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Post-Conference Session Summaries“Radiation and Targeted Therapies: The Dynamic Duo” Instructional Session 21, presented Thursday April 26, 2007 Targeted therapies and radiation are becoming more and important in cancer care. This session highlighted the role of radiation in two specific diseases, head and neck cancer and lung cancer, and its side effects in both cases; and targeted therapies and related nursing implications. Head and neck cancer was diagnosed in more than 40,000 people in 2006, most in advanced stages. Depending on stage at diagnosis, patients with head and neck cancer can be treated with surgery, radiation, chemotherapy, biologics, or a combination. Types of radiation for this type of cancer include conventional, three-dimensional treatment planning, intensity modulated, and brachytherapy. Acute side effects with irradiation of the head and neck area are fatigue, skin reactions, xerostomia, mucositis, dysphagia and odynophagia, taste alterations, and weight loss and anorexia. Chronic side effects are xerostomia, dental complications, trismus, oral infections, hypothyroidism, and osteoradionecrosis. The presenters offered myriad solutions for the most common side effects, including pharmacologic and nonpharmacologic interventions. Lung cancer caused more than 160,000 deaths in 2006. Survival rates are poor, despite treatment modalities of surgery, radiation, chemotherapy, biologics, and several combinations. Types of radiation in lung cancer are the same as with head and neck cancer, with the addition of image-guided radiotherapy. In addition, radiation can be used for palliation in terminal cases. Acute side effects of irradiation of the lungs are fatigue, skin reactions, esophagitis, and pneumonitis. Pneumonitis also can be chronic, along with fibrosis. Presenters offered strategies for management of the side effects. Targeted therapies are directed toward specific pathways, such as antigens, growth factors, receptors, and other molecules, to moderate, control, or kill cancer cells. One example of a target for therapy is epidermal growth factor receptor (EGFR), which is overexpressed in many types of cancer, including head and neck cancer and lung cancer. Examples of agents currently available that target EGFR are cetuximab (Erbitux®, Imclone), erlotinib (Tarceva®, Genentech/OSI), gefitinib (Iressa®, AstraZeneca). Cetuximab, a monoclonal antibody, is indicated in the treatment of EGFR-expressing metastatic colorectal cancer, as well as squamous cell carcinoma of the head and neck. Erlotinib, a tyrosine kinase inhibitor, is used as monotherapy for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy treatment. Gefitinib is another tyrosine kinase inhibitor, and its benefits are being reviewed by the U.S. Food and Drug Administration. Its initial indication was for patients with NSCLC who had failed platinum-based and docetaxel chemotherapies, but it is not currently available to new patients. The session reviewed administration guidelines, side effects, and management of all three medications. In general, EGFR inhibitors cause grade 1 or 2 dermatologic toxicities in 75%-85% of recipients, sometimes requiring dose modifications. The reason for the side effect is unknown. A sterile, follicular rash often appears on the face, chest, and upper back within one to three weeks of treatment, but the rash improves over time and resolves spontaneously when treatment stops. Options for keeping patients comfortable were reviewed, such as avoiding sun and using mild soaps and agents to soothe the rash. Healthcare professionals armed with combination therapy should be aware that combination therapy boosts tumor cell kill but also increases side effects and decreases quality of life. Therefore, they should be well aware of the side effects and management strategies.
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