搜索结果：Journal of the advanced practitioner in oncology

Adverse events (AEs) are unintended, harmful effects that occur in clinical trials, particularly in early-phase oncology clinical trials (EPOCT), where the risk of adverse effects from experimental therapies is high. Effective AE identification and management are essential for ensuring patient safety, improving outcomes, and advancing research. Advanced practice providers (APPs) play a key role in detecting and managing AEs, serving as a bridge between clinical care and research. However, their full impact on EPOCT remains underexplored. This integrative review examines existing literature on AE identification, reporting, and management in EPOCT. It explores the role of APPs in managing AEs, emphasizing their impact on patient outcomes, clinical trial efficiency, and oncology science. A systematic search of peer-reviewed literature from 2020 to 2025 was conducted using various databases. Inclusion criteria were studies addressing AE management in EPOCT, patient-reported outcomes (PROs), and APP roles. Studies unrelated to oncology, AE management, or health-care providers were excluded. Findings highlight the variability in AE reporting and the growing utility of electronic PRO tools in capturing timely and accurate data. Advanced practice providers contribute significantly to outpatient AE management, reducing emergency visits and improving treatment adherence. However, challenges remain, including underreporting with clinician-based tools, lack of standardized APP training, and limited comparison to physician-led AE management. APPs serve as key players in enhancing AE reporting and improving clinical trial processes. Future research should focus on standardizing structured training programs for APPs and comparative studies assessing the effectiveness of APP-led care.

Advanced practice providers (APPs), including physician associates (PAs) and nurse practitioners (NPs), are increasingly utilized in radiation oncology. However, radiation oncology-specific training for APPs is not standardized. This study elucidates the current role of US radiation oncology APPs by assessing clinical responsibilities. Radiation oncology APPs in the US were sent a survey examining demographics, training, practice structure, and clinical tasks using the framework of the 52 entrustable professional activities (EPAs) developed by the Radiation Oncology Education Collaborative Study Group (ROECSG). 37 PAs and 84 NPs participated. 53.7% practiced a different specialty previously. 63.6% had three or more APPs in the department, and 71.9% covered multiple physicians. 65.3% worked in a practice alongside radiation oncology residents, and 79.7% of these APPs worked directly with residents. 25.6% performed procedures. 95% completed follow-up/survivorship visits, 71% completed acute symptom visits, 65% completed ambulatory consults, 45% completed inpatient consults, and 38% completed on-treatment visits. 21.5% specialized in one disease site, 39.7% covered multiple disease sites, and 38.8% covered all disease sites. 22 of 52 ROECSG EPAs were performed by > 90% in some capacity. > 90% did not complete EPAs 15, 32, 33, 35, 36, 37, 38, 40, and 46. Only 2.5% of APPs received formal radiation oncology training during APP education. APPs perform many ROECSG EPAs, primarily during follow-up/survivorship visits. However, job responsibilities vary widely across radiation oncology clinics. Further definition of the APP role is essential to meet the growing demands of cancer care, support the evolution of radiation oncology, and enhance patient care.

Symptom burden is the primary driver for patients with indolent systemic mastocytosis (ISM) to seek medical care, whether or not they are diagnosed. This descriptive study aimed to describe the advanced practitioner (AP) and ISM patient perspective relative to the symptom burden of ISM, multidisciplinary diagnosis and management of ISM, barriers to symptom management, strategies for collaborative management of ISM, and communicative health literacy in patients with ISM. An ISM patient survey and AP survey were developed by an AP-led steering committee incorporating validated tools to measure symptom burden, symptom burden impact, barriers, and strategies for improving symptom burden. Surveys were embedded in Qualtrics and were deployed by Conexiant to a convenience sample of AP members of the Advanced Practitioner Society for Hematology/Oncology (APSHO), AP members of the American Initiative in Mast Cell Diseases, and patients affiliated with The Mast Cell Disease Society between December 22, 2024, and February 3, 2025. 50 APs and 53 ISM patients completed 100% of the questions on the corresponding surveys. The symptom burden described using the Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) to identify the symptoms that are most common, most challenging, and have the greatest impact on quality of life aligns with published data for patients in this survey. Only 24% (n = 13) of ISM patients indicated their disease was well controlled, while 76% of APs indicated greater than 50% of their ISM patients had well-controlled disease (n = 38). Most APs (68%) in the survey indicated they saw one to five ISM patients per year but were comfortable with managing ISM-related symptoms (54%, n = 27). Practice patterns for triage, multidisciplinary management, and shared decision-making are described. This is the first ISM symptom burden-focused survey to provide a direct comparison of patient responses to those of APs in hematology/oncology and allergy and immunology. Indolent systemic mastocytosis symptom burden measurement and symptom burden reduction remain challenging, with several barriers and gaps identified in this study. The APSHO Toolkit for Systemic Mastocytosis, developed in parallel to this study, provides an AP-focused resource for overcoming some of the barriers and gaps identified in this study.

