{"id":378375,"date":"2026-04-06T19:41:09","date_gmt":"2026-04-06T19:41:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/378375\/"},"modified":"2026-04-06T19:41:09","modified_gmt":"2026-04-06T19:41:09","slug":"supporting-safe-surgery-in-tnbc-through-early-management-of-immune-related-adverse-events","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/378375\/","title":{"rendered":"Supporting Safe Surgery in TNBC Through Early Management of Immune-Related Adverse Events"},"content":{"rendered":"

\"\"<\/p>\n

iStock.com\/SDI Productions<\/p>\n

Oncology nurses are often among the first clinicians to recognize immune-related adverse events (irAEs), frequently when patients call triage to report new symptoms such as rash, fatigue, or gastrointestinal changes. For many patients receiving immunotherapy, this initial outreach represents the first sign of toxicity, placing nurses at the forefront of early assessment and intervention. Early recognition is critical, as irAEs often take time to improve and may worsen without prompt management, potentially leading to delays in care. As immunotherapy becomes increasingly integrated into the treatment of triple-negative breast cancer (TNBC), understanding how irAEs may affect both symptom management and surgical timing is essential.<\/p>\n

Real-World Insights Into irAEs During Neoadjuvant Therapy<\/p>\n

A retrospective study<\/a>, recently published in\u00a0Cancers,\u00a0by Jeeyeon Lee and colleagues examines the real-world incidence and clinical impact of irAEs in patients with TNBC receiving pembrolizumab in combination with neoadjuvant chemotherapy (NAC), with a particular focus on how these toxicities influence surgical timing and perioperative management.<\/p>\n

Breast cancer has traditionally been considered poorly immunogenic, meaning it doesn\u2019t naturally provoke a strong immune response, which has limited the role of immunotherapy. However, the introduction of immune checkpoint inhibitors, particularly pembrolizumab, has significantly improved outcomes for patients with TNBC, including higher rates of pathologic complete response and improved survival. As a result, pembrolizumab is now incorporated into neoadjuvant regimens for patients with stage II-III disease. Despite these advances, irAEs remain incompletely characterized in this setting, particularly in terms of their implications for surgery.<\/p>\n

In this study, 82 patients with stage II-III TNBC received a KEYNOTE-522\u2013based regimen consisting of pembrolizumab combined with paclitaxel and carboplatin, followed by pembrolizumab with doxorubicin and cyclophosphamide. Patients were systematically monitored for irAEs using clinical assessment and laboratory evaluation, including thyroid function testing to detect hypothyroidism or hyperthyroidism and adrenal axis evaluation to assess cortisol production, both of which can affect surgical safety and require correction before anesthesia is administered.<\/p>\n

The findings demonstrate that irAEs are common, occurring in 72% of patients, with many experiencing multiple toxicities. The most frequently reported events were myalgia and dermatologic reactions such as rash or dermatitis. Other commonly observed toxicities included peripheral neuropathy, thyroid dysfunction, and gastrointestinal symptoms such as diarrhea. Although the majority of these events were low grade and manageable, a subset of patients developed more clinically significant toxicities requiring intervention.<\/p>\n

Importantly, irAEs had measurable implications for treatment delivery. Surgical delays occurred for 7.3% of patients, primarily due to grade 2 or higher toxicities. Endocrine dysfunction, particularly hypothyroidism, was the most common cause of delay. In several cases, patients developed markedly elevated thyroid-stimulating hormone levels requiring thyroid hormone replacement before proceeding with surgery. Given the time required to achieve euthyroid status, these patients experienced delays of 8 weeks or longer. Other causes of delay included severe systemic symptoms such as fatigue and poor oral intake, as well as hepatotoxicity with significant transaminase elevation.<\/p>\n

These findings underscore the unique challenges associated with immunotherapy in the neoadjuvant setting. Unlike metastatic settings, in which treatment delays may be more flexible, delays in curative-intent surgery can compromise overall treatment timelines and potentially impact outcomes. Endocrine irAEs are particularly important in this context, as they may be asymptomatic yet carry significant perioperative risk. Hypothyroidism, for example, can affect cardiovascular stability, reduce cardiac output, and increase anesthesia-related complications if not adequately corrected.<\/p>\n

The study has several limitations, including its retrospective design, relatively small sample size, and limited follow-up restricted to the neoadjuvant period. Despite these limitations, the study provides valuable real-world insight into the frequency and clinical relevance of irAEs in patients with TNBC receiving pembrolizumab-based NAC.<\/p>\n

Nursing Considerations<\/p>\n

Oncology nurses play a key role in supporting oncology teams with vigilant monitoring for irAEs. This includes routine laboratory assessments, particularly of thyroid and adrenal function, to identify endocrine toxicities that may be asymptomatic but carry perioperative risk. Nurses should also be alert for less common but serious toxicities, such as pneumonitis or hepatotoxicity, which can have a disproportionate impact on surgical planning.<\/p>\n

Patient education is essential for early detection and management. Nurses should counsel patients on symptoms to report promptly, such as fatigue, rash, gastrointestinal changes, or shortness of breath, and reinforce the importance of adhering to monitoring schedules.<\/p>\n

Interdisciplinary communication is critical. Nurses help coordinate care among oncology, surgery, anesthesia, and endocrinology teams to ensure patients are medically optimized before surgery and to minimize the risk of treatment delays.<\/p>\n","protected":false},"excerpt":{"rendered":"iStock.com\/SDI Productions Oncology nurses are often among the first clinicians to recognize immune-related adverse events (irAEs), frequently when…\n","protected":false},"author":2,"featured_media":378376,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[163,85,46],"class_list":{"0":"post-378375","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-health","9":"tag-il","10":"tag-israel"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/378375","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=378375"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/378375\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/378376"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=378375"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=378375"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=378375"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}