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  Subjects -> PHARMACY AND PHARMACOLOGY (Total: 575 journals)
Showing 1 - 200 of 253 Journals sorted by number of followers
Nature Reviews Drug Discovery     Full-text available via subscription   (Followers: 332)
International Journal of Drug Policy     Hybrid Journal   (Followers: 254)
Journal of Clinical Oncology     Hybrid Journal   (Followers: 242)
Journal of Medicinal Chemistry     Hybrid Journal   (Followers: 157)
Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 155)
Drugs     Full-text available via subscription   (Followers: 146)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 98)
Pharmaceutical Research     Hybrid Journal   (Followers: 94)
European Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 86)
Drug Safety     Full-text available via subscription   (Followers: 83)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 56)
Biomaterials     Hybrid Journal   (Followers: 54)
Clinical Pharmacology & Therapeutics     Hybrid Journal   (Followers: 44)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 42)
Journal of Controlled Release     Hybrid Journal   (Followers: 38)
Annual Review of Pharmacology and Toxicology     Full-text available via subscription   (Followers: 38)
International Journal of Pharmaceutics     Hybrid Journal   (Followers: 37)
Clinical Therapeutics     Hybrid Journal   (Followers: 34)
European Journal of Pharmaceutics and Biopharmaceutics     Hybrid Journal   (Followers: 34)
Pharmacoepidemiology and Drug Safety     Hybrid Journal   (Followers: 33)
British Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 32)
Journal of Pharmacy and Pharmacology     Full-text available via subscription   (Followers: 31)
Drug Development and Industrial Pharmacy     Hybrid Journal   (Followers: 29)
PharmacoEconomics     Full-text available via subscription   (Followers: 27)
Clinical Pharmacokinetics     Full-text available via subscription   (Followers: 27)
AAPS Journal     Hybrid Journal   (Followers: 26)
Critical Reviews in Toxicology     Hybrid Journal   (Followers: 25)
Journal of Clinical Psychopharmacology     Hybrid Journal   (Followers: 24)
International Journal of Pharmacy Practice     Full-text available via subscription   (Followers: 24)
Toxicology and Applied Pharmacology     Hybrid Journal   (Followers: 24)
Chemical Research in Toxicology     Hybrid Journal   (Followers: 22)
Journal of Pharmacokinetics and Pharmacodynamics     Hybrid Journal   (Followers: 22)
Journal of Pain & Palliative Care Pharmacotherapy     Hybrid Journal   (Followers: 21)
Trends in Pharmacological Sciences     Full-text available via subscription   (Followers: 20)
Journal of Applied Toxicology     Hybrid Journal   (Followers: 19)
Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 19)
Pharmaceutical Development and Technology     Hybrid Journal   (Followers: 19)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 19)
Clinical Trials     Hybrid Journal   (Followers: 18)
Toxicology     Hybrid Journal   (Followers: 18)
Journal of Pharmaceutical and Biomedical Analysis     Hybrid Journal   (Followers: 18)
Clinical Toxicology     Hybrid Journal   (Followers: 18)
International Journal of Toxicology     Hybrid Journal   (Followers: 17)
Critical Reviews in Clinical Laboratory Sciences     Hybrid Journal   (Followers: 16)
Journal of Clinical Pharmacy and Therapeutics     Hybrid Journal   (Followers: 16)
Journal of Natural Products     Hybrid Journal   (Followers: 16)
Pharmaceutical Statistics     Hybrid Journal   (Followers: 15)
Toxicology Letters     Hybrid Journal   (Followers: 15)
Journal of Pharmacy Practice     Hybrid Journal   (Followers: 15)
Psychopharmacology     Hybrid Journal   (Followers: 15)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 14)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
European Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 14)
Current Medicinal Chemistry     Hybrid Journal   (Followers: 13)
American Journal of Therapeutics     Hybrid Journal   (Followers: 13)
Drug and Chemical Toxicology     Hybrid Journal   (Followers: 13)
Journal of the American Pharmacists Association     Full-text available via subscription   (Followers: 13)
Clinical Research and Regulatory Affairs     Hybrid Journal   (Followers: 12)
Seminars in Hematology     Hybrid Journal   (Followers: 12)
Drug Discovery Today: Technologies     Full-text available via subscription   (Followers: 12)
Current Pharmaceutical Design     Hybrid Journal   (Followers: 12)
Journal of Oncology Pharmacy Practice     Hybrid Journal   (Followers: 12)
Journal of Psychopharmacology     Hybrid Journal   (Followers: 11)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 11)
Toxicology in Vitro     Hybrid Journal   (Followers: 11)
Drug Development Research     Hybrid Journal   (Followers: 11)
Drug Metabolism and Disposition     Hybrid Journal   (Followers: 11)
Seminars in Oncology Nursing     Full-text available via subscription   (Followers: 10)
Biochemical Pharmacology     Hybrid Journal   (Followers: 10)
Journal of Separation Science     Hybrid Journal   (Followers: 10)
CNS Drugs     Full-text available via subscription   (Followers: 10)
Current Pharmaceutical Biotechnology     Hybrid Journal   (Followers: 10)
Journal of Medical Marketing     Hybrid Journal   (Followers: 10)
Drugs & Aging     Full-text available via subscription   (Followers: 10)
European Neuropsychopharmacology     Hybrid Journal   (Followers: 9)
Food Additives & Contaminants Part A     Hybrid Journal   (Followers: 9)
Journal of Pharmacology and Experimental Therapeutics     Hybrid Journal   (Followers: 9)
Environmental Toxicology and Pharmacology     Hybrid Journal   (Followers: 9)
Medicinal Chemistry     Hybrid Journal   (Followers: 9)
Biometrical Journal     Hybrid Journal   (Followers: 9)
Drugs & Therapy Perspectives     Full-text available via subscription   (Followers: 9)
Prescriber     Hybrid Journal   (Followers: 9)
ChemMedChem     Hybrid Journal   (Followers: 9)
Current Opinion in Pharmacology     Hybrid Journal   (Followers: 9)
European Journal of Pharmacology     Hybrid Journal   (Followers: 8)
Inhalation Toxicology     Hybrid Journal   (Followers: 8)
Antiviral Research     Hybrid Journal   (Followers: 8)
Drug Metabolism Reviews     Hybrid Journal   (Followers: 8)
Progress in Neuro-Psychopharmacology and Biological Psychiatry     Hybrid Journal   (Followers: 8)
Human & Experimental Toxicology     Hybrid Journal   (Followers: 8)
Drug Delivery     Open Access   (Followers: 8)
BioDrugs     Full-text available via subscription   (Followers: 8)
Frontiers in Drug Design & Discovery     Hybrid Journal   (Followers: 8)
Expert Review of Pharmacoeconomics & Outcomes Research     Full-text available via subscription   (Followers: 8)
Experimental and Clinical Psychopharmacology     Full-text available via subscription   (Followers: 7)
Toxicology Mechanisms and Methods     Hybrid Journal   (Followers: 7)
Journal of Pharmacological and Toxicological Methods     Hybrid Journal   (Followers: 7)
Clinical and Experimental Pharmacology and Physiology     Hybrid Journal   (Followers: 7)
Scandinavian Journal of Clinical and Laboratory Investigation     Hybrid Journal   (Followers: 7)
Epilepsy Research     Hybrid Journal   (Followers: 7)
Clinical Drug Investigation     Full-text available via subscription   (Followers: 7)
Journal of Veterinary Pharmacology and Therapeutics     Hybrid Journal   (Followers: 6)
Toxicology and Industrial Health     Hybrid Journal   (Followers: 6)
Skin Pharmacology and Physiology     Full-text available via subscription   (Followers: 6)
Journal of Cardiovascular Pharmacology     Hybrid Journal   (Followers: 6)
AAPS PharmSciTech     Hybrid Journal   (Followers: 6)
Current Drug Discovery Technologies     Hybrid Journal   (Followers: 6)
Current Drug Delivery     Hybrid Journal   (Followers: 6)
Current Therapeutic Research     Open Access   (Followers: 6)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 6)
Neuropharmacology     Hybrid Journal   (Followers: 5)
Current Drug Metabolism     Hybrid Journal   (Followers: 5)
Fitoterapia     Hybrid Journal   (Followers: 5)
Expert Review of Molecular Diagnostics     Full-text available via subscription   (Followers: 5)
Expert Review of Anti-infective Therapy     Full-text available via subscription   (Followers: 5)
Anti-Infective Agents     Hybrid Journal   (Followers: 5)
Toxicon     Hybrid Journal   (Followers: 5)
Medicinal Research Reviews     Hybrid Journal   (Followers: 5)
Investigational New Drugs     Hybrid Journal   (Followers: 5)
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 5)
Current Cancer Therapy Reviews     Hybrid Journal   (Followers: 5)
Reviews of Physiology, Biochemistry and Pharmacology     Hybrid Journal   (Followers: 4)
Planta Medica     Hybrid Journal   (Followers: 4)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 4)
Pharmaceutical Medicine     Full-text available via subscription   (Followers: 4)
Journal of Child and Adolescent Psychopharmacology     Hybrid Journal   (Followers: 4)
CNS Drug Reviews     Open Access   (Followers: 4)
Inpharma Weekly     Full-text available via subscription   (Followers: 4)
Journal of Labelled Compounds and Radiopharmaceuticals     Hybrid Journal   (Followers: 4)
Immunopharmacology and Immunotoxicology     Hybrid Journal   (Followers: 4)
International Journal of Pharmaceutical and Healthcare Marketing     Hybrid Journal   (Followers: 4)
Inflammation Research     Hybrid Journal   (Followers: 4)
Cancer Chemotherapy and Pharmacology     Hybrid Journal   (Followers: 4)
International Journal of Neuropsychopharmacology     Open Access   (Followers: 3)
Pharmacology & Therapeutics     Hybrid Journal   (Followers: 3)
Physiology International     Full-text available via subscription   (Followers: 3)
Cardiovascular Therapeutics     Open Access   (Followers: 3)
ASSAY and Drug Development Technologies     Hybrid Journal   (Followers: 3)
Pharmacopsychiatry     Hybrid Journal   (Followers: 3)
Chemotherapy     Full-text available via subscription   (Followers: 3)
Therapeutic Drug Monitoring     Hybrid Journal   (Followers: 3)
Current Drug Therapy     Hybrid Journal   (Followers: 3)
Research in Social and Administrative Pharmacy     Hybrid Journal   (Followers: 3)
PharmacoEconomics & Outcomes News     Full-text available via subscription   (Followers: 3)
Journal of Aerosol Medicine and Pulmonary Drug Delivery     Hybrid Journal   (Followers: 3)
Journal of Ethnopharmacology     Hybrid Journal   (Followers: 3)
Drug Resistance Updates     Hybrid Journal   (Followers: 3)
Journal of Pain Management & Medicine     Open Access   (Followers: 3)
Journal of Infection and Chemotherapy     Hybrid Journal   (Followers: 3)
Journal of Cardiovascular Pharmacology and Therapeutics     Hybrid Journal   (Followers: 3)
Current Pharmacogenomics and Personalized Medicine     Hybrid Journal   (Followers: 3)
Acta Pharmacologica Sinica     Hybrid Journal   (Followers: 3)
Microbial Drug Resistance     Hybrid Journal   (Followers: 3)
Frontiers in Medicinal Chemistry     Hybrid Journal   (Followers: 3)
Human Psychopharmacology Clinical and Experimental     Hybrid Journal   (Followers: 3)
BMC Pharmacology     Open Access   (Followers: 2)
The Brown University Psychopharmacology Update     Hybrid Journal   (Followers: 2)
International Clinical Psychopharmacology     Hybrid Journal   (Followers: 2)
Canadian Journal of Physiology and Pharmacology     Hybrid Journal   (Followers: 2)
Journal of Drug Targeting     Hybrid Journal   (Followers: 2)
Inflammopharmacology     Hybrid Journal   (Followers: 2)
Journal of Inflammation     Open Access   (Followers: 2)
Fundamental & Clinical Pharmacology     Hybrid Journal   (Followers: 2)
Behavioural Pharmacology     Hybrid Journal   (Followers: 2)
Vascular Pharmacology     Hybrid Journal   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Biomedicine & Pharmacotherapy     Full-text available via subscription   (Followers: 2)
Clinical Neuropharmacology     Hybrid Journal   (Followers: 2)
Drugs in R & D     Full-text available via subscription   (Followers: 2)
International Immunopharmacology     Hybrid Journal   (Followers: 2)
Pharmacology Biochemistry and Behavior     Hybrid Journal   (Followers: 2)
Letters in Drug Design & Discovery     Hybrid Journal   (Followers: 2)
Archiv der Pharmazie     Hybrid Journal   (Followers: 2)
Pharmacological Reviews     Hybrid Journal   (Followers: 2)
Molecular Pharmacology     Hybrid Journal   (Followers: 2)
Journal of Microencapsulation: Microcapsules, Liposomes, Nanoparticles, Microcells, Microspheres     Hybrid Journal   (Followers: 2)
Toxicological & Environmental Chemistry     Hybrid Journal   (Followers: 2)
Particulate Science and Technology: An International Journal     Hybrid Journal   (Followers: 1)
Pharmacological Research     Hybrid Journal   (Followers: 1)
Current Enzyme Inhibition     Hybrid Journal   (Followers: 1)
Journal of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1)
Current Pharmaceutical Analysis     Hybrid Journal   (Followers: 1)
Current Neuropharmacology     Hybrid Journal   (Followers: 1)
Pharmacogenetics and Genomics     Hybrid Journal   (Followers: 1)
Journal of Texture Studies     Hybrid Journal   (Followers: 1)
Pharmaceutical Biology     Open Access  
Journal of Liposome Research     Hybrid Journal  
Toxin Reviews     Hybrid Journal  
Kaohsiung Journal of Medical Sciences     Open Access  
Redox Report     Open Access  
Pharmacology     Full-text available via subscription  
Pharmaceutical Chemistry Journal     Hybrid Journal  
NeuroMolecular Medicine     Hybrid Journal  
Journal of Ocular Pharmacology and Therapeutics     Hybrid Journal  
Harm Reduction Journal     Open Access  
Current Nanoscience     Hybrid Journal  
Infectious Disorders - Drug Targets     Hybrid Journal  
Current Bioactive Compounds     Hybrid Journal  
Cancer Biotherapy & Radiopharmaceuticals     Hybrid Journal  
Autonomic & Autacoid Pharmacology     Hybrid Journal  