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a highly effective treatment for relapsed or refractory multiple myeloma (MM). However, manufacturing CAR T cells can take 3 to 4 weeks, leaving patients vulnerable to disease progression during this waiting period. Bridging therapy aims to address this gap by controlling disease and improving CAR T-cell efficacy. This review summarizes the role of bridging therapy in CAR T-cell therapy for MM, focusing on the rationale and goals of bridging therapy, timing of initiation, infection risk management, selection of bridging regimens, and clinical implications, including patient education and communication. Relevant literature on CAR T-cell therapy and bridging therapy in MM was reviewed, including clinical trials and real-world data. Bridging therapy may be crucial for some patients, particularly for those with rapidly progressive disease. The optimal timing for initiating bridging therapy remains under investigation, but it can begin as soon as leukapheresis is completed. Prophylactic antibiotics or antivirals and close monitoring are essential for preventing infections during this period. The choice of bridging regimen depends on individual patient characteristics and prior therapies. Effective patient education and communication between local oncology teams and CAR T-cell centers are critical. Bridging therapy plays a vital role in optimizing CAR T-cell therapy outcomes for MM patients. Further research is needed to define the optimal use of bridging therapy in this evolving treatment landscape.

Narratives are central to the practice of medicine. However, modern health care faces numerous new demands, including increased patient loads and professional commitments, which interfere with opportunities to listen to and tell stories. These challenges can negatively impact patient care and provider burnout. Narrative medicine has been proposed as an approach to overcome these difficulties. Through implementation of this technique, engaging with illness anecdotes can become a more integral clinical focus. Its main movements are attention, reflection, and affiliation. There are multiple styles proposed for its use, although they all assist in the exploration of meaning within illness narratives. Over the past several decades, a shift toward promoting these tools has led to more research in the field. Multiple studies demonstrate the benefits to patients, providers, and caregivers. Additionally, programs are expanding to further the development of these skills. With guidance and repetition, these abilities can foster better engagement and understanding between all those involved in health care. This article discusses the various principles of narrative medicine and the benefits of its incorporation into health care, specifically in the role of oncology advanced practitioners.

Oncology advanced practitioners (OAPs) play an important role in cancer care delivery. However, leadership in clinical research remains low among OAPs. Although OAPs often participate in patient care for early-phase clinical trials, they rarely have the opportunity to lead as a principal investigator (PI), despite being capable and effective PIs when provided education and mentoring. As cancer care needs continue to increase, there is a critical need for well-trained PIs and sub-investigators (sub-Is) to evaluate novel therapeutics. To address this need, an intensive 3.5-day educational course at HonorHealth Research Institute (HRI) was developed to provide education and guidance to OAPs who desire to learn and evolve into the role of a PI in clinical trials. The course involved lectures, roundtable discussions with physicians, and protocol synopsis workshops. Participants included 21 OAPs. Participants were given questionnaires to evaluate the impact of the course and assess knowledge retention. In lectures, 65% of questions answered demonstrated improvement. In course evaluations, 100% of participants agreed that the learning objectives were met. In follow-up surveys, 63% reported they had reviewed their drafted protocol synopsis with their mentor, while the majority felt at least somewhat confident that they would be able to move forward with their protocol synopsis. Overall, participants responded favorably to the course, which successfully provided foundational knowledge for OAPs to transition into clinical research leadership positions.

