overview of the principles of immunology, including immunotherapy, and information about monoclonal antibody therapy in the treatment of non-Hodgkin's lymphoma. DATA SOURCES: Published literature. CONCLUSIONS: Immunotherapy is a form of disease treatment that enhances the immune system with the use of biologic agents. One such agent is the monoclonal antibody, which can be combined with a radioisotope (e.g., iodine-131 or yttrium-90) or chemotherapeutic drug to deliver treatment directly to tumor cells with less toxicity to normal cells. IMPLICATIONS FOR NURSING PRACTICE: As the field of monoclonal antibody therapy continues to grow, nurses will play an important role in treatment and patient education. Nurses need to become knowledgeable in this area of cancer treatment and gain a better understanding of basic principles involved in immunotherapy.

Urgencias derivadas de la inmunoterapia en alergología / Emergencies derived from immunotherapy in allergology

La controversia existente en la bibliografía consultada respecto a la seguridad de la inmunoterapia en alergología en diferentes países nos induce a realizar este estudio con el fin de evaluar sus riesgos. Para ello cuantificamos las reacciones adversas producidas en 2.413 pacientes tratados en la Unidad de Alergología del Servicio Navarro de Salud (Osasunbidea) durante el año 1994.De éstos, un 97,8 por ciento correspondían a pacientes con alergia por vía inhalatoria (61,2 por ciento asmáticos y 36,6 por ciento riníticos), y un 2,2 por ciento a pacientes con diagnóstico de anafilaxia por veneno de himenópteros. Se analizaron las reacciones sistémicas inmediatas, por ser las que entrañan un mayor riesgo potencial y las que originan situaciones de urgencia. Éstas se estudiaron en base a: diagnóstico clínico, alergeno, grado de reacción, fase de la vacuna y lugar de administración (Unidad de Inmunoterapia y/o centros de atención primaria). El porcentaje de reacciones registrado (0,9 por ciento de las dosis administradas) nos indica que la inmunoterapia es un tratamiento seguro si se lleva a cabo de forma monitorizada. La frecuencia de las reacciones sistémicas inmediatas (0,2 por ciento) está relacionada con el diagnóstico etiopatogénico del paciente y con la fase y el lugar de administración del extracto (AU)

Immunotherapy targets in critical care.

Advances in our understanding of the immune system and the body's normal response to injury have allowed for the development of innovative new therapies for critically ill patients. In the area of sepsis, significant information is being generated to support the concept that adjunctive immunotherapy can improve both morbidity and mortality. Investigational agents directed at immunotherapy targets that are currently being studied include colony stimulating factors, immunoglobulins, anticytokines, and opioid antagonists. This article reviews the basis for the use of such adjunctive immunotherapy in the critically ill patient.