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Journal of Oncology Pharmacy Practice
Journal Prestige (SJR): 0.59
Citation Impact (citeScore): 1
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1078-1552 - ISSN (Online) 1477-092X
Published by Sage Publications Homepage  [1175 journals]
  • Genetic variants found in paediatric oncology patients with severe
           chemotherapy-induced toxicity: A case series

    • Free pre-print version: Loading...

      Authors: EC Bernsen, LM Hanff, LM Haveman, BBJ Tops, M van der Lee, JJ Swen, ADR Huitema, MHM Diekstra
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Paediatric oncology patients who develop severe chemotherapy-induced toxicity that requires dose reduction, delay or termination of treatment are at risk of decreased treatment efficacy. Previous research has provided evidence that genetic variants in TPMT, NUDT15, UGT1A1 and DPYD are associated with toxicity of anticancer drugs. This led to pharmacogenetic guidelines that are integrated into clinical practice in paediatric oncology. Recently, novel genetic variants have been associated with a higher risk of developing chemotherapy-induced toxicity. In this case series, we selected 21 novel variants and genotyped these in nine patients with excessive chemotherapy-induced toxicity using whole exome sequencing or micro-array data. We observed that six out of nine patients carried at least one variant that, according to recent studies, potentially increased the risk of developing methotrexate- or vincristine-induced toxicity. As patient-derived genetic data are becoming widely accessible in paediatric oncology, these variants could potentially enter clinical practice to mitigate chemotherapy-induced toxicity.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-12-05T05:37:33Z
      DOI: 10.1177/10781552221137302
       
  • Siltuximab as a primary treatment for cytokine release syndrome in a
           patient receiving a bispecific antibody in a clinical trial setting

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      Authors: Brea C Lipe, Thomas Renaud
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common toxicities associated with immunotherapies, including T cell redirecting bispecific antibodies. Although cooperative group guidelines recommend the use of tocilizumab or other IL-6/IL-6R inhibitors for the management of CRS and ICANS, reports on the use of siltuximab, an IL-6 inhibitor, for the treatment of CRS are limited.Case reportWe present the case of a 77-year-old male who received T cell redirecting bispecific antibody therapy with talquetamab for relapsed/refractory multiple myeloma (RRMM) and developed CRS with concurrent ICANS after receiving a second dose of talquetamab.Management and OutcomeThe patient received an infusion of siltuximab. The patient recovered from CRS within 1 h of siltuximab administration and ICANS within 7 h of siltuximab administration. Patient tolerated the subsequent dose of talquetamab with no evidence of CRS and continued on study.DiscussionThis case describes the successful use of siltuximab for the management of CRS in a patient treated with a T cell redirecting bispecific antibody for RRMM.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-12-05T04:24:31Z
      DOI: 10.1177/10781552221140320
       
  • Rituximab-induced severe acute thrombocytopenia in a patient with splenic
           marginal zone lymphoma

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      Authors: Taha Ulutan Kars, Zahit Furkan Yorgancı, Osman Yaşkıran, Atakan Tekinalp, Sinan Demircioğlu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionRituximab, which is widely used in the treatment of B-cell lymphoma, is a chimeric monoclonal antibody directed against the CD20 antigen. Rituximab has many side effects, mainly allergic and neurological. Rituximab may cause thrombocytopenia in the long term after administration. Rare cases of rituximab-induced acute thrombocytopenia have been reported in the literature.Case ReportA 51-year-old female patient who was newly diagnosed with splenic marginal zone lymphoma received rituximab as first-line therapy. Petechiae occurred in the lower extremities on the day following rituximab administration. The blood test showed a severe drop in the platelet count from 112,000/μL to 5000/μL. Blood peripheral smear evaluation confirmed severe thrombocytopenia.Management and outcomeThere was no change in hemoglobin or white blood cell levels. After the diagnosis of rituximab-induced acute thrombocytopenia, thrombocyte suspension was administered due to the risk of bleeding. Close clinical and laboratory observations were made. The platelet count began to rise gradually in the following period. Before the second week of rituximab administration, the platelet count was 122,000/μL. No complications developed after premedication and slow rituximab administration, and subsequent treatments were continued in the same way.DiscussionRituximab has widespread use, especially in malignancies and autoimmune diseases. Like many monoclonal antibodies, rituximab has several side effects. Thrombocytopenia is a long-term side effect associated with rituximab, and rituximab-induced severe acute thrombocytopenia has been rarely reported. Therefore, it should be kept in mind that severe acute thrombocytopenia may develop after rituximab administration.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-12-02T07:12:02Z
      DOI: 10.1177/10781552221142870
       
  • Safe administration of temozolomide in end-stage renal disease patients

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      Authors: Jasmin Hundal, Aditi Singh, Megan K Pereira, James Vredenburg
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionGlioblastoma multiforme is the most common and aggressive type of central nervous system tumor. We present a novel case of the challenges of dosing temozolomide in a patient with end stage renal disease on peritoneal hemodialysis with unpredictable clearance and toxicities.Case reportIn this case, a 60-year-old male with a past medical history of hypertension and Stage V chronic kidney disease presented with worsening confusion and word-finding difficulty in the emergency department. Magnetic resonance imaging demonstrated a large intra-axial mass within the posterior left frontal lobe measuring 4.5 × 4.1 × 3.5 cm with irregularly, predominant peripheral tumoral enhancement.Management and outcomeThe patient underwent a surgical resection which confirmed the diagnosis of glioblastoma (grade 4). The standard treatment for glioblastoma is 6 weeks of radiation therapy and daily temozolomide. Given his history of renal dysfunction and limited data on the safety of temozolomide in patients on hemodialysis (HD), the patient was administered dose-reduced temozolomide and closely monitored for toxicities. Temozolomide was successfully up-titrated to the full dose.DiscussionRenal replacement therapy is a life-saving treatment for end-stage kidney disease patients. A stepwise increase in the dosage of temozolomide did not increase the risk of toxicity with HD. There are no studies with patients on temozolomide and peritoneal dialysis. Our case transitioned to peritoneal dialysis from HD without significant toxicity from temozolomide. As a more substantial proportion of the population becomes dialysis-dependent in the coming years, we need further studies to understand the safety profiles of chemotherapeutic agents in this complex subset of patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-12-02T07:11:12Z
      DOI: 10.1177/10781552221131908
       