Patient access to clinical trials has been identified as a key measure for delivery of quality cancer care. Effective recruitment and retention strategies remain an issue. Furthermore, clinical trial participants historically lack diversity. This project focused on advanced practice provider (APP) mentorship and paired clinical research support to enhance minority accrual to supportive care trials in Hawai'i. Over a 1-year period, a formal mentorship program for six participating APPs and three clinical research coordinators (CRCs) in the Hawai'i Minority/Underserved National Cancer Institute Community Oncology Research Program (HI M/U NCORP) was implemented. An introductory meeting kicked off the project. The APP and CRC teams then met weekly for targeted screening and accrual to supportive care trials. Monthly meetings between the mentor and teams were conducted to discuss barriers, best practices, and problem solve issues. 26 unique accruals were obtained by the APP and CRC teams over the project period while increasing minority accrual. All six APPs are now actively enrolling to trials. Four of the six participating APPs are now reviewing protocols for the HI M/U NCORP for feasibility and scientific merit. Eight of the nine participating APPs and CRCs found the intervention to be acceptable and feasible. Mentorship of APP and CRC teams can be a successful strategy in increasing accrual and participation of APPs in clinical trial activities. Measuring minority accrual based on this strategy is more complex and dependent on the APP location, clinical trial portfolio, APP patient panel and clinical interest, as well as the expertise of the APP.

Patients with cancer frequently desire to incorporate integrative oncology (IO) practices into their care. However, patients are often uncertain about how to best access safe and effective IO practices and providers. The National Comprehensive Cancer Network (NCCN) Best Practices Committee (BPC), in collaboration with a National Cancer Institute (NCI)-Designated Comprehensive Cancer Center, sought information regarding IO practices of NCCN Member Institutions. The BPC conducted a survey of NCCN Member Institution IO practices, which was distributed via a web-based survey tool to a representative at each center. Results were compiled using descriptive statistics. Twenty-nine centers responded to the survey, with 100% of the responding institutions offering IO services. Services provided included nutritional/dietary services (97%), stress and anxiety management services (76%), mind-body practices (72%), physical therapy/occupational therapy (72%), acupressure/acupuncture (69%), and massage therapy (59%). While the mechanism for patient access varied, the most common was provider referral with some services available by self-scheduling. Twenty-one percent of centers used institutionally designed algorithms for referrals. Significant variation in funding for services existed between institutions, including combinations of self-pay, insurance-based, and philanthropically funded models. There was substantial variation in how NCCN Member Institutions deliver IO services. These results provide guidance for health-care organizations seeking to develop IO services and an opportunity to align best practices. As data were compiled solely from sites providing comprehensive cancer services, non-academic community settings may find similar implementation challenging. However, this information provides cancer providers insight into IO services most often sought by patients with cancer.

Monoclonal gammopathy of undetermined significance (MGUS) is characterized as a nonmalignant or premalignant state whereby monoclonal immunoglobulins are detected in plasma, urine, or both. Approximately 3% to 4% of the population over the age of 50 is diagnosed with MGUS. It is estimated that 1% will progress to multiple myeloma or lymphoma over 20 years and therefore require ongoing clinical monitoring. Monoclonal gammopathy of undetermined significance is categorized into three types that are determined by the paraprotein clone: immunoglobulin M (IgM) MGUS, non-IgM MGUS, and light chain MGUS. There are high-risk genetic, biochemical, and clinical factors that increase the risk of transformation to multiple myeloma or lymphoma. The incidence of MGUS is two- to threefold higher in the Black population compared with the White population, along with an earlier age of onset. Familial risk and modifiable lifestyle factors are also associated with the development of MGUS and multiple myeloma. Certain monoclonal gammopathies, known as monoclonal gammopathy of clinical significance (MGCS), are associated with various organs that are involved (kidney, brain, skin, lungs, liver, eyes, and heart). The most common MGCS are associated with renal and neurological abnormalities, and treatment may be considered. Early diagnosis and multidisciplinary approaches to mitigate organ damage and other complications are important for the recognition and management of MGCS. Monoclonal gammopathy of undetermined significance is monitored rather than treated unless there are clinical findings of progression or organ dysfunction. Ongoing research and clinical trials are essential to refine monitoring guidelines, develop targeted therapies, and explore preventive measures aimed at reducing progression to multiple myeloma and other malignancies.

