APHON Pediatric Chemotherapy-Biotherapy Renewal

Late Effects Acquired resistance is an important long-term concern related to the use of small molecule inhibitors. Acquired resistance can be categorized according to the presence or absence of symptoms derived from progressive disease, the kinetics of tumor growth, and the number of progressive metastases (Westover et al., 2018). In some cases, the tumor develops mutations that counteract the effect of the small molecule inhibitor. In other cases, the tumor cells develop alternate signaling pathways that bypass the target of the small molecule inhibitor. Because of potential resistance mechanisms, pharmacokinetics, selectivity, and tumor environment, single- and multi-kinase inhibitors have advantages and disadvantages (Kuhlen et al., 2019). Small molecule inhibitors are only beginning to be prescribed, so not enough time has elapsed to allow researchers to obtain adequate long-term data on possible late effects. However, imatinib, the small molecule inhibitor that has been used the longest, has provided a glimpse into late effects of agents in this biotherapy category. The most prevalent late effect of imatinib is growth delay in children with chronic myeloid leukemia (Narayanan et al., 2013). A few common late effects are starting to emerge. Kuhlen and colleagues (2019, p. 2). have observed that “attention should be paid to the various acute and long-term side effects of TKIs including gastrointestinal, cardiovascular, pulmonary, dermatologic, and—particularly in children—endocrine toxicities.” Very little is known yet about most small molecule inhibitors, and only time will unveil their major long-term and acute side effects. References Anderson, J. A., Herring, R. A., & Salazar-Abshire, M. (2019). Biotherapy: Principles and agents. In R. A. Herring (Ed.), The Pediatric Chemotherapy and Biotherapy Curriculum (4th ed., pp. 91– 147). Association of Pediatric Hematology/Oncology Nurses. Conley, S. B., & Rae, M. L. (2019). Safe handling of hazardous drugs. In R. A. Herring (Ed.), The Pediatric Chemotherapy and Biotherapy Curriculum (4th ed., pp. 149–160). Association of Pediatric Hematology/Oncology Nurses. Kuhlen, M., Klusmann, J-H., & Hoell, J. I. (2019). Molecular approaches to treating pediatric leukemias. Frontiers in Pediatrics , 7, 1–2. https://doi.org/10.3389/fped.2019.00368 Lexicomp. (n.d.). https://online.lexi.com Li, Q., Liu, Z., Kolli, S., Wetz, K., Griffith, N., & Poi, M. J. (2016). Stability of extemporaneous erlotinib, lapatinib, and imatinib oral suspensions. American Journal of Health-System Pharmacy, 73 (17), 1331–1337. https://doi.org/10.2146/ajhp150581 Martin, J. R., Beegle, N. L., Zhu, Y., & Hanisch, E. M. (2015). Subcutaneous administration of bortezomib: A pilot survey of oncology nurses. Journal of the Advanced Practitioner in Oncology, 6 (4), 308–318. https://doi.org/10.6004/jadpro.2015.6.4.2