  • Predictors of community pharmacists’ readiness to manage the effective
           and safe use of oral anticancer medicines in a developing setting

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      Authors: Sara Dahmani, Emelith Florendo Cerbito, Anas Hamad, Kazeem Babatunde Yusuff
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundThere is a paucity of studies about the readiness of community pharmacists to manage the safe and effective use of oral anticancer medicines (OAMs) in developing settings.ObjectivesUsing the readiness component (knowledge and willingness) of the situational theory of leadership, the study assessed community pharmacists’ readiness to manage the safe and effective use of OAMs in Qatar, and also identified its significant predictors.MethodsA cross-sectional assessment of 252 community pharmacists was conducted with a pre-tested 48-item questionnaire. Readiness was assessed with a 5-point Likert-type scale and the maximum obtainable score was 70. The mean was used as the cut-off point to categorize willingness and knowledge as either high (≥ mean) or low (< mean). Independent t-test, one-way analysis of variance and multiple linear regression was used for data analyses.ResultsThe mean SD score for the readiness of community pharmacists was 39.3 ± 11.2 (min = 11, max = 70). Only a minority of the respondents expressed an excellent understanding of the chemotherapy cycles (19.6%; 45/230), and familiarity with targeted anticancer therapy (14.3%; 33/230), side effects (22.2%; 51/230), and dosing of OAMs (14.4%; 33/230). Employment status, number of OAMs prescriptions dispensed per month and adequacy of the contents related to OAMs in undergraduate training were the significant predictors of readiness (R2 = 0.558, (F (11, 209) = 3.559, p = 0.0001).ConclusionsCommunity pharmacists’ readiness appear inadequate especially regarding its dosing, side effects, handling, and disposal of OAMs. These inadequacies probably underline community pharmacists’ low familiarity and comfortability with dispensing and educating patients on the effective and safe use of OAMs.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-25T08:24:44Z
      DOI: 10.1177/10781552221141696
       
  • A review of the novel tissue factor antibody–drug conjugate:
           Tisotumab vedotin

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      Authors: Kevin Luu, Angelyne Chu, Brandon Chang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveTo review and compare the pharmacology, efficacy, and safety of the novel tissue factor antibody–drug conjugate, tisotumab vedotinData sourcesLiterature search was performed through PubMed MEDLINE, Google Scholar, ClinicalTrials.gov, and the Food and Drug Administration.Data summaryTisotumab vedotin, a novel tissue factor antibody–drug conjugate, was granted accelerated approval by the US FDA on 20 September 2021 for adult patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy. Tisotumab vedotin demonstrated clinical efficacy in a number of solid tumors in innovaTV 201 and more specifically in cervical cancer in the pivotal phase 2 innovaTV 204. In the single-arm innovaTV 204 study, 101 patients with recurrent or metastatic cervical cancer received intravenous tisotumab vedotin at the recommended dose of 2 mg/kg every 3 weeks until disease progression or unacceptable toxicity. The independent review committee confirmed an objective response rate of 24% with 7% complete responses and 17% partial responses. Tisotumab vedotin is associated with several notable adverse events with data from innovaTV 204 including ocular toxicity, hemorrhage, and peripheral neuropathy. Ninety-two percent of patients experienced treatment-related adverse events with 28% experiencing an adverse event of grade 3 or higher.ConclusionsMetastatic cervical cancer has a high risk of relapse with few effective second-line therapeutic options. Current guidelines recommend single agent tisotumab vedotin as a possible option. Ongoing trials will further define its place in therapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-23T05:42:40Z
      DOI: 10.1177/10781552221139775
       
  • Letermovir and tacrolimus interaction effects in hematopoietic cell
           transplantation recipients receiving moderate cytochrome P450 3A4
           inhibitors for antifungal prophylaxis

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      Authors: Jack Malespini, Matthew Lei, Erica Tavares, Sarah P Hammond, Yi-Bin Chen, Samantha O Luk, Zachariah DeFilipp
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionLetermovir inhibits cytomegalovirus replication and is approved for the prevention of cytomegalovirus infection in cytomegalovirus seropositive hematopoietic cell transplantation recipients. Studies have found that letermovir coadministration has minimal effect on tacrolimus levels prior to the start of voriconazole, a strong cytochrome P450 (CYP) 3A4 inhibitor. However, data are lacking for hematopoietic cell transplantation recipients receiving letermovir and tacrolimus with moderate CYP 3A4 inhibitors as antifungal prophylaxis.MethodsIn this retrospective single-center analysis, we reviewed the charts of 92 consecutive adult allogeneic hematopoietic cell transplantation recipients receiving letermovir, tacrolimus, and moderate CYP3A4 inhibitors for antifungal prophylaxis.ResultsTacrolimus concentration/dose (C/D) ratios were evaluated for the first 7 days pre-letermovir and for the first and second 7-day periods after letermovir. The tacrolimus mean C/D ratios [(ng/mL)/(mg/kg/day)] increased significantly with the addition of letermovir: 172.99 (95% confidence interval (CI): 158.2–187.78) pre-letermovir, 268.66 (95% CI: 244.34–292.98) first-week letermovir, and 312.19 (95% CI: 279.39–344.99) second-week letermovir (P 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-18T07:06:00Z
      DOI: 10.1177/10781552221139772
       
  • Acute liver injury induced by drug interaction between dacomitinib and
           metoprolol due to the inhibition of CYP2D6 by dacomitinib

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      Authors: Xuejia Qiu, Bingnan Ren, Yufei Lian, Lingzhi Fang, Zhanjun Dong
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIn recent years, oral antineoplastic agents are commonly used in antitumor therapy. The interaction between drugs may affect the efficacy of drugs or lead to adverse reactions. We describe the case of a patient who presented acute liver injury, possibly induced by the concomitant use of metoprolol and dacomitinib.Case reportA 62-year-old male patient with non-small cell lung cancer was admitted for anti-cancer treatment. He regularly took metoprolol tartrate 12.5 mg, 2/day for hypertension. He was treated with dacomitinib according to EGFR Exon21 L858R positive. After 3 days of dacomitinib, the patient's alanine aminotransferase (ALT) and glutathione aminotransferase (AST) increased, and the heart rate and systolic blood pressure of the patient decreased significantly. The patient was diagnosed with acute liver injury.Management and outcomesDacomitinib was discontinued and glutathione, magnesium isoglycyrrhizinate were given to treat acute liver injury. Two days after discontinued dacomitinib, the patient's heart rate increased, but the ALT and AST of the patient elevated again. Metoprolol tartrate was subsequently discontinued and the ALT and AST gradually decreased and the patient discharged from the hospital eight days later with his liver function improved.DiscussionTo our knowledge, this is the first case in the literature of acute liver injury possibly induced by the interaction between metoprolol and dacomitinib. The interaction most likely arose because dacomitinib is a CYP2D6 strong inhibitor and could therefore impair the metabolism of metoprolol (a CYP2D6 substrate) and increase its serum concentration. Therefore, hepatic function should be carefully monitored in patients treated with dacomitinib and metoprolol and other inhibitors or inducers of CYP2D6.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-16T07:23:15Z
      DOI: 10.1177/10781552221139773
       
  • Safe handing of hazardous drugs

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      Authors: Kardi Kennedy, Cathy Vu, Nadia Coakley, Jennifer Daley-Morris, Leta Forbes, Renee Hartzell, Darrilyn Lessels
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-14T07:28:38Z
      DOI: 10.1177/10781552221135121
       
  • Pharmacokinetic characterization, benefits and barriers of subcutaneous
           administration of monoclonal antibodies in oncology

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      Authors: Ana Homšek, Jelena Spasić, Neda Nikolić, Tatjana Stanojković, Marija Jovanović, Branislava Miljković, Katarina M Vučićević
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveTherapeutic monoclonal antibodies in oncology are slowly becoming the dominant treatment option for many different cancer types. The main route of administration, infusion, requires extensive product preparations, patient hospitalization and close monitoring. Patient comfort improvement, staff workload reduction and cost savings dictated the development of subcutaneous formulations. The aim of this review is to present pharmacokinetic characteristics of subcutaneous products, discuss the differences between intravenous and subcutaneous routes and to point out the advantages as well as challenges of administration route shift from the formulation development and pharmacometric angle.Data sourcesFood and Drug administration's Purple book database and electronic medicines compendium were used to identify monoclonal antibodies in oncology approved as subcutaneous forms. Using keywords subcutaneous, monoclonal antibodies, pharmacokinetics, model, as well as specific drugs previously identified, both PubMed and ScienceDirect databases were researched.Data summaryThere are currently six approved subcutaneous onco-monoclonal antibodies on the market. For each of them, exposure to the drug was similar in relation to infusion, treatment effectiveness was the same, administration was well tolerated by the patients and costs of the medical service were reduced.ConclusionDevelopment of subcutaneous forms for existing and emerging new monoclonal antibodies for cancer treatment as well as shifting from administration via infusion should be encouraged due to patient preference, lower costs and overall lack of substantial differences in efficacy and safety between the two routes.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-09T07:14:32Z
      DOI: 10.1177/10781552221137702
       
  • Medication errors in cancer therapy: Reports from German hospital
           pharmacists between 2008 and 2019