Systematic reviews are a critical tool in oncology practice to facilitate informed clinical decision-making, synthesize current research, and guide practice policy. To facilitate early exploration of a literature query or topic, Scopus Artificial Intelligence (AI), which was introduced in 2024 and is subscription-based, provides a new tool for researchers and providers to access current data or begin a systematic review topic exploration. The following article is intended to familiarize advanced practice providers (APPs) with both the recently released AI tool of Scopus AI and associated AI interface capabilities with literature search methodologies. Scopus AI is embedded within the extensive resources of Scopus, an established search engine database. Scopus AI simplifies a topic search by allowing a user to enter the question or phrase in natural language, or ordinary spoken or written language. It then translates the query into a vector and/or keyword search. Scopus AI summarizes the output results to include bullet points, numbered highlights, and conclusions. Associated citations, with internal URL links to articles embedded within the Scopus database, allow for confidence in the output summary. Pivotal or landmark study foundational document citations are also listed. The utilization of AI tools can aid APP researchers and clinicians to expedite steps in the systematic review process. Multiple tools are available to assist the researcher; Scopus AI is one of the tools that can be used to assist in streamlining specific aspects such as the initial tasks and literature search steps of the systematic review development process.

The Centers for Disease Control and Prevention and U.S. Public Health Service recommend that clinicians prioritize coprescribing take-home naloxone (THN) for patients with cancer receiving opioids in high doses or in the presence of a concomitant high-risk medication. Despite this, THN coprescribing rates remain low. The aim of this quality improvement project (QIP) was to determine if the implementation of an electronic health record (EHR) alert could result in increased THN coprescribing rates in patients with cancer at risk for opioid overdose. This pre- and post-intervention QIP was conducted in an outpatient medical oncology clinic in the Mountain West region of the US. Opioid prescriptions for the management of cancer-related pain totaling &#x2265; 100 morphine milligram equivalents (MME) per day or with a concomitant high-risk medication were eligible for inclusion (N = 224). An EHR alert was developed to notify the provider when eligibility criteria were met, prompting them to coprescribe THN. The primary outcome measure to increase THN coprescribing rates for opioid prescriptions totaling &#x2265; 100 MME per day was 38% at the end of the post-intervention period, a 29 percentage point increase from baseline (odds ratio [OR] = 6.57, 95% confidence interval [CI] = 1.85-23.39, p = .003). The coprescribing rate for opioid prescriptions with a high-risk medication was 57% at completion of the project, a 53 percentage point increase from baseline (OR = 30.67, 95% CI = 8.91-105.59, p < .001). This project established the practicality and success of THN coprescribing alert implementation and can be utilized as a roadmap for other practices to achieve safe opioid prescribing for patients with cancer.

Operationalizing workflows to manage cytokine release syndrome (CRS) in community practices presents challenges for multidisciplinary teams. Real-world experience was gathered from OneOncology community health-care professionals to establish best-prac-tice workflows for CRS management. Qualitative data were gathered via focus groups from hematology-oncology MDs, PharmDs, and nurse providers (N = 13) with experience treating patients with bispecific T-cell-engaging antibodies (BsAbs). Theme matrix techniques facilitated analysis. Three themes were identified: (1) creating a coordinated workflow plan, (2) building network partnerships, and (3) understanding patient support. Workflow decisions were driven by community practices managing patients treated with BsAbs or partnering with sites for initial dosing and maintenance. Catalysts for developing CRS workflows included: FDA approval of BsAbs; BsAbs clinical trial experience; BsAbs on formulary; having patients receiving BsAbs; and practice champion(s) for protocol development. Key steps included defining communication during and after practice hours, designating training leads, and creating practice-specific plans for interdisciplinary team coordination. Inpatient admission processes developed with hospital staff and hospital staff training were fundamental for successful patient management. Communication processes among practice, pharmacy, and hospital staff throughout BsAbs treatment were established, along with methods to ensure the availability of CRS treatment if needed. Continuous patient/caregiver education on BsAbs treatment, monitoring for adverse events (particularly CRS), and how/when to access care were described. BsAb use in community settings requires multidisciplinary coordination between practices and hospitals. Actions included identifying practice champions, establishing clear workflows for transitioning patients between inpatient and outpatient settings, and ensuring continuous training of staff, patients, and caregivers.

