Avelumab First-Line Maintenance Treatment in Advanced Bladder Cancer: Practical Implementation Steps for Infusion Nurses

Laura S Wood; Dawn Conway; Maria Lapuente; George Salvador; Sheila Fernandez Gomez; Andrea Carroll Bullock; Geeta Devgan; Kathleen D Burns

doi:10.1097/NAN.0000000000000465

Avelumab First-Line Maintenance Treatment in Advanced Bladder Cancer: Practical Implementation Steps for Infusion Nurses

J Infus Nurs. 2022 May-Jun;45(3):142-153. doi: 10.1097/NAN.0000000000000465.

Authors

Laura S Wood^{1

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9}, Dawn Conway^{1

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9}, George Salvador^{1

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9}, Sheila Fernandez Gomez^{1

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9}, Andrea Carroll Bullock^{1

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9}, Geeta Devgan^{1

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9}, Kathleen D Burns^{1

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Affiliations

¹ Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio (Ms Wood); University of Chicago Medicine, Genitourinary Oncology, Chicago, Illinois (Ms Conway); St Bartholomew's Hospital, London, United Kingdom (Ms Lapuente, Mr Salvador, Ms Fernandez Gomez); St George's Hospital, London, United Kingdom (Ms Fernandez Gomez); EMD Serono, Rockland, Massachusetts (Ms Carroll Bullock); Pfizer Inc, New York, New York (Dr Devgan); City of Hope Medical Center, Genitourinary Medical Oncology, Duarte, California (Ms Burns).
² Laura S. Wood, MSN, RN, OCN®, is the renal cancer clinical research coordinator at the Cleveland Clinic Cancer Center in Cleveland, Ohio. She completed both her bachelor's and master's degrees in nursing at Kent State University in Kent, Ohio. She is involved in the care of patients with renal and genitourinary cancers. Ms Wood is a member of the Protocol Review and Monitoring Committee, the Immunotherapy Education Committee, and the Immune-Related Adverse Event Tumor Board. She is also active in the local and national Oncology Nursing Society, the American Society of Clinical Oncology, and the Society for Immunotherapy of Cancer. A national and international lecturer on topics related to oncology nursing, Ms Wood has authored many book chapters and journal articles on therapeutic approaches and nursing care in the management of cancer. She was also the recipient of the 2012 Oncology Nursing Society Clinical Lectureship Award.
³ Dawn Conway, BSN, RN, OCN®, is a registered nurse with 14 years of oncology experience, the first 3 years of which were spent as a bone marrow transplant nurse at Mount Sinai in New York City. For the past 11 years, Ms Conway has been working with the genitourinary oncology group at University of Chicago Medicine, specifically with patients with urothelial cancer, making her an expert in urothelial cancer management.
⁴ Maria Lapuente, RN, works as the lead research nurse for the genitourinary team at St Bartholomew's Hospital in London, United Kingdom. She has 10 years of experience in oncology, including more than 4 years of cancer research collaboration with Dr Thomas Powles. She has specialized in immunotherapy treatments, particularly in phase 1 combination trials. Ms Lapuente has recently expanded her area of expertise into radiotherapy and chemotherapy in combination with immunotherapy trials for patients with metastatic nonsmall cell lung cancer. She is also the principal investigator for a questionnaire study exploring the assessment of the Managing Advanced Cancer Pain Together conversation tool to facilitate communication between patients and their health care professionals, involving patients with genitourinary, lung, breast, and myeloma cancer.
⁵ George Salvador, RGN, has 9 years of nursing experience and 6 years of experience in a hematology-oncology department. He is also part of the vascular team at St Bartholomew's Hospital that deals with peripheral and central lines, such as Hickman, Portacath, and peripherally inserted central catheters. Currently, Mr Salvador is pursuing his master's degree in advanced cancer care, which includes nurse prescribing.
⁶ Sheila Fernandez Gomez, RN, CNS, is a registered nurse with 8 years of experience in oncology, including more than 4 years working as a senior chemotherapy/oncology/hematology nurse at St Bartholomew's Hospital. She has recently been promoted to acute oncology clinical nurse specialist at St George's Hospital in London and has acquired a specialty in systemic anticancer therapy regimens. This experience, along with her qualifications, has given her the confidence to assess and manage acute oncology complications.
⁷ Andrea Carroll Bullock, BSN, ISMPP, CMPP, is the director of US medical communications at EMD Serono, where she has directed US medical publications and communications in the oncology, neurology, immunology, fertility, and HIV therapeutic areas for the past 4 years. She has 20 years of experience in the pharmaceutical industry. Prior to joining industry, Ms Carroll Bullock worked as a registered nurse in teaching hospitals, such as the MedStar Washington Hospital Center. Her primary area of focus in the clinical setting was caring for patients in the medical intensive care and oncology units. Additionally, she has experience as a nurse manager for a community-based hematology/oncology practice, where she was responsible for treating patients and managing the infusion center. Ms Carroll Bullock holds a bachelor of science in nursing from Howard University and is a master of business administration candidate at Johns Hopkins Carey Business School.
⁸ Geeta Devgan, PhD, is a senior medical director in US medical affairs at Pfizer Oncology. She received her PhD in molecular, cellular, and developmental biology from Yale University and completed her postdoctoral training at Memorial Sloan-Kettering Cancer Center. Dr Devgan has more than 15 years of oncology experience in medical leadership roles within pharmaceutical companies.
⁹ Kathleen D. Burns, MSN, RN, AGACNP-BC, OCN®, has a postmaster's certificate for nurse practitioners in acute care-gerontology from the University of Connecticut. Her work experience includes 28 years of cancer nursing in patient care, education, and management.

Abstract

Immune checkpoint inhibitors, such as programmed cell death ligand 1 inhibitors pembrolizumab, nivolumab, atezolizumab, and avelumab, are used to treat patients with advanced urothelial carcinoma (UC). Based on data from the phase 3 JAVELIN Bladder 100 trial, avelumab first-line (1L) maintenance is now considered the standard-of-care treatment for patients with locally advanced or metastatic UC who responded or experienced disease stabilization after 1L platinum-containing chemotherapy, and it is the only category 1 preferred checkpoint inhibitor maintenance option in the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for patients with cisplatin-eligible and cisplatin-ineligible locally advanced or metastatic UC. This article reviews key considerations related to avelumab 1L maintenance therapy that infusion nurses should be familiar with, including dosing, administration, and immune-related adverse event recognition and management, to ensure safe and appropriate use of this important and impactful therapy.

Publication types

Review

MeSH terms

Antibodies, Monoclonal, Humanized
Carcinoma, Transitional Cell* / drug therapy
Cisplatin / therapeutic use
Female
Humans
Male
Urinary Bladder Neoplasms* / drug therapy
Urinary Bladder Neoplasms* / pathology

Substances

Antibodies, Monoclonal, Humanized
avelumab
Cisplatin