Targeted Cancer Therapy
What do Targeted cancer therapies do
medications that block growth and spread of cancer by interfering with specific molecules involved in tumor growth, progression, and spread
What are the targeted therapy classes and associated protype drugs
Angiogenesis inhibitors- Bevacizumab
Epidermal growth factor receptor- Erlotinib
Tyrosine Kinase Inhibitor- Imatinib Mesylate
Protease Inhibitors- Bortezomib
Monoclonal Antibodies- Bevacizumab & Rituximab
Major Side effects to monitor for with Protease inhibitors
*Bortezomib*
Hypotension, neuropathy, pancytopenia, rash, urticaria, vasculitis, pruritis, injection site rxn, back pain, bone pain, bone fractures
Clinical judgement of proteasome inhibitors and monoclonal antibodies
Assess for cardiac events
monitor labs
Assess for bleeding
Examine skin for rash, erythema, peeling, or blister
monitor liver and renal fxn
Avoid alcohol and nonessential drugs
A patient receiving bortezomib should be monitored for:
A. Hypotension and neuropathy
B. Hair loss and anemia
C. Tachycardia and diarrhea
D. Cough and rash
Answer: A
Rationale: Bortezomib (proteasome inhibitor) can cause low BP and nerve pain—monitor BP and safety.
Name the types of targeted cancer therapies
Anticoagulant inhibitors
Epidermal growth factor receptor inhibitors
Tyrosine Kinase Inhibitor
Monoclonal antibodies
Proteasome Inhibitors
MOA of Bortezomib
Promote accumulation of proteins that promote programmed cell death in cancer cells
Limited action on normal cells
Name the Angiogenesis inhibitor protype medication and MOA
Bevacizumab
MOA-Prevent new blood vessels from forming
Which teaching should the nurse give to a patient taking erlotinib?
A. “Avoid sunlight and report new rashes.”
B. “Take this medication with antacids.”
C. “You won’t have any skin changes.”
D. “You can use NSAIDs for pain relief.”
Answer: A
Rationale: Erlotinib often causes rash and acne-like eruptions; sun can worsen this. Avoid NSAIDs (bleeding risk).
What is the main nursing consideration when a patient is on Bevacizumab
Watch for bleeding, infection and blood pressure
Limitations of targeted cancer therapies
Potential for cancer cell mutation and drug resistance
Difficult developing drugs for identified targets
If cancer is lacking sufficient quantities of the specific molecular targets it will not respond to medication
EGFR MOA and Side effects
*Erlotinib*
MOA- binds to different areas of EGFR blocking its activity so that it can't activate TK, Works indirectly
S/E- Elevated hepatic enzymes, conjunctivitis, Interstitial lung disease, rash, acne, pruritus, GI distress/perforation
How is Erlotinib given
Orally
Clinical judgement for angiogenesis inhibitors
Examine pt skin closely
Monitor for infection
Assess for evidence of thromboembolic events Monitor for perforation
Assess for pulmonary complications
Teach pt to avoid NSAIDS
Bevacizumab (Avastin) works by:
A. Stimulating immune cells
B. Stopping new blood vessels from forming
C. Directly killing cancer cells
D. Increasing hormone production
Answer: B
Rationale: Bevacizumab is an angiogenesis inhibitor—it “starves” tumors by preventing blood vessel growth.
Describe how targeted cancer therapy attacks cancer cells
Block or turn off chemical signals
Change proteins in cancer cells
Prevent cancer cells from forming new vessels
Trigger immune system to kill cancer cells
Toxic to cancer cells but not noncancerous cells
Drug class and MOA of Imatinib Mesylate
MOA- Prevent activation of tyrosine kinase. CANNOT eradicate disease, can control it
S/E: Electrolyte imbalance, Anemia, Elevated liver enzymes, hepatotoxicity, Bradycardia, myalgia
A patient on imatinib mesylate develops swelling in the ankles and fatigue. What is the likely cause?
A. Cardiac failure
B. Normal drug effect
C. Bone marrow recovery
D. Allergic reaction
Answer: A
Rationale: TKIs like imatinib can cause fluid retention and heart failure—swelling and fatigue are warning signs.
During chemotherapy teaching, which statement by the patient shows the need for further education?
A. “I’ll avoid crowds and sick people.”
B. “If I get mouth sores, I’ll rinse with alcohol mouthwash.”
C. “I’ll drink plenty of fluids each day.”
D. “I’ll report any fever or bleeding.”
B
12. Which finding needs immediate intervention in a patient receiving bevacizumab?
A. Mild fatigue
B. Nosebleed
C. Slight nausea
D. Headache
Answer: B
Rationale: Bevacizumab increases bleeding risk; any sign of hemorrhage requires prompt action.
How are targeted therapy drugs classified
Inhibit enzymes
Induce apoptosis
Inhibit formation of new vasculatures
MOA and Major side effects of Monoclonal antibodies
Bind to their specific target antigen to inactivate or destroy cancer cells. Also transporters for other anticancer agents
S/E: Bronchospasm, hyperglycemia, blood dyscrasias, cardiotoxicity, anaphylaxis, fever, chills, HA, rash, dizziness, hypotension, *myelosuppression*
Side effects of Bevacizumab
Severe/intractable bleeding, GI bleeding, pulmonary hemorrhage, Hypertensive crisis, nephrotic syndrome, compromised wound healing, dehiscence, microangiopathy
clinical judgment regarding tyrosine kinase and mulitikinase inhibitors
Monitor for signs of bleeding
monitor for dysrhythmias, decreased CO, HR, and BP
Monitor IV site
Encourage small frequent meals that are high in calories and protein
Assess need for IV hydration
How are targeted therapy medications classified
Classified by their actions:
Inhibit enzymes, induce apoptosis, inhibit formation of new vasculatures