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      Authors: Lisa Weber, Claudia Langebrake, Gesine Picksak, Tilman Schöning, Ingo Schulze, Ulrich Jaehde
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveSince medication errors can have severe consequences, the development of methods to improve patient safety is becoming increasingly important. The aim of this evaluation was to identify frequent medication errors in oncology as well as characteristic correlations in the various error patterns. In addition, the implementation rate of the proposed pharmaceutical intervention was determined in order to assess the benefit of a clinical pharmacist in the field of oncology.MethodsThe evaluation was based on a data-set from a national documentation system for medication errors and interventions (DokuPIK) used by hospital pharmacists in the field of oncology from 2008 to 2019, namely 6684 reported cases in oncology, representing about 5% of all reports in DokuPIK.ResultsThe most frequently reported errors were incorrect doses (22% of reported errors), followed by interactions (14%); in 10% of errors the prescription/documentation was incomplete/incorrect. The intervention suggested by the pharmacist was implemented in 97% of the cases. Based on the respective Anatomical Therapeutical Chemical Classification (ATC codes), drugs (or groups of drugs) were identified that were reported frequently in connection with medication errors, namely carboplatin and cyclophosphamide as anticancer drugs pantoprazole as non-anticancer drug.ConclusionFrequently occurring medication errors in the field of oncology were identified, facilitating the development of specific recommendations for action and prevention strategies. The implementation of an electronic prescription software is particularly recommended for the avoidance of dosage errors in chemotherapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-09T07:13:38Z
      DOI: 10.1177/10781552221135130
       
  • Cost-effectiveness of poly-(ADP-ribose) polymerase (PARP)-inhibitors for
           the maintenance treatment after responding to first- and second-line
           chemotherapy in advanced ovarian cancer

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      Authors: Jacopo Giuliani, Beatrice Mantoan, Lucrezia Ferrario, Maria Viviana Candela, Giuseppe Aprile
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      The introduction of inhibitors of poly-(ADP-ribose) polymerase (PARP) for the treatment of women with epithelial ovarian cancers (EOC) has radically changed the treatment in maintenance setting after responding to first- and second-line chemotherapy. The aim of this paper was to assess the pharmacological costs of PARP inhibitors (olaparib, niraparib, rucaparib and veliparib) in maintenance treatment after responding to first-line chemotherapy in EOC. Incremental cost-effectiveness ratio (ICER) was calculated as the ratio between the difference of the costs in the intervention and in the control groups (pharmacy costs) and the difference between the effect in the intervention and in the control groups (progression-free survival (PFS)). We have considered the pivotal phase III randomized controlled trials (RCTs). Three different populations were considered: the overall population, patients with germline BRCA mutation (gBRCA) and homologous recombination deficiency (HRD) patients non-gBRCA mutation. Three thousand four hundred and twenty patients and 1209 patients were considered in maintenance treatment after responding to first- and second-line chemotherapy in EOC, respectively. At the actual price, the treatment with PARP inhibitors is not cost-effective in maintenance treatment after responding to first-line and second-line chemotherapy in EOC. A reduction in pharmacological costs is mandatory.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-08T01:55:15Z
      DOI: 10.1177/10781552221137705
       
  • Non-Hodgkin's lymphoma developed during imatinib mesylate treatment of
           chronic myeloid leukemia

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      Authors: Olfa Kassar, Aicha Ben Kahla, Asma Koubaa, Faten Kallel, Imen Ben Amor, Moez Elloumi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionNon-Hodgkin lymphoma induced by imatinib, as a tyrosine kinase inhibitor, is a rare complication.Case reportA 54-year-old female with a history of chronic myeloid leukemia (CML) was treated with imatinib as first-line therapy. The patient achieved a profound molecular response with treatment-free remission after five years but lost major molecular responses. A second deep molecular remission was again achieved. Nine years after imatinib therapy, the patient developed odynophagia and rhinorrhea. Physical examination revealed enlarged tonsils with a tumor-like appearance without palpable lymph nodes. Immunohistochemical examination of the tonsils revealed a large B-cell lymphoma. According to Naranjo's algorithm, the causality relationship with the drug is possible with a score of 3.Management and outcomeImatinib was discontinued. The lymphoma was treated with rituximab and chemotherapy.DiscussionNon-Hodgkin's lymphoma is a rare side effect of tyrosine kinase inhibitors and highlights the importance of follow-up CML patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-08T01:54:36Z
      DOI: 10.1177/10781552221137700
       
  • Mercaptopurine induced myelosuppression in a child with a NUDT15
           rs116855232 homozygous variant

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      Authors: Navya Gupta, Latha Sneha Magatha, Dhaarani Jayaraman, Julius Xavier Scott, Sharon Benita Antony, Teena Koshy
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionMercaptopurine (6-MP) is the backbone of the consolidation and maintenance therapy for paediatric acute lymphoblastic leukaemia (ALL). Nevertheless, it can cause critical myelosuppression. Predicting adverse reactions to 6-MP often involves the investigation of pharmacogenetic variants; in particular thiopurine S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15). Lately, NUDT15 variants have been shown to play a significant pharmacogenetic role in predicting 6-MP intolerance in children of Asian descent.Case ReportWe present a six-year-old male child of Indian origin with persistent cytopenia after treatment. This prompted targeted sequencing of the genes TPMT and NUD15. The results revealed two copies of the variant of NUD15 rs116855232, that is, NUDT15*2 genotype.Management and OutcomeSince the NUDT15*2 allele classified the patient as a poor metabolizer, he was restarted on a low dose of 6-MP, which he tolerated.DiscussionIndividuals with the NUDT15*2allele (*2/*2 genotype) are poor metabolizers of thiopurines which results in an adverse reaction to 6-MP. About 3.5% of Indians show variations in the TPMT gene as compared to 19.4% variations observed in NUDT15, which makes the latter a more reliable disease marker.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-07T07:01:02Z
      DOI: 10.1177/10781552221137709
       
  • Transition to ePrescribing for systemic anti-cancer therapy –
           Perceptions of a multidisciplinary haematology/oncology team in a large
           teaching hospital

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      Authors: Hannah O’Connor, Gail Melanophy, Carlos Medina Martin, Martin Flattery, Edel O’Dea
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionA National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems.MethodsA mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition.ResultsTwelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability.ConclusionThis study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems’ implementation in haematology/oncology settings.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-07T07:00:32Z
      DOI: 10.1177/10781552221126102
       
  • Use, response and outcomes of second-line chemotherapy in patients with
           advanced biliary tract cancers

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      Authors: Brittney Mathers, Shirin Abadi, Janine M Davies, Connor McIntyre, Cheryl Ho
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionFirst-line chemotherapy for advanced biliary tract cancers has been established as gemcitabine and cisplatin; however, there is currently no recognized standard second-line chemotherapy. The purpose of this study is to review and evaluate the outcomes of second-line chemotherapy for advanced biliary tract cancers.MethodsPatients who received chemotherapy for unresectable or metastatic biliary tract cancers at BC Cancer between August 2009 and December 2015 were retrospectively studied to identify second-line chemotherapy treatments used and to determine overall survival, time-to-treatment discontinuation and characteristics predicting for improved overall survival.ResultsOf 325 patients who received first-line chemotherapy for advanced biliary tract cancer, 90 (30%) received second-line chemotherapy. Median overall survival for patients who received only first-line chemotherapy was 9.5 months versus 17.3 months for patients who received second-line chemotherapy. Median time-to-treatment discontinuation for second-line chemotherapy was 2.0 months. Common drugs used in second-line chemotherapy treatments included capecitabine (30%), 5-fluorouracil and irinotecan (17%) and 5-fluorouracil monotherapy (15%). There was no difference in overall survival for patients who received single-agent second-line chemotherapy compared to doublet second-line chemotherapyConclusionsPatients who are fit enough to receive second-line chemotherapy may benefit in terms of overall survival and should be offered treatment with single-agent therapy. Capecitabine was the most common second-line chemotherapy treatment. The improved median overall survival for patients who received second-line chemotherapy may be impacted by independent patient-specific factors which are unknown at this time.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-11-02T05:51:23Z
      DOI: 10.1177/10781552221122058
       
  • Processes and perceptions of chemotherapy supply chain in Ethiopia: A
           mixed-method study

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      Authors: Kurtis J Stocker, Andrew Tiemann, Kelly M Brunk, Bemnat Agegnehu, Kaitlyn Buhlinger, Lindsey Amerine, Megan C Roberts, Jacqueline E McLaughlin, Stephen M Clark, Robert Rose, Befikadu Mekonnen, Nickhill Bhakta, Atalay Mulu Fentie, Thomas B Alexander, Sachiko Ozawa, Michael Chargualaf, Benyam Muluneh
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundThe impact and downstream effects of the chemotherapy supply chain in Ethiopia are not well understood. The purpose of this study was to identify perceived gaps in supply chain and characterize their impact on patient care.MethodsA concurrent mixed-method study was conducted at a large academic cancer center in Ethiopia. In-depth interviews (IDIs) and surveys were completed in collaboration with external stakeholders with knowledge about chemotherapy supply chain in Ethiopia. Thematic coding was used for qualitative analysis of IDI and descriptive statistics were used to summarize quantitative survey data.ResultsSix stakeholders participated in the IDIs and seven completed surveys. IDIs revealed that most chemotherapeutic agents are purchased by the Ethiopian Pharmaceutical Supply Agency (EPSA) and are distributed to cancer treatment centers. A free-market purchasing option also exists, but for chemotherapy obtained outside of government-subsidized channels, the potential for substandard or falsified chemotherapy was a concern. Participants expressed confidence that the correct treatment was administered to patients, but viewpoints on reliability and consistency of medication supply were variable. Quantitative data from the survey showed that participants were not confident that medications are prepared safely and correctly. Improper storage and manipulation of high-risk medications remain a significant risk to staff.ConclusionsThis study provides insight from a healthcare staff perspective on how gaps in the chemotherapy supply chain process impact patient care in a low-income country. Inventory management, disruptions in supply chain, and product integrity were perceived as the largest gaps in the current chemotherapy supply chain structure.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-10-28T05:39:50Z
      DOI: 10.1177/10781552221134254
       
  • Comparative cost savings of biosimilar and dose rounding utilization in
           oncology care

