Episode 433: Cancer Treatments for Noncancer Indications: Chemotherapy/Immunotherapy

“Unlike our cancer indications where we use these medications often to activate the immune system to target cancerous cells, in noncancer indications, the goal is really to either suppress an overactive immune or inflammatory cells or modulate the immune system. Immune modulation by use of chemotherapy and immunotherapy can help reduce abnormal inflammation, decrease autoantibody production, and also can alter T-cell and B-cell activity,” ONS member Kelsey Miller, MSN, RN, AGCNS-BC, OCN^®, clinical nurse specialist in oncology and infusion therapy at Reading Hospital in West Reading, PA, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN™, oncology clinical specialist at ONS, during a conversation about chemotherapy and immunotherapy for noncancer indications.

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 18, 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: Learners will report an increase in knowledge related to the use of anticancer therapies for noncancer indications.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Pharmacology 101 series
• Episode 152: Administer Rituximab Immunotherapy With Confidence
• ONS Voice articles:
• JAK1 Inhibitor Quickly Relieves ICI-Related Dermatitis
• Oncology Drug Reference Sheet: Cyclophosphamide
• Oncology Drug Reference Sheet: Methotrexate
• What Oncology Nurses Need to Know About Arboviral Disease in Patients Receiving B-Cell–Depleting or –Modulating Therapies
• ONS books:
• Access Device Guidelines: Recommendations for Nursing Practice and Education (fourth edition)
• Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
• Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
• Clinical Journal of Oncology Nursing article: Early Recognition and Response of Chemotherapy-Induced Hypersensitivity Reactions: A Nursing Discussion
• ONS courses:
• ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
• Safe Handling Basics
• Vascular Access Devices
• ONS Huddle Cards:
• Anaphylaxis
• Monoclonal Antibodies
• ONS position statement: Education of the Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies
• American Academy of Neurology: Practice Guideline Recommendations: Disease-Modifying Therapies for Adults With Multiple Sclerosis
• American College of Rheumatology: Treatments
• National Multiple Sclerosis Society:
• Infused therapies
• Injectable therapies
• Medications Used Off-Label
• NCODA Patient Education Sheets

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 [email protected].

Highlights From This Episode

“The most common immunotherapy agent that’s well known to both oncology and other autoimmune disorders is rituximab. And that is used for rheumatoid arthritis, granulomatous, and antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. And then it also has many off-label indications for other autoimmune disorders, such as lupus and multiple sclerosis. It’s also used in immune thrombocytopenia and Sjogren’s condition.” TS 3:28

“Two common chemotherapy agents that come to mind that are used in lower doses for noncancer conditions are methotrexate, which helps modify the underlying disease process to reduce inflammation and preserve organ and joint function. And that’s most commonly used rheumatology-wise first-line for rheumatoid arthritis and psoriatic arthritis. A second chemotherapy agent that’s well known to oncology is cyclophosphamide, and that really serves as a powerful immunosuppressant for conditions such as ANCA-associated vasculitis and severe lupus nephritis.” TS 3:57

“When talking about the monoclonal antibody frequency, it’s often shorter in our oncology indications. We may see it weekly, every 21 days, every 28 days—compared to our autoimmune disorders that are months in between. This is really due to cancer cells continuously proliferating, so we need to stop the growth and not allow residual cancer cells to remain. And for the monoclonal antibodies, for example, rituximab again, it’s depleting B cells that contribute to autoantibody production and inflammation. So targeting that after one to two infusions, the peripheral B cells are often depleted within days to weeks because of how well the drug works, how targeted it is. Those effects may persist for 6–12 months or even longer.” TS 8:39

“Infection prevention education—it’s so important to get to know the patient to individualize your teaching. For example, you need to know what matters most of the patients when they go home. Are they taking care of their grandchildren? Do they love to go outside and garden and do mulching? Are they cleaning up their chicken coop? So those kind of things, as a nurse, you can then help tailor your education so you can help prevent infection in these patients because I don’t think just standard run-of-the-mill infection prevention teaching is as beneficial as when you can individualize it for that patient.” TS 17:33

“If organizations are going to allow non-oncology nurses to administer, we just want to make sure that there is an established process or a protocol to administer rescue medications. That may include what you’re already doing if you have a change in patient condition—calling for activating that emergency response system if you’re in an inpatient setting. When we look at our ambulatory infusion centers that may have non-oncology nurses administering, you still have to have that training and competency verification and also emergency medical equipment readily available. That would include oxygen and your rescue medications. For the non-oncology nurse, some key points are to make sure that you check on your patient throughout these infusions and have that conversation up front to report any symptoms, both big and small.” TS 23:06

“For safe handling, there are many misconceptions that it differs between cancer and non-cancer. When I first started at our organization, even some providers may minimize the risk for low-dose oral chemotherapy. However, it’s still metabolized and excreted through our bodily fluids. And we know that traditional chemotherapy, like methotrexate and cyclophosphamide, is cytotoxic. So if a patient’s prescribed them for noncancer indications, you still need to cover the basics, like shared bathrooms, what to do if there’s contaminated linen, and also bring up the topic of contraception to ensure that our patients and their partners remain safe and do not get exposed.” TS 27:13