Indications for the use of cytomegalovirus (CMV)-neg-ative and irradiated blood products (IRBP) are not standardized and are often poorly understood by providers. This project evaluated the use of a transfusion algorithm in an outpatient oncology clinic to reduce the risk of transfusion-associated graft-vs.-host disease (TA-GVHD) and eliminate the improper use of CMV-negative and irradiated blood products. The aim of this project was to increase the correct use of CMV-negative and irradiated blood products at an outpatient oncology clinic by establishing a transfusion algorithm, to evaluate the effectiveness of clinical transfusion algorithms on the use of specialty blood products, and to educate providers on TA-GVHD. This quasi-experimental project compared 12 weeks of transfusion data before the implementation of a transfusion algorithm to 12 weeks of transfusion data after the algorithm was introduced. A preand post-test survey measured the satisfaction and the impact of the education. The transfusion algorithm resulted in a clinically significant increase in the correct use of both CMV-negative and irradiated blood products at an outpatient oncology clinic. The education in-services provided to staff about TA-GVHD and the indications for irradiated blood product resulted in a significant increase in provider knowledge on ordering specialty blood products.

Patients on clinical trials experience numerous quality of life (QOL) concerns, including those associated with advancing disease. This pilot project tested the feasibility and initial outcomes of an advanced practice registered nurse (APRN)-led intervention for patients with gastrointestinal (GI) tumors transitioning after completing a phase I trial. The objectives were to (1) Develop the "Transitions" care plan intervention based on prior research to support patient QOL including symptom management, psychosocial and spiritual support, and care after trial completion; (2) Test the feasibility of the intervention in a sample of patients with GI tumors; and (3) Evaluate the impact of the Transitions care plan intervention on improved care and QOL. A single-group, convenience sample of patients with GI tumors completing phase I clinical trials was accrued at a National Cancer Institute-designated Comprehensive Cancer Center in the western US. Patients completed questionnaires at baseline, 3 months, and 6 months. Interviews were conducted at 3 months for further understanding of patient needs. A Transitions care plan for the patient was developed by the APRN in collaboration with the patient and medical oncologist. Chart audits were conducted to capture supportive services referrals and completions. Key variables included domains of QOL, distress, and use of supportive care services. Patients (N = 37) had significant needs for support across all QOL domains. The Transitions care plan model was valuable in assessing QOL needs, facilitating patients' understanding of disease status, and providing access to supportive care services. APRNs can develop a model of care to support patients completing clinical trials.

As oral anticancer agents become more prominent in the treatment landscape, their expanded use may raise concerns, such as nonadherence, adverse events, drug monitoring, and high costs. Clinical pharmacists (CPs) provide patient education and medication management to address these concerns. To understand the services and communication offered, interviews were conducted with clinical pharmacists in oncology clinics. Telephone interviews were conducted with pharmacists from oncology clinics across the US. The interviews evaluated clinical support services provided by CPs for patients on oral chemotherapy, and facilitators and barriers CPs face in implementing communication with the oncology team. The function and support of CPs in this context were assessed. A total of 16 pharmacists were interviewed. As a result, three overarching themes were identified pertaining to typical roles: (1) CPs provide key support to oncology patients; (2) CPs face logistical, coordination, and communication challenges when supporting oncology patients, and (3) CPs contribute to patient safety and quality of care outside of direct patient care. A total of eight subthemes were identified. CPs provide high-quality care to patients according to national guidelines. However, they continue to be pulled in various directions to fill gaps that exist in the patient care pathway. This leads to pharmacists feeling unsupported, leading to burnout. Many CPs expressed not billing for services provided, making it difficult to advocate for additional supportive resources.

Cytotoxic chemotherapies and immunotherapies cause harmful side effects in over half of patients with cancer. Early intervention is critical for improving outcomes, but in outpatient settings, patient self-assessment and patient-initiated pursuit of follow-up care often cause delays. Digital health technologies for remote patient monitoring (RPM) can minimize these delays. This study assessed the feasibility and perceived user experience of RPM technology for early detection of febrile neutropenia and infection in allogeneic bone marrow transplant (BMT) patients. Ten BMT patients between the ages of 18 and 89 years wore biometric monitoring devices for up to 90 days post-transplant. Devices sent real-time alerts to clinicians in response to elevated temperature, heart rate, or respiratory rate. Patients and caregivers completed surveys about their experience at 30 and 90 days post-transplant; patients were asked to participate in interviews at these time points. Providers completed surveys at the end of the study. Biometric and health utilization outcomes and responses to survey items were analyzed through descriptive statistics. Rapid content analysis of survey data and interview data was conducted to explore emergent themes. Seven patients wore RPM devices until study completion. 369 alerts were generated, with 101 requiring follow-up. Two patients had infections during the study. One had infection detected through alert data and received outpatient treatment; the second stopped wearing their device prior to symptom onset and required hospitalization. Overall, RPM technology was perceived as generally acceptable, comfortable, and easy to use. Refinements to alerting practices and technology performance are recommended to improve adoption and use as intended in the outpatient setting.