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      Authors: Verona Abdelmeseh, Britny R Brown, Justin P Huynh, Andrew R Zullo
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe exponential rise in cancer costs has led many centers to utilize dose rounding to the nearest vial size when the difference in dose is ≤10% to decrease costs. The recent approval of several biosimilar products has presented another opportunity to mitigate the rising costs of oncology care. Scarce information exists about the expected cost savings of combining dose rounding strategies (DRS) with biosimilar use (BU). We therefore assessed the cost savings of combining DRS and BU.Methods:Electronic health record data for two health systems in Rhode Island were used to identify patients who received ≥1 of trastuzumab, trastuzumab-anns, bevacizumab, or bevacizumab-awwb from October 1, 2015 to September 1, 2020. Costs were estimated using Medicare drug pricing. Multivariable generalized estimating equations adjusting for age, gender, presence of metastases, dosing weight, and dose administered were used to compare costs per dose between the four exposure groups: DRS + BU, DRS only, BU only, and neither DRS or BU.Results:A total of 1156 patients were administered 15,145 doses of drug. After covariate adjustment, average savings per dose was greatest in the DRS + BU group (vs. the neither DRS nor BU group); $331 for trastuzumab and $497 for bevacizumab.ConclusionsCombining dose rounding with biosimilar substitution for trastuzumab and bevacizumab resulted in significant cost savings per dose and should be implemented by healthcare systems.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-10-19T07:22:03Z
      DOI: 10.1177/10781552221134257
       
  • Melphalan on day -1 versus day -2 in patients with plasma cell disorders
           undergoing autologous stem cell transplant

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      Authors: Aleksandra N Watson, Shreya A Shah, Sila D Shalhoub, Katrina M Piedra, Krishna V Komanduri, Deukwoo Kwon, Denise L Pereira
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      High-dose melphalan-based autologous stem cell transplant (ASCT) remains a standard of care for plasma cell disorders (PCDs). Currently, there is variability in the literature surrounding the timing of melphalan administration to avoid potential cytotoxic effects, although the administration has been safely proposed when given at least 8 hours prior to stem cell infusion. The objectives of this study were to assess differences in safety and efficacy outcomes between day -1 and day -2 single-dose melphalan administration in patients undergoing ASCT for PCDs. A retrospective chart review was performed at our institution comparing patients receiving melphalan on day -1 to an equal number of patients receiving melphalan on day -2. The primary endpoint was time to neutrophil engraftment from stem cell infusion. Univariate analyses were performed. Mean time to neutrophil engraftment from stem cell infusion was identical at 10.7 days for both cohorts (p = 0.88). Mean time to platelet engraftment from stem cell infusion was shorter with day -1 administration (17.4 vs. 18.6 days, p = 0.06). Mean time to neutrophil and platelet engraftment from melphalan infusion were significantly shorter with day -1 administration. Similar outcomes were observed for length of hospitalization, infection- and mucositis-related toxicities, hematologic response, transplant-related mortality, and overall survival. Our findings show no difference in time to neutrophil engraftment from stem cell infusion and a trend toward shorter time to platelet engraftment with day -1 administration. Based on our study, day -1 melphalan administration is an acceptable and safe practice.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-10-17T07:48:27Z
      DOI: 10.1177/10781552221125871
       
  • Investigation of the frequency of bortezomib neuropathy in patients with
           multiple myeloma diagnosis with normal and abnormal genetic
           characteristics

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      Authors: Ayse N Kul, Yildiz Ipek
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionBortezomib-induced peripheral neuropathy in patients with multiple myeloma is an undesirable and sometimes severe side effect. Our study aimed to examine whether there was a difference in bortezomib-induced peripheral neuropathy between multiple myeloma patients with normal and abnormal genetic characteristics.MethodsThis retrospective analysis is based on the assessment of bortezomib-induced peripheral neuropathy frequency in newly-diagnosed multiple myeloma patients with normal (n = 68) and abnormal (n = 45) genetic profiles. A total of 113 patients diagnosed with multiple myeloma according to the International Myeloma Working Group criteria, between 2016 and 2021, were included in this study.ResultsNeuropathy was detected in 42 (37.1%) patients. The most common genetic anomalies were 13q del (in 28.9%), t(4.14) (in 22.2%), and trisomy 7 (in 20.0%). When patients with and without bortezomib-induced peripheral neuropathy were compared, the only significant differences were observed for age (p = 0.032) and genetic grouping (p = 0.001); whereas other characteristics that could be associated with bortezomib-induced peripheral neuropathy were similarly distributed in both groups. Bortezomib-induced peripheral neuropathy was significantly more frequent in multiple myeloma patients with normal genetic characteristics (p = 0.001).ConclusionAs a result of our study, it was observed that the frequency of bortezomib neuropathy was significantly higher in patients with normal genetic features compared to those with abnormal genetic features. This result suggested that factors other than genetic factors should be investigated to clarify the etiology of bortezomib-associated neuropathy in patients with multiple myeloma.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-10-14T06:02:47Z
      DOI: 10.1177/10781552221132554
       
  • Management of chemotherapy-induced febrile neutropenia and use of
           granulocyte colony-stimulating factor in patients with soft tissue or bone
           sarcoma

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      Authors: Raphaele Teixeira Mazzaro, Mahanna Vanzeler Vaz, Rebeka Caribé Badin, Eliza Dalla Bernardina, Liliane Rosa Alves Manaças
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionFebrile neutropenia, an oncological complication related to myelosuppressive chemotherapy, can lead to unplanned hospitalization, morbidity, mortality, and changes in the oncological therapeutic plan. The present study aimed (1) to determine the prevalence of chemotherapy-induced febrile neutropenia requiring hospitalization and the use of granulocyte colony-stimulating factor and (2) to evaluate its consequences for the oncological treatment of patients with soft tissue or bone sarcomas.MethodsThis is a cross-sectional and retrospective study (January 2018 to December 2019) carried out in a reference oncology hospital in the Brazilian public health system. Inpatients diagnosed with chemotherapy-induced febrile neutropenia, older than the age of 18 years, and treated with granulocyte colony-stimulating factor were included in the study.ResultsTwenty-nine chemotherapy-induced febrile neutropenia events were identified, involving 25 patients. Among the febrile neutropenia events, 90% were grade 4, and 59% occurred during palliative chemotherapy. Among patients with febrile neutropenia, 31% had arterial hypertension or/and diabetes mellitus comorbidities, 34% had infectious skin sites, such as compression ulcers and tumor wounds, and 31% had infections with defined etiologic agents. Treatment of hospitalized patients was performed with cefepime in combinations or alone (97%) and filgrastim. The outcomes related to chemotherapy-induced febrile neutropenia were chemotherapy dose reduction (31%), chemotherapy cycle delays (21%), chemotherapy treatment suspension (17%), deaths (7%), and other associated complications (10%). Granulocyte colony-stimulating factor prophylaxis was prescribed in 72.41% of febrile neutropenia events. The frequency of febrile neutropenia concerning total chemotherapy cycles was 2.15%.ConclusionEven with granulocyte colony-stimulating factor prophylaxis, an overall prevalence of 2.15% of febrile neutropenia associated with hospitalization was observed, causing negative outcomes in chemotherapy treatment of patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-10-13T07:22:40Z
      DOI: 10.1177/10781552221131901
       
  • Automated chemotherapy compounding: Process optimization for the
           preparation of admixture containing high-dose of cyclophosphamide

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      Authors: Gianluca Perego, Giorgia Longobardo, Anna Baldisserotto, Matteo Feliciani, Maria Fazio
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-29T06:09:35Z
      DOI: 10.1177/10781552221130012
       
  • Inpatient utilization of immune checkpoint inhibitors and clinical
           outcomes

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      Authors: Jonathan Wang, Chung-Shien Lee, Shirin Attarian, Nina Kohn, Craig Devoe
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionRetrospective studies have suggested that patients with poor performance status treated with immune checkpoint inhibitors have shorter overall survival and poorer response rates. This study was undertaken to investigate the possible relationships between inpatient immune checkpoint inhibitor use and clinical outcomes.MethodsThis was a retrospective chart review of cancer patients who received an immune checkpoint inhibitor while hospitalized from 1 January 2016 to 30 December 2020. The primary outcome was 90-day mortality or admission to hospice rate. Secondary outcomes included overall survival, time to death or discharge to hospice, and descriptive summarization of patient characteristics.ResultsA total of 52 patients were analyzed. At 90 days, 68.2% of subjects were expired or admitted to hospice (95% CI: 54.7–81%). 90-day overall survival was 47.1%; median survival time was 81 days (95% CI: 28–242 days). The median time to death or hospice was 35 days (95% CI: 24–72 days). The time to death or hospice was shorter for immune checkpoint inhibitor-naive patients compared to those who received immune checkpoint inhibitors prior to admission (29 days, 95% CI: 12–43 days vs. 242 days, 95% CI: 36–1288 days, respectively; HR: 2.74, 95% CI: 1.2–6.25; p = 0.0121). No differences were found when comparing other baseline characteristics.ConclusionA majority of patients who received an immune checkpoint inhibitor while hospitalized were either discharged to hospice or expired by 90 days. An increased rate of death or discharge to hospice was observed for patients who were immune checkpoint inhibitor-naive prior to their admission.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-22T05:42:33Z
      DOI: 10.1177/10781552221123967
       
  • Economic burden in patients with anaplastic lymphoma kinase (ALK)-positive
           non-small cell lung cancer (NSCLC), with or without brain metastases,
           receiving first-line ALK inhibitors

