Immunotherapy after chemoradiotherapy in stage III non-small cell lung cancer: a new standard of care?

Immunotherapy Assessment: Using a Survey Instrument to Examine Oncology Nurses' Confidence Levels With Administration and Management

Immuno-oncology is a complex treatment paradigm for many malignancies. As a result, nurses need to increase their knowledge awareness regarding safe, evidence-based care of patients who receive oncologic immunotherapy with their treatment regimen. This pilot study looks at nurse confidence levels specific to the challenges associated with this complex treatment. The Oncology Nurse Immunotherapy Confidence Survey, developed for this project, allowed for 28 confidence measurements, demographic collection, and a brief quasi-thematic analysis. The pre- and posteducation confidence scores demonstrated a 51% overall improvement.

Invasive Aspergillosis in a Patient with Stage III (or 3a or 3b) Non-Small-Cell Lung Cancer Treated with Durvalumab

Durvalumab is a therapeutic monoclonal antibody that blocks the checkpoint inhibitor, programmed death ligand 1 (PD-L1), resulting in T-cell activation and an antitumor response. Durvalumab is approved for patients with unresectable stage III non-small-cell lung cancer (NSCLC) which has not progressed following platinum-based chemoradiotherapy. A 63-year-old man presented to the emergency department with a 15-day history of increasing shortness of breath. Several months previously, he had been diagnosed with a poorly differentiated stage IIIB NSCLC. He had completed six cycles of chemotherapy with paclitaxel and carboplatin and four cycles of immunotherapy with durvalumab 13 days before his emergency hospital admission. Computed tomography (CT) imaging showed a large left-sided loculated hydropneumothorax suggestive of empyema, patchy opacification of the left lung, and a left upper lobe lung mass. Histology of the cell block from the pleural fluid and decorticated lung tissue showed hyphae suggestive of invasive Aspergillus fumigatus. Treatment with voriconazole resulted in clinical improvement. To our knowledge, this is the first reported case of pleural aspergillosis in a patient treated with durvalumab. However, the increasing use of immune checkpoint inhibitors in oncology requires increased awareness by clinicians of immune-related adverse events (irAEs) due to opportunistic infection.