Examining the Role of the Nurse Coordinator in the CheckMate-73L Trial of Nivolumab/Ipilimumab in NSCLC

Sandra Duncan, RN, BSN

Nurse coordinators can serve as a mouthpiece for promoting awareness and providing necessary education regarding the ongoing phase 3 CheckMate-73L trial (NCT04026412), which is examining the effectiveness of nivolumab plus concurrent chemoradiation followed by nivolumab plus ipilimumab (Yervoy) vs concurrent chemoradiation followed by durvalumab (Imfinzi) in patients with untreated locally advanced non–small cell lung cancer (NSCLC), according to Sandra Duncan, RN, BSN.

“Nurses who are [lung specialists] can become mouthpieces for family members or for the community, just to [question], ‘Did you know this study exists?’ [This is] especially [true] for the [patients] who do not opt to have surgery,” Duncan said. “Nurses can indirectly help educate others about this clinical trial.”

In an interview with OncLive^®, Duncan, a clinical oncology research nurse who supports patients with cancer being screened or enrolled in clinical trials at the Georgia Cancer Center at Augusta University, discussed her experience with the CheckMate-73L trial thus far, overcoming communication challenges, and the importance of nurse coordinators in the realm of clinical trials.

OncLive^®: Could you speak to your experience with the CheckMate-73L trial, specifically with regard to eligibility and enrollment?

Duncan: We had our site initiation visit in May of 2021. We have yet to enroll the first patient, but our goal accrual here will be 4 patients over the next life of the clinical trial. I know we will meet that goal.

We have clinics on every Tuesday & Thursday. We also screen the patients that our other multidisciplinary physicians have, such as CT surgery, our radiation oncologist, and other medical oncologists. We screen their listing of patients. Since we have access to electronic health records, and since we can't meet all the patients, we screen based upon eligibility and prescreen to see whether they are potential patients at that time.

[Essentially,] we prescreen those clinics, and then we will, at that time, come up with any potential subjects before we bring them in for clinic. As such, we have an idea [of whether] that patient will meet eligibility requirements before even being approached at all.

We had 1 potential patient, [with whom unfortunately] when we got the referral, the patient already had received cardiothoracic surgery and was opted to be unresectable.

We use that as an educational piece to other multidisciplinary [teams] and our tumor board to say, “This is the kind of patient who would have benefited from this type of clinical trial.” As we move forward, [the focus is] going to be continuing education.

What is the goal of this research and how might it address existing unmet needs in NSCLC?

What this particular clinical trial is going to do is give our patients more options. [If a patient says,] ‘I know I don't want surgery, [but] what else is out there for me?’ that’s when we start discussing immunotherapy. That’s one of the things that's needed for patients who do not opt to have surgery; many of [these patients] do not want to be in the hospital setting. This simply gives patients more options to have immunotherapy while doing radiation therapy than the 1-year maintenance treatment.

What are some of the challenges faced with ensuring adequate communication between all providers involved in the research? Where should efforts be focused to overcome these issues?

It is a communication challenge to make sure everyone receives the same message. For efficiency and effectiveness, the challenge is ensuring that everyone hears the same message at the same time­­­–it is important to relay information to all parties at the same time; that's not always possible. Therefore, as a study coordinator, you are constantly either emailing or calling and trying to ensure everyone knows who is on board: Did you check your emails? Did you do this? Where are we?

You are constantly trying to ensure all parties are on board because what you don't want is to have patients wait and delay their care. Being proactive and ensuring that all parties are up to date is imperative, including the patients in the middle. We must make sure that in the middle of the circle [these patients] have what they need because sometimes we have challenging cases. For example, 1 [case] we had recently, not for this clinical trial, but a patient was in the waiting room for over an hour. [It is] just frustrating. Our goal is to be as efficient as possible, and, therefore, improve the patient’s overall survival.

Do you foresee data from CheckMate-73L trial impacting the treatment paradigm, particularly from a supportive care standpoint?

I do believe that. Once the numbers or the data come back, it will reflect that this may become the overall standard of care for patients.

Reference

1. A study of nivolumab and ipilumumab in untreated pateints with stage 3 non-small cell lung cancer (NSCLC) that is unable or not planned to be removed by surgery (CheckMate73L). ClinicalTrials.gov. Updated July 26, 2021. Accessed September 28, 2021. https://clinicaltrials.gov/ct2/show/NCT04026412