Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy
The ONS Podcast
“You want to try to act quickly and be able to know what the pathways are for appropriate escalating when a patient is having symptoms that are reflective of cytokine release syndrome (CRS) or neurotoxicity. These toxicities are very manageable and treatable when recognized early. To summarize, choosing the right patient, knowing the toxicity profile for each product, and acting early is really what helps to prevent severe outcomes with chimeric antigen receptor (CAR) T-cell therapy,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center at...
info_outline
Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices
The ONS Podcast
“Our goal of precision oncology has been to shift to tailored therapies that can help to improve treatment efficacy and ultimately improve patient outcomes. Resistance biomarker testing can help the care team to detect these genomic changes that the tumor may have acquired during therapy that makes the cells resistant to therapy. This information can be extremely helpful when we’re talking about making choices about second-line or subsequent-line therapy,” ONS member Danielle Fournier, DNP, APRN, AGPCNP-BC, AOCNP®, advanced practice RN at the University of Texas MD Anderson Cancer...
info_outline
Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses
The ONS Podcast
“The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®,...
info_outline
Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications
The ONS Podcast
“We print education sheets that we have, and we say, ‘Just ignore this part that says cancer. You’re getting this med but for a different indication.’ And then you have to really point out what our goals of care are. You’re using the information that, as oncology nurses, we like and love, but we’re having to cross it out and say, ‘Just read this portion and just do this here.’ And that can be challenging for the nurse and probably confusing for the patient,” ONS member Brandy Thornberry, RN, OCN®, outpatient infusion and VAD supervisor at Logan Health in Kalispell, MT,...
info_outline
Episode 403: Pharmacology 101: Checkpoint Inhibitors
The ONS Podcast
“Because the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That’s one of our biggest questions that we ask, usually every consult that we’re seeing with solid tumor. ‘Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?’ And then also patients who have undergone organ transplants. Now, interestingly, this does include stem...
info_outline
Episode 402: Radiation Site-Specific Side Effects: Head and Neck Cancer
The ONS Podcast
“It’s important to clarify that most patients will experience and at least some side effects—and often several. So prevention really means reducing severity, complications, and long-term impact rather than avoiding side effects altogether. This process starts before radiation begins and continues throughout the treatment and includes dental evaluation, baseline swallowing assessments, and thorough patient education,” ONS member Astrid Amoresano, RN, OCN®, lead oncology nurse specialist at New York Proton Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager...
info_outline
Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses
The ONS Podcast
“You also want to deal with patient preferences. We do want to get their disease under control. We want to make them live a long, good quality of life. But do they want to come to the clinic once a week? Is it a far distance? Is geography a problem? Do they prefer not taking oral chemotherapies at home? We have to think about what the patient’s preferences are to some degree and kind of incorporate that in our decision-making plan for treatments for relapsed and refractory myeloma,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University...
info_outline
Episode 400: Pharmacology 101: Radioimmunoconjugates
The ONS Podcast
“Radioimmunoconjugates work through a dual mechanism that combines immunologic targeting with localized radiation delivery. The monoclonal antibody components bind to specific tumor-associated antigens such as CD20, expressed on malignant B cells. Once found, the attached radioisotope delivers beta radiation directly to the tumor, causing DNA damage and cell death,” Sabrina Enoch, MSN, RN, OCN®, CNMT, NMTCB (CT), theranostics clinical specialist at Highlands Oncology in Rogers, AR, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a...
info_outline
Episode 399: National Hazardous Drug Exposure Registry
The ONS Podcast
“The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we’re trying to set up, is a way to make what is currently an invisible risk, visible,” ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public...
info_outline
Episode 398: An Overview of Multiple Myeloma for Oncology Nurses
The ONS Podcast
“[Multiple myeloma] is very treatable, very manageable, but right now it is still considered an incurable disease. So, patients are on this journey with myeloma for the long term. It’s very important for us to realize that during their journey, we will see them repeatedly. They are going to be part of our work family. They will be with us for a while. I think it’s our job to be their advocate. To be really focused on not just the disease, but periodically assessing that financial burden and psychosocial aspect,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer...