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      Authors: Yanyu Wu, Kaili Ren, Yin Wan, Huamao M Lin
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThis observational study describes the real-world economic burden in patients with anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC) receiving a first-line ALK inhibitor, and the economic impact of brain metastases (BM).MethodsAdministrative claims data (Truven Health MarketScan® Commercial Claims and Encounters database and Medicare Supplemental and Coordination of Benefits database; January 1, 2015–March 31, 2020) for adult patients with ALK+ NSCLC who received a first-line ALK inhibitor were retrospectively reviewed. Healthcare costs and resource utilization were calculated on a per-patient-per-month (PPPM) basis and stratified by the presence or absence of BM prior to first-line ALK inhibitor. Factors associated with costs were identified.ResultsA total of 496 patients were eligible for analysis. Mean PPPM total healthcare costs were $21,961 for all patients receiving up to 1 year of a first-line ALK inhibitor. Patients were significantly more likely to have higher mean PPPM total costs if they had BM prior to first-line ALK inhibitor (vs. no BM; odds ratio: 1.11; 95% confidence interval: 1.02, 1.21; p = 0.013). Mean PPPM days of hospital stay (p = 0.0056), and inpatient hospital visits (p = 0.0030) were significantly higher for patients with BM compared to no BM. The main cost drivers for non-inpatient procedures for all patients were medications, radiation therapy, and other diagnostic procedures.ConclusionsThe economic burden in patients with ALK+ NSCLC receiving a first-line ALK inhibitor was high. Patients with ALK+ NSCLC and BM had higher healthcare costs and resource utilization than patients without BM.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-22T04:58:55Z
      DOI: 10.1177/10781552221126174
       
  • Efficacy and safety of topical 5-fluorouracil in conjunctival
           intraepithelial neoplasia refractory to interferon alpha-2b

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      Authors: Pilar Pérez-García, Bárbara Burgos-Blasco, Verónica Gómez-Calleja, Beatriz Vidal-Villegas, Rosalía Méndez-Fernández, José Antonio Gegúndez-Fernández, David Díaz-Valle
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeTo report the efficacy and safety of 5-fluorouracil as the second line of treatment for two cases of conjunctival intraepithelial neoplasia refractive to topical interferon alpha-2b.Case reportIn the first case, a 77-year-old woman was evaluated because of a fleshy vascularized lesion in the temporal conjunctiva on her right eye with leukoplakia of the corneal epithelium from 10- to 5-o’clock limbus. In the second case, an 81-year-old man, a nodular lesion in the temporal conjunctiva on his RE, with corneal adjacent opalescence, one millimeter in extent, was observed. Both patients were initially treated with excisional surgery, the samples being reported as conjunctival intraepithelial neoplasia with high-grade dysplasia. Co-adjuvant treatment with topical interferon alpha-2b 1 mIU/mL was indicated 4 times/day uninterruptedly. In the first case, there was no response despite 8 months of treatment, while in the second, the corneal lesion progressed in an arboriform pattern after 4 months of topical chemotherapy.Management & outcomeIn the absence of efficacy, the treatment was then changed to topical 5-fluorouracil (1%), 4 times/day for 7 days with a time-lapse of 21 days off, which constitutes a course. Two and four courses of treatment with 5-fluorouracil 1% were completed in both cases in the absence of important side effects. After the first course, both patients showed complete remission of the lesions. No clinical signs of relapse were noted after 1 year of follow-up.DiscussionThe treatment with 5-fluorouracil is a good option as the second line of treatment for conjunctival intraepithelial neoplasia who are low-responders to interferon alpha-2b, with fewer side effects than other currently available alternatives.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-22T04:58:25Z
      DOI: 10.1177/10781552221125763
       
  • Novel approach of desensitization in allergic reaction to Olaparib

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      Authors: Björn M Beurer, Luise M Sprenger, Kristina Graneß, Freia Feldmann, Ulrich Warnke, Maria G Biersack, Dorothea Fischer
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPARP (Poly ADP Ribose Polymerase) inhibitors are an effective maintenance therapy for various entities, such as BRCA (breast cancer gene) mutated or HRD (homologous recombination deficiency) positive primary platin-sensitive advanced ovarian cancer after platin induction therapy and in relapse after responding to carboplatin reinduction. Other entities are metastatic BRCA mutated pancreas, prostate and Her2-negative breast cancer. Therefore, patients with allergic reactions to PARP inhibitors should undergo a desensitization procedure to be able to receive this efficient therapy.Case reportWe conducted a two-day desensitization on a 45-year-s old patient with advanced ovarian cancer who displayed symptoms of an allergic reaction to Olaparib.Management and outcomeUsing an Olaparib tablet suspension, we orally administered increasing Olaparib doses, starting with 12.5 mg and reaching a cumulative dose of 387.5 mg on the first day and starting with 100 mg and reaching a cumulative dose of 600 mg on the second day, without concomitant antiallergic medication.Except for mild erythema on day one receding within the hour, no further allergic reactions appeared during desensitization. The patient has since received 300 mg of Olaparib twice a day without further complications or interruptions.ConclusionDesensitization in a two-day suspension protocol is a safe method that ensures effective maintenance therapy for patients with allergic reactions to PARP inhibitors.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-21T08:03:04Z
      DOI: 10.1177/10781552221124041
       
  • Comparison of permeabilities of eight different types of cytotoxic drugs
           to five gloves with different materials by LC-MS/MS methods to reduce
           occupational exposure of medical personnel

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      Authors: Hailong Zhou, Yunyun Li, Fan Xu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeOccupational exposure is a long-standing public health concern, which has drawn more and more attention in recent years to the problem of how to carry out occupational protection effectively. Gloves are regarded as the most critical protective equipment for cytotoxic medications. However, there is still little research conducted on the protective performance of gloves made of different materials and the optimal glove combination for cytotoxic agents.MethodsIn this research, a specific instrument intended for glove permeation experiment was designed, with various methods of liquid chromatography-tandem mass spectrometry (LC-MS/MS) developed and validated. By using the specific instrument and LC-MS/MS methods, a study was conducted on the permeation ability of eight selected cytotoxic drugs (fluorouracil, epirubicin (EPI), docetaxel (DCT), methotrexate (MTX), cyclophosphamide (CTX), etoposide (ETP), vincristine sulfate (VCR), and cisplatin derivatives Pt-(DDTC)3) into five kinds of gloves (rubber (RB), nitrile (NT), chlorinated polyethylene (CPE), low-density polyethylene, and polyvinylchloride (PVC) resin) given different contact times. Then, the experimental data were analyzed through a generalized estimation equation and Pearson correlation analysis.ResultsThe results show that within a short period of time (less than five minutes), ETP, CTX, fluorouracil, DCT, and cisplatin passed through five types of gloves but the level of MTX, VCR, and EPI permeation was minimal, despite the duration of contact between the three drugs and the gloves reaching as long as three hours. Furthermore, the permeation of DCT and ETP was found to be positively correlated with time.ConclusionsChlorinated polyethylene and PVC resin perform well in protecting against most cytotoxic drugs and are recommendable for clinical practice. Due to the poor protective ability, RB gloves are not recommended for this purpose. Based on the performance of various gloves in offering protection, the protection grade of two gloves can be deduced. Chlorinated polyethylene  +  PVC resin, CPE  +  NT glove combination shows good protective performance against most target drugs and can be recommended for clinical practice.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-20T06:30:09Z
      DOI: 10.1177/10781552221127698
       
  • Immune-related pneumonitis requiring low-dose prednisone maintenance in
           one patient with durable complete response

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      Authors: Yu Zhou, Baozhen Ma, Tiepeng Li, Quanli Gao, Lingdi Zhao
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionImmune-related pneumonitis is an uncommon but potentially life-threatening adverse event associated with anti-programmed cell death protein-1 therapy, and has a higher recurrence rate than that of other pneumonitis. Glucocorticoids are the first treatment of choice for patients with immune-related pneumonitis over grade 1. Given the toxicity associated with glucocorticoids, they should be withdrawn gradually as soon as pneumonitis is controlled. However, low-dose glucocorticoids are maintained in some patients to prevent immune-related pneumonitis.Case reportWe report a rare case of a patient with Hodgkin lymphoma who developed grade 2 immune-related pneumonitis, requiring long-term low-dose glucocorticoid maintenance therapy, during which pneumonitis disappeared, and complete response was achieved.Management and outcomeTislelizumab treatment was stopped tentatively, and the patient was given prednisone at an initiating dose of 1 mg/kg/d. The cough symptoms were relieved significantly, and pneumonitis was reduced. The prednisone gradually dwindled, but the immune-related pneumonitis was recurrent, requiring prednisone 10 mg daily maintenance therapy. Subsequently, prednisone and tislelizumab were administered simultaneously, and at present, pneumonitis disappeared and the lesions are in complete remission.DiscussionLow-dose glucocorticoids might play an important role in controlling the recurrence and development of immune-related pneumonitis. The dose and course of glucocorticoid in immune-related pneumonitis patients should be individualized to minimize the toxicity of glucocorticoid.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-19T05:06:00Z
      DOI: 10.1177/10781552221127699
       
  • Oral oncolytic monitoring pilot with patient-reported outcomes and
           adherence assessments

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      Authors: Jessie Signorelli, Christopher Bell, Stephanie Monaco
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPatients on oral oncolytics are responsible for self-monitoring adherence and adverse drug reactions (ADRs). Oncology pharmacists are in position to focus on quality and safety of care for patients on oncolytics while providing communication between the patient, physician, and specialty pharmacies. This pilot aimed to monitor patients treated by our leukemia team initiated on oral oncolytics.MethodsFrom July 2020 to February 2021, patients treated by our leukemia team newly started on oncolytics were included. Pharmacists performed medication reconciliation and drug interaction screening on initiation of oral oncolytic. Pharmacists followed up at predefined intervals. On follow up adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8) and patient reported outcomes (PROs) were assessed using the revised Edmonton Symptom Assessment Scale (ESAS-r). After each follow-up, a note was placed in the chart with assessment scores and recommendations.ResultsA total of 32 patients were screened with 19 patients included. Oral oncolytics included: imatinib (4), dasatinib (5), ponatinib (1), gilteritinib (2), enasidenib (1), and venetoclax (6). Fourteen drug interactions were identified, 11 medications discontinued, nine medications added, and two medications doses were changed. Twenty-six adherence assessments were performed with 21, 4, and 1 assessment demonstrating adherence, medium adherence, and low adherence, respectively. 62 ESAS-r assessments were performed with 64% reported as no symptoms, 17% as mild, 13% as moderate, and 5% as severe symptoms. Twenty laboratory tests were ordered from pharmacist recommendation on initiation and follow-up.ConclusionThis pilot demonstrated the role pharmacists play in oral oncolytic monitoring and symptom management.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-16T12:41:57Z
      DOI: 10.1177/10781552221112603
       