Imetelstat is a first-in-class, direct, and competitive inhibitor of telomerase enzymatic activity that selectively induces apoptosis of malignant clones and allows for recovery of erythropoiesis. Imetelstat was approved by the United States Food and Drug Administration in June 2024 and the European Medicines Agency in March 2025 for the treatment of certain patients with lower-risk (low to intermediate-1) myelodysplastic syndromes (LR-MDS) with transfusion-dependent anemia who have failed or lost response to or are ineligible for erythropoiesis-stimulating agents. Imetelstat is infused at 7.1 mg/kg (active dose, equivalent to 7.5 mg/kg sodium salt) intravenously over 2 hours once every 4 weeks. In the pivotal IMerge trial in LR-MDS, significantly more patients treated with imetelstat vs. placebo, respectively, achieved &#x2265; 8-week RBC-transfusion independence (TI; 40% [95% confidence interval [CI] = 30.9-49.3] vs. 15% [95% CI = 7.1-26.6]) and &#x2265; 24-week RBC-TI (28% [95% CI = 20.1-37.0] vs. 3% [95% CI = 0.4-11.5]). The safety profile of imetelstat was characterized primarily by cytopenias, including neutropenia (incidence of 74% any grade and 68% grade 3-4 events) and thrombocytopenia (75% and 62%, respectively). Grade 3 to 4 hematologic events occurred early in the treatment and had a median duration of 1.9 weeks for neutropenia and 1.4 weeks for thrombocytopenia; cases resolved to grade &#x2264; 2 within 2 weeks in 81% and 86% of cases, respectively, with limited severe complications. This review highlights key topics related to the use of imetelstat in patients with LR-MDS, including its mechanism of action, clinical efficacy and safety data, dosing and administration, management of adverse events, and notable clinical practice implications.

Breast cancer is the most common cancer in women in the United States. The treatment of breast cancer has multiple side effects, including cancer-related fatigue (CRF). While physical activity has the strongest evidence in treating CRF, it is limited by a patient's functional status, disease, and safety concerns. Several studies have demonstrated that exogenous melatonin has improved depressive symptoms, insomnia, and sleep quality in breast cancer patients. However, few have focused on the effects of melatonin on CRF. This review explores the effect of melatonin on CRF in breast cancer patients. A review of current literature was conducted by searching PubMed, Cochrane, Scopus, and CINAHL databases. One hundred articles resulted, and after applying exclusion criteria, five articles were chosen for this review. Results showed a significant improvement in CRF in the studies utilizing 5 mg and 18 mg of melatonin in breast cancer patients undergoing chemotherapy or radiation. Melatonin can be considered an option for patients with breast cancer experiencing CRF, especially in the context of patients with physical limitations where exercise may not be an option. Additional research is needed to further evaluate the role and ideal dose of melatonin in the management of CRF.

Rearrangements of the anaplastic lymphoma kinase (ALK) gene are present in about 3% to 7% of patients with non-small cell lung cancer (NSCLC) and are the key drivers of cancer cell proliferation in ALK-positive NSCLC. ALK tyrosine kinase inhibitors (TKIs) are potent oral inhibitors of the abnormal ALK protein and are standard first-line treatments for patients with ALK-positive metastatic NSCLC (mNSCLC). Lorlatinib is a brain-penetrant, third-generation ALK TKI that was approved by the US Food and Drug Administration in 2018 for the second- or third-line treatment of patients with ALK-positive mNSCLC and in 2021 for first-line treatment, based on the results of the phase III CROWN study (NCT03052608). The recent 5-year results of the CROWN study showed that median progression-free survival had yet to be reached in the lorlatinib group, corresponding to the longest progression-free survival reported with any single-agent molecular targeted treatment in advanced NSCLC and all metastatic solid tumors (Solomon et al., 2024). These results, along with the extended intracranial efficacy and consistent safety profile of long-term lorlatinib treatment, are unprecedented in patients with ALK-positive mNSCLC. This Grand Rounds article summarizes the efficacy, safety, and tolerability of lorlatinib after 5 years and includes a fictional patient case to demonstrate how advanced practice providers contribute to personalized patient care and the identification and management of adverse events.