info_outline“All of these TKIs [tyrosine kinase inhibitors] inhibit BCR-ABL1 in some way, shape, or form. When BCR-ABL1 is mutated, it has uncontrolled tyrosine kinase activity, leading to rapid cell proliferation. When we then inhibit that BCR-ABL1 that’s been mutated, we disrupt this abnormal signaling pathway that drives CML [chronic myeloid leukemia] cell proliferation and survival, ultimately leading to decreased cancer cell growth, increased apoptosis or cell death, and potentially inducing a disease remission,” Samantha Maples, PharmD, BCOP, clinical pharmacy specialist supervisor for hematology and cellular therapy at Allegheny Health Network in Pittsburgh, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the BCR-ABL1 inhibitor drug class.
Music Credit: “Fireflies and Stardust” by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by September 5, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Learning outcome: Learner will report an increase in knowledge related to the use of BCR-ABL1 inhibitors in the treatment of CML.
Episode Notes
- Complete this evaluation for free NCPD.
- ONS Podcast™ episodes:
- ONS Voice articles:
- ONS course: Safe Handling Basics
- Clinical Journal of Oncology Nursing articles:
- Oncology Nursing Forum articles:
- Other ONS resources:
- National Comprehensive Cancer Network
- National Comprehensive Cancer Network patient resources
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
“The IRIS study led to the approval of the BCR-ABL1 and TKI, imatinib, for CML in 2001 and completely changed the landscape of CML treatment. Then came the second-generation BCR-ABL1 TKIs: dasatinib in 2006, quickly followed by nilotinib in 2007. Thereafter came our second-generation, bosutinib, and our first approved third-generation TKI, ponatinib, both in 2012, which was a huge milestone as ponatinib overcomes resistance to the T315 I mutation, which no previously approved TKIs worked against.” TS 2:16
“The newest approved TKI, asciminib, is an allosteric inhibitor that binds to a different pocket on the BCR-ABL kinase via allosteric binding to the ABL myristoyl pocket. It’s what’s called a STAMP inhibitor, where STAMP stands for ‘specifically targeting the ABL myristoyl pocket.’ And while all the TKIs target the BCR-ABL1 binding site, they can also inhibit different off-target kinases. And these differences in off-target inhibition are responsible for some of the different toxicities we see among the TKIs.” TS 4:51
“As a class, common toxicities include nausea; vomiting; diarrhea; cardiac toxicities, including cardiac arrhythmias and congestive heart failure; metabolic abnormalities such as hypercholesterolemia and hypertriglyceridemia; nephrotoxicity; hepatic toxicity; hemorrhaging and bleeding; as well as cytopenia. Individually, some of these agents are more likely to cause certain side effects compared to others, and there are unique toxicities associated with certain TKIs.” TS 8:10
“We’ve moved to using preemptive loperamide [in our clinic] for the first three days of starting treatment, because it’s really hard to get patients to continue to take a medication if they have such severe diarrhea that they end up in the hospital or they’re unable to leave their house. A lot of times, we will proactively give patients antiemetics and loperamide to help with the nausea, vomiting, and diarrhea. And then we can back off to an as-needed basis once they’ve been established on treatment. We can also use medications to help manage long-term complications that can require supportive care, such as statin therapy for high cholesterol, levothyroxine for hypothyroidism, anticoagulants for any venous thromboembolism, and antihypertensive medications for managing any new or worsening high blood pressure.” TS 12:44
“We are continually seeing these agents expand their indications to different lines of therapy, as well as more TKIs being approved for acute lymphoblastic leukemia. For example, asciminib just got approved in the frontline setting within the last year, whereas previously it was only approved in relapsed refractory setting. Last year, imatinib was the first BCR-ABL1 TKI to come out with a commercially supplied suspension option as well, which is huge in the pediatric space and [for] our adult patients who are unable to swallow tablets for other clinical reasons.” TS 21:22
“There is more information being published on the safe discontinuation of these medications with treatment-free remissions, and more information is coming out about who would be eligible and who can have the option to stop these treatments instead of having a lifelong chronic condition requiring continuous treatment. We're seeing more patients in clinical practice be able to stop BCR-ABL1 treatment, which has been a great development in CML.” TS 25:29