  • Combination of available topical beta-blockers and antibiotic ointment for
           epidermal growth factor receptor tyrosine kinase inhibitor-induced
           paronychia and pseudopyogenic granulomas in Taiwan

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      Authors: Hui-Lin Liu, Cheng-Hao Chuang, Chin-Ling Chen, Po-Ju Wei, Chih-Jen Yang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundPainful paronychia and pseudopyogenic granuloma (PG) are common adverse drug reactions (ADRs) associated with the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) to treat non-small cell lung cancer (NSCLC). Multiple local management approaches have been tested with unsatisfactory results. We have introduced an occlusion therapy technique through which available topical drugs for longer than 2 years.MethodsBased on the cancer registry and case management system of our hospital, from July 2019 to July 2020, we retrospectively enrolled patients with NSCLC who were treated with EGFR-TKIs and received applications of 0.5% timolol ophthalmic solution (TIMOPTOL XE 0.5%®) combined with a neomycin/tyrothricin ointment (Biomycin®) using the occlusion method to treat paronychia or PG.ResultsA total of 22 patients were enrolled, with a mean age of 66.5 years, most of whom were women (72.7%). Periungual lesion-related pain was reported by all patients, and periungual bleeding and PG were reported in 14% (3/22) and 64% (14/22) of patients, respectively. After the occlusion therapy application of timolol ophthalmic solution combined with neomycin/tyrothricin ointment twice daily, the overall response rate was 83.3%, including complete response in 18% (4/22) of cases and partial response in 68% (15/22) of cases.ConclusionWe presented an occlusion method using available topical beta-blockers and antibiotic ointment for EGFR-TKI-induced paronychia and PG in Taiwan. The result is favorable. Further randomized control trial is urgent to validate our findings
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-15T07:18:21Z
      DOI: 10.1177/10781552221122051
       
  • Radiation recall myositis with pazopanib in a patient with soft tissue
           sarcoma

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      Authors: Melike Pekyürek Varan, Hande Turna, Fazilet Öner Dinçbaş
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionRadiation recall reaction is an acute inflammatory reaction confined to previously irradiated areas that are most commonly triggered by the administration of anti-cancer agents after radiotherapy. Radiation recall myositis is a relatively rare form of radiation recall reaction.Case reportHere we report a 29-year-old female patient who suffered from metastatic monophasic synovial sarcoma. 8.5 months after post-operative radiotherapy of the right thigh region, the patient suffered pain, edema, redness, and increased temperature locally on the right thigh. Physical exam showed red fixed skin, rigidity and severe tenderness of region, and thigh magnetic resonance imaging revealed dense edema areas at the addiction, semimembranous-semitendinous muscle, and superior part of the biceps femoris and vastus lateralis isointense on T1AG, hyperintense T2AG images. Based on these findings, the patient was diagnosed with pazopanib-induced radiation recall myositis.Management & outcomePazopanib was stopped and pentoxifylline (2  × 400 mg), Vitamin E (3  × 400 mg), and methylprednisolone (2  × 8 mg) were prescribed. After 1 month, complete relief of thigh pain and marked recovery of rigidity, as well as erythema, were achieved and no recurrence of radiation recall reaction-related symptoms was observed after the pazopanib rechallenge.DiscussionMyositis is a relatively rare presentation of radiation recall reaction and physicians must be aware of the symptoms of the patients who are treated by radiotherapy and pazopanib.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-15T06:23:49Z
      DOI: 10.1177/10781552221125869
       
  • Impact of single-nucleotide variants and nutritional status on population
           pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in
           children with leukemia

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      Authors: Jesús Alonso Gándara-Mireles, Ismael Lares-Asseff, Elio Aarón Reyes Espinoza, Ignacio Villanueva Fierro, Verónica Loera Castañeda, Lourdes Patricia Cordova Hurtado, Carla Díaz González, Leslie Patrón Romero, Horacio Almanza Reyes
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Purpose Doxorubicin is an important antineoplastic agent with wide interindividual variability in response to treatment and in its cardiotoxic effects. To determine the effect of genotypic status of three single-nucleotide variants in ABCC1, NCF4, and CBR3 genes and nutritional status assessed by body mass index, on the population pharmacokinetics of Doxorubicin and its cardiotoxic effects in pediatric patients with leukemia.Patients and methodsSeventy pediatric patients treated with Doxorubicin were studied, in which 189 biological samples were obtained to determine Doxorubicin concentrations (1 to 3 samples per patient) at different times, for 20 h.ResultsLow body mass index and age ≤ 7 years were associated with decreased clearance of Doxorubicin, and female gender was associated with increased clearance of Doxorubicin. Low BMI and low height were associated with a decrease and increase, respectively, in the intercompartmental clearance (Q) of Doxorubicin. TT homozygosity of the single-nucleotide variant rs3743527 of the ABCC1 gene was associated with an increase in clearance and decreased area under the curve, AA homozygosity of the single-nucleotide variant rs1883112 of the NCF4 gene was associated with a decrease in the volume of distribution in the peripheral compartment (V2), and GG homozygosity of CBR3 rs1056892 with increasing area under the curve.ConclusionSome covariates studied are directly related to the increase or decrease of the pharmacokinetic parameters of Doxorubicin. Decreased clearance, V2, and increased area under the curve were associated with systolic dysfunction, and decreased Q and V2 were associated with diastolic dysfunction. These results may contribute to the effective and safe use of Doxorubicin in pediatric patients with leukemia.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-14T05:12:39Z
      DOI: 10.1177/10781552221117810
       
  • Lenalidomide induced pneumonitis

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      Authors: Kelsey Finch, Deepankar Sharma, Stephanie Wagner
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIatrogenic lung injury is a very rare, albeit serious complication with antineoplastic therapy, including immunomodulatory drugs. Pneumonitis typically presents clinically with symptoms such as cough, dyspnea, fever, and hypoxemia. Radiographic evaluation often demonstrates diffuse, patchy infiltrates and ground-glass opacities.Case reportWe present a case in which therapy from an immunomodulatory drug, lenalidomide, elicited a pneumonitis in the form of a 9 cm lung mass. An exhaustive workup was completed to rule out viral, bacterial, and fungal infections as well as malignant causes. Lenalidomide-induced lung injury was suspected.Management and outcomeLenalidomide was discontinued and corticosteroid therapy was initiated. This resulted in a complete clinical and radiographic resolution of symptoms.DiscussionSeveral case reports of pneumonitis have been associated with immunomodulatory drug therapy, and while most of these exhibit diffuse ground-glass opacities radiographically, our patient presented with a 9 cm lung mass. Our findings stress the importance of a thorough medication review while ruling out other potential causes of lung injury.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-08T05:17:03Z
      DOI: 10.1177/10781552221124533
       
  • Switching to daratumumab SC from IV is safe and preferred by patients with
           multiple myeloma

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      Authors: Maria-Victoria Mateos, Sophie Rigaudeau, Supratik Basu, Ivan Spicka, Rik Schots, Tomasz Wrobel, Gordon Cook, Meral Beksac, Katharine S Gries, Anupa Kudva, Brenda Tromp, Rian Van Rampelbergh, Huiling Pei, Susan Wroblewski, Robin Carson, Maria Delioukina, Darrell White
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionTwo phase 3 studies demonstrated superior efficacy of intravenous daratumumab (DARA IV) plus bortezomib/melphalan/prednisone (ALCYONE) or lenalidomide/dexamethasone (Rd; MAIA) versus standard-of-care regimens for transplant-ineligible newly diagnosed multiple myeloma. In these studies, patients could switch from DARA IV to subcutaneous daratumumab (DARA SC) while receiving daratumumab monotherapy in ALCYONE (as of Cycle 11) or daratumumab plus Rd in MAIA. The phase 3 COLUMBA study demonstrated noninferiority of DARA SC to DARA IV. DARA SC reduced administration time, allowing patients to spend less time in healthcare settings, a relevant practical consideration for patient care in the COVID-19 pandemic/settings of limited healthcare resources.MethodsDARA SC 1800 mg was administered every 4 weeks, per approved dosing schedules. We evaluated safety and patient-reported experience (ALCYONE only) among patients who switched from DARA IV to DARA SC.ResultsFifty-seven patients in ALCYONE and 135 in MAIA switched to DARA SC. Three (2.2%; MAIA) patients reported injection-site reactions, all of which were mild. No infusion-related reactions occurred with DARA SC. In ALCYONE,>80% of patients preferred DARA SC over DARA IV. Grade 3/4 treatment-emergent adverse events (TEAEs) occurred in 5.3% of patients in ALCYONE and 25.9% in MAIA; one (0.7%; MAIA) patient experienced a TEAE with an outcome of death.ConclusionFor transplant-ineligible newly diagnosed multiple myeloma, DARA SC (monotherapy/with Rd) was safe and preferred over DARA IV. ClinicalTrials.gov, NCT02195479/NCT02252172.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-09-06T04:43:53Z
      DOI: 10.1177/10781552221103551
       
  • Risk factors associated with nausea and vomiting in children with cancer
           receiving chemotherapy

