Episode 412: Pharmacology 101: Cytokines

“They are small, powerful little nuggets. They are actually small signaling proteins that our immune cells use to communicate. They really help regulate immune activation or inflammation and even the growth and survival of immune cells. When cytokines are used therapeutically in oncology, they help to stimulate immune cells such as T cells or natural killer cells to better recognize and attack cancer cells,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center of Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, manager of oncology nursing practice at ONS, during a conversation about the cytokine drug class.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours (including 30 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by April 24, 2027. 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: Nurses caring for people with cancer require knowledge of cytokines to provide appropriate education and to safely administer related therapies.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Pharmacology 101 series
• Episode 256: Cancer Symptom Management Basics: Hematologic Complications
• Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis
• ONS Voice articles:
• FDA Approves Nogapendekin Alfa Inbakicept-Pmln for BCG-Unresponsive Non–Muscle Invasive Bladder Cancer
• Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents
• Oncology Drug Reference Sheet: Motixafortide
• ONS books:
• Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) and 2024 Drug Supplement
• Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
• Guide to Cancer Immunotherapy (second edition)
• Clinical Journal of Oncology Nursing article:
• Tumor-Infiltrating Lymphocyte Therapy for Melanoma: Nursing Considerations
• What’s Old Is New Again, Unfortunately
• ONS Symptom Interventions
• Colony-Stimulating Factors Including Biosimilars for At-Risk Patients for Prevention of Infection: General
• Platelet Growth Factors for Prevention of Bleeding
• National Comprehensive Cancer Network

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To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“Cytokines are actually among some of the earliest forms of immunotherapy used in the treatment of cancer, and it really goes back to the 1980s and the 1990s. We’re talking therapies like interferon [alpha] or interleukin-2 that were used to stimulate the immune system, with the idea that they would recognize and attack cancer cells, particularly in diseases like metastatic melanoma and renal cell carcinoma. What made these therapies unique was that although the overall response rates were relatively modest, when patients did respond, those responses could be very durable and sometimes long lasting. And that observation was really important for the field of oncology, because it was part of the process that demonstrated that the immune system could potentially control cancer in really meaningful ways.” TS 1:49

“One nice new example of an engineered cytokine is nogapendekin alfa inbakicept, which is quite the tongue twister to say. … This agent is really interesting because it’s an engineered interleukin-15 receptor agonist that works on stimulating natural killer cells and CD8-positive T cells. And what makes this so interesting is that it’s used in combination with a medication that probably some of us are familiar with—good old BCG—for patients specifically with invasive bladder cancer. The other really interesting thing about this new therapy is the fact that it is one of our first ones to be engineered in a combination fashion. So the nogapendekin alfa is combined with a receptor component that is called inbakicept. And what happens is it forms a complex to enhance signaling and prolong the activity of the cytokine.” TS 7:50

“When you’re looking at our therapeutic cytokines, those tend to produce larger-scale systemic inflammatory effects leading to much more global side effect reactions, while your supportive care cytokines are more commonly associated with either bone marrow stimulation effects or hematologic changes.” TS 14:01

“Regardless of what type of cytokine therapy may you be using, across the board, early recognition of the symptoms and proactive supportive care are really important. And this is where many of our oncology nurses play such a critical role in identifying changes that are happening in real time to the patient’s condition and helping to coordinate, relay information to the rest of the providing team so that timely interventions can occur for the best care of the patient.” TS 18:01

“The other fascinating thing about these cytokines is that they’re not being used as monotherapy anymore. They’re now being looked at in combination with other therapies or even other immunotherapies like our checkpoint inhibitors. They’re being looked at in the sense that they may be able to help expand and further activate immune cells that our current therapies rely on. And so it’s really interesting that while cytokines were some of the earliest forms of cancer immunotherapy, they’re now being reimagined as part of modern combination strategies designed to really further help enhance the immune responses against cancer.” TS 29:08