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Targeted Therapy | 마이메르시 MyMerci
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Targeted Therapy

NCLEX Review Guide: Hematological & Oncological Targeted Therapy

Overview of Targeted Therapy

Mechanism of Action

  • Targeted therapy uses drugs that specifically attack cancer cells by targeting specific proteins, genes, or tissue environments that contribute to cancer growth and survival. Unlike traditional chemotherapy, these agents selectively target malignant cells while minimizing damage to healthy tissues.
  • Common targets include growth factor receptors, angiogenesis pathways, and cell cycle checkpoints that are overexpressed or mutated in cancer cells.

Key Points

  • Targeted therapy is precision medicine based on specific tumor characteristics
  • Less toxic than traditional chemotherapy but still requires careful monitoring
  • Often used in combination with other cancer treatments

Major Classes of Targeted Therapy

Monoclonal Antibodies

  • Rituximab (Rituxan) targets CD20 protein on B-cell lymphomas and is used for non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Monitor for severe infusion reactions including cytokine release syndrome.
  • Trastuzumab (Herceptin) targets HER2 protein in breast cancer patients with HER2-positive tumors. Monitor cardiac function closely as cardiotoxicity is a major adverse effect.

Tyrosine Kinase Inhibitors (TKIs)

  • Imatinib (Gleevec) blocks BCR-ABL protein in chronic myeloid leukemia (CML) and has revolutionized CML treatment with excellent outcomes. Common side effects include fluid retention, muscle cramps, and myelosuppression.
  • Erlotinib (Tarceva) targets EGFR in non-small cell lung cancer and pancreatic cancer. Monitor for severe skin reactions and interstitial lung disease.

Memory Aid: TKI Side Effects

"SKIN-HEART-LUNG"
S - Skin rash/reactions
K - Kidney dysfunction
I - Interstitial lung disease
N - Nausea/GI effects
H - Hepatotoxicity
E - Edema/fluid retention
A - Arrhythmias
R - Rash
T - Thrombocytopenia
L - Liver toxicity
U - Ulceration
N - Neutropenia
G - GI perforation

Nursing Considerations & Monitoring

Pre-Administration Assessment

  1. Verify patient has appropriate biomarker testing (HER2, EGFR, BCR-ABL) before initiating targeted therapy
  2. Obtain baseline laboratory values including CBC, comprehensive metabolic panel, liver function tests
  3. Assess cardiac function with baseline ECG and echocardiogram for cardiotoxic agents
  4. Screen for active infections and assess immunization status

Administration Guidelines

  • Many targeted therapies are administered orally as daily medications, requiring patient education on adherence and proper storage. Emphasize importance of taking medications exactly as prescribed without skipping doses.
  • IV monoclonal antibodies require premedication with antihistamines, corticosteroids, and acetaminophen to prevent infusion reactions. Start infusions slowly and monitor vital signs frequently.

Clinical Scenario

A patient receiving rituximab develops fever, chills, and hypotension 30 minutes into the first infusion. What is the priority nursing action?

Answer: Stop the infusion immediately, maintain IV access, assess vital signs, and notify the physician. This represents cytokine release syndrome, a potentially life-threatening reaction.

Commonly Confused Concepts

Aspect Traditional Chemotherapy Targeted Therapy
Mechanism Kills rapidly dividing cells Targets specific proteins/pathways
Selectivity Non-selective (affects healthy cells) Selective for cancer cells
Side Effects Severe systemic toxicity More targeted, less severe
Administration Usually IV, cyclical Often oral, continuous

Common Pitfalls

  • Don't assume targeted therapy is "safer" - still requires intensive monitoring
  • Biomarker testing is essential before starting treatment
  • Drug interactions are significant with oral targeted agents

Patient Education & Safety

Essential Teaching Points

  • Educate patients about skin care as many targeted therapies cause acneiform rash. Recommend gentle cleansers, moisturizers, and sun protection with SPF 30 or higher.
  • Emphasize infection prevention measures including hand hygiene, avoiding crowds, and reporting signs of infection immediately as some agents suppress immune function.
  • Teach patients to report cardiac symptoms such as shortness of breath, chest pain, or unusual fatigue, especially with cardiotoxic agents like trastuzumab.

Patient Teaching Checklist: "SAFE-CARE"

S - Skin protection and care
A - Adherence to medication schedule
F - Follow-up appointments importance
E - Emergency signs to report
C - Cardiac symptom awareness
A - Avoid infections
R - Regular lab monitoring
E - Exercise and nutrition support

Quick Check Knowledge Test

Self-Assessment

  • ☐ I can identify the difference between targeted therapy and traditional chemotherapy
  • ☐ I understand the major classes of targeted therapy agents
  • ☐ I know the key nursing assessments for targeted therapy patients
  • ☐ I can recognize signs of serious adverse reactions
  • ☐ I understand patient education priorities for targeted therapy

Quick Facts for NCLEX

  • Targeted therapy requires biomarker testing before initiation
  • Monoclonal antibodies end in "-mab"
  • Tyrosine kinase inhibitors often end in "-nib"
  • Cardiac monitoring is essential with trastuzumab
  • Skin reactions are common with EGFR inhibitors

Remember: You're preparing to save lives and provide compassionate care. Master these targeted therapy concepts to ensure safe, effective patient care in oncology settings. Every study session brings you closer to becoming the nurse your patients need!

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