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      Authors: Astrid Eliasen, J Kornholt, R Mathiasen, J Brok, C Rechnitzer, K Schmiegelow, K Dalhoff
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionDespite treatment with antiemetic medications, nausea remains uncontrolled for many children receiving chemotherapy. One reason is that risk factors for nausea in children remain poorly explored. The purpose of this study was to identify risk factors for chemotherapy-induced nausea (CIN) in children.MethodsProspective, observational study including 101 children (median age 6.4 years, range 0.8–17.9) with cancer receiving moderately or highly emetogenic chemotherapy. Primary endpoints were complete control of acute and delayed CIN, defined as no nausea in the acute phase 0–24 h after chemotherapy and in the delayed phase starting after the acute phase and ending 5 days later. Multivariable analyses included age, sex, cancer type, susceptibility to motion sickness, chemotherapy duration, numbers of antiemetics, co-administration with opioids or tricyclic antidepressants, and previously uncontrolled nausea or vomiting.ResultsAcute CIN was associated with susceptibility to motion sickness (odds ratio [OR] 5.73, 95% confidence interval [CI] 1.36–33.7) and older age (OR 4.19, 95% CI 1.30–14.7), comparing age group 8–18 years with 0–3 years. Delayed CIN was associated with uncontrolled acute nausea or vomiting (OR 10.3, 95% CI 2.65–50.9), highly emetogenic chemotherapy (OR 8.26, 95% CI 1.17–76.8), and having a hematologic cancer type (OR 7.81, 95% CI 1.05–79.2).ConclusionsSusceptibility to motion sickness and age can influence the risk of acute CIN. More research is needed on how best to integrate risk information in preventive antiemetic strategies. Sufficient acute nausea and vomiting control are crucial to prevent delayed CIN.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-30T06:55:05Z
      DOI: 10.1177/10781552221122026
       
  • Impact of oral chemotherapy pharmacists on cost avoidance of oral
           oncolytics in an integrated health system

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      Authors: Analia L Nguyen
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundWhile the impact of oncology pharmacist interventions on patient outcomes has been well-documented in previous studies, there is a scarcity of articles relating to oncology pharmacists’ impact on cost avoidance of oral oncolytics within an integrated health care system. Cost savings and cost avoidance studies are needed to help promote the expansion of clinical services provided by the oncology pharmacy department.ObjectiveThe primary objective of this study was to analyze interventions made by oncology pharmacists in the Oral Chemotherapy Treatment Program (OCTP) at the Kaiser Permanente—San Diego Service Area and determine the direct cost avoidance effects over one year. A secondary objective was to evaluate oncologists’ satisfaction with OCTP.MethodsThis was a retrospective, observational, single-arm study where the drug cost avoidance impact resulting from oncology pharmacists’ interventions was calculated. A report containing all documented oncology pharmacist interventions made in OCTP from 1 January to 31 December 2021 were reviewed for study inclusion. A retrospective chart review was conducted to verify that the interventions were made by the oncology pharmacists. The average wholesale price of drugs listed on Lexicomp as of 1 November 2021 was used to calculate drug cost avoidance values.ResultsA total of 238 OCTP oncology pharmacist interventions associated with direct drug cost avoidance values were identified, amounting to a total cost avoidance of $2,521,844 and an annual return on investment of 440%.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-25T04:43:08Z
      DOI: 10.1177/10781552221122034
       
  • Assessment of chemotherapy-related educational needs of colorectal cancer
           patients

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      Authors: Songul Tezcan, Gökçen İlke Tanır, Hayriye Yılmaz, Semra Memiş, Perran Fulden Yumuk, Şule Apikoğlu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      AimAim of our study was to evaluate cancer patients’ knowledge about their chemotherapy regimens in order to assess educational needs of patients.MethodsStudy was conducted on 58 colorectal carcinoma patients who were treated in an outpatient chemotherapy unit. These patients had received a 2-page information pamphlet about their chemotherapy treatments before the commencement of treatment. During the first interview with patients, pharmacist collected demographic data and evaluated patients’ knowledge about their medications using a standardized questionnaire.FindingsMean age of the patients was 59.6 ± 1.3 years; 65.5% were male. Majority (77.6%) of patients were graduates of primary school. Sixty-four percent of these had at least one comorbid disease. Median number of chemotherapy courses already received by patients was 4 (1–9). Fifty-nine percent reported that they did not receive any patient education and 43.1% reported that they did not receive any informative document. Twenty-nine percent of patients did not know what actions to take in case of nausea-vomiting; while 53.4% did not know how to react if their body temperature exceeded 38 °C and 25.9% had no idea about dietary necessities. About one-third of patients did not pay attention to oral care.ConclusionOur study showed that patients did not understand (or remember) the basic points about their chemotherapy sufficiently, but remembered the adverse effects they experienced occasionally. Pharmacists will have the chance to increase the level of knowledge of the patients receiving chemotherapy by providing patient education and follow-up.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-24T07:58:24Z
      DOI: 10.1177/10781552221122782
       
  • Elevated transaminases and development of cardiomyopathy in a 32-year-old
           woman with metastatic breast cancer after treatment with ribociclib
           followed by palbociclib

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      Authors: Christina Watts, Karin Nadori
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCyclin-dependent kinase 4 and 6 inhibitors, ribociclib and palbociclib, are associated with reports of transaminitis and adverse cardiac events.Case reportThe patient is a previously healthy 32-year-old female diagnosed with estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor 2 negative metastatic breast cancer. From July to September 2021, the patient was initiated on ribociclib followed by palbociclib for metastatic breast cancer. She subsequently experienced two episodes of transaminitis and was diagnosed with cardiomyopathy.Management and outcomeThe patient experienced transaminitis 2 weeks after the initiation of ribociclib resulting in discontinuation. When rechallenged with palbociclib, the patient experienced transaminitis within 1 week of initiation, which resulted in discontinuation. Approximately 1 month after palbociclib discontinuation, the patient was diagnosed with congestive heart failure with a left ventricular ejection fraction of 24%.DiscussionTo our knowledge, there are few case studies investigating cyclin-dependent kinase 4 and 6 inhibitor rechallenge following transaminitis. Prior literature suggests that transaminitis with cyclin-dependent kinase 4 and 6 inhibitors is not a class effect, but this case report suggests otherwise. This report presents a rare case of cardiomyopathy and transaminitis following the administration of cyclin-dependent kinase 4 and 6 inhibitors, ribociclib and palbociclib.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-24T07:58:15Z
      DOI: 10.1177/10781552221122057
       
  • Ocular toxicity following carboplatin chemotherapy for neuroendocrine
           tumour of the bladder

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      Authors: Jia Ng, Muhayman Sadiq, Qasim Mansoor
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCarboplatin is a commonly used platinum analogue chemotherapeutic agent that is similar to cisplatin but is known to be better tolerated. This case report outlines a case of ocular toxicity following carboplatin chemotherapy used for the management of a neuroendocrine tumour of the bladder.Case reportA 70-year-old man with a history of neuroendocrine bladder cancer underwent chemotherapy with carboplatin and etoposide. He presented 4 weeks following his fourth chemotherapy cycle with a 1-week history of right eye blurriness. The patient had suffered a similar episode 2 weeks following his third chemotherapy cycle in his left eye. Carboplatin-induced ocular toxicity was suspected and his vision remained stable following cessation of carboplatin chemotherapy.DiscussionCurrent literature on carboplatin-induced ocular toxicity remains scanty, however, previous cases have reported symptoms beginning 5 days to 2 weeks following carboplatin use. Visual disturbance in the form of altered colour vision, blind spot, blurred vision and metamorphopsia have been reported by previous literature. This case report emphasised a case of bilateral sequential blurring of vision following carboplatin chemotherapy.ConclusionIt remains critical for ophthalmologists and oncologists to look out for ocular side effects of chemotherapy due to its devastating effects.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-24T07:57:55Z
      DOI: 10.1177/10781552221122005
       
  • Protective effects of Panax ginseng against doxorubicin-induced cardiac
           toxicity in patients with non-metastatic breast cancer: A randomized,
           double-blind, placebo-controlled clinical trial

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      Authors: Malihe Hamidian, Farzaneh Foroughinia, Shirin Haghighat, Armin Attar, Elham Haem
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAnthracycline-based chemotherapy increases the risk of cancer therapeutics-related cardiac dysfunction. Recently, evidences from in vitro experiments and animal studies have shown that ginsenosides may exert cardiovascular protection against cancer therapeutics-related cardiac dysfunction. Here, we aimed to evaluate this effect in a clinical situation.MethodsIn this randomized, double-blind, placebo-controlled clinical trial, women with non-metastatic breast cancer whose left ventricular ejection fraction was ≥ 50% were randomly assigned in 1:1 ratio to receive ginseng (1 g/day) or placebo besides standard chemotherapy. Echocardiographic measurements were performed at baseline, after the fourth, and eighth chemotherapy cycles. High-sensitive cardiac troponin I was assessed at baseline and after the 4th cycle. The primary endpoint of the study was change in left ventricular ejection fraction. Cancer therapeutics-related cardiac dysfunction was defined as a drop in left ventricular ejection fraction of ≥ 10% from baseline.ResultsResults from 30 patients were included in the final analysis (15 patients in each group). In the intervention and control groups, left ventricular ejection fraction was dropped from 62.0 ± 0.9% to 60.7 ± 1.0% (difference = −1.3 ± 1.1%) and from 63.27 ± 1.1% to 58.0 ± 1.3% (difference = −5.27 ± 0.8%), respectively (difference = 3.97%, p = 0.006) at the end of the fourth cycle of chemotherapy. After the eighth cycle of chemotherapy, the mean left ventricular ejection fraction was increased by 0.8 ± 1.3% from baseline in the intervention group, whereas the placebo group experienced a reduction of −7.3 ± 1.4% (difference = 8.1%, p-value < 0.001). None of the patients in the ginseng group in comparison to 1(6.7%, p-value = 0.5) and 5 (33.3%, p-value = 0.02) patients in the placebo group developed cancer therapeutics-related cardiac dysfunction after the fourth and eighth cycles, respectively. High-sensitive cardiac troponin I levels were not significantly different between groups.ConclusionsProphylactic ginseng supplementation may protect against doxorubicin-induced early cancer therapeutics-related cardiac dysfunction and early decline in left ventricular ejection fraction in breast cancer patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-17T08:01:18Z
      DOI: 10.1177/10781552221118530
       
  • Prognostic and predictive biomarkers with therapeutic targets in breast
           cancer: A 2022 update on current developments, evidence, and
           recommendations

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      Authors: Clement Chung, Vanessa T.Y. Yeung, Kenneth C.W. Wong
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveTo evaluate and validate the recent and emerging data for prognostic and predictive biomarkers with therapeutic targets in breast cancer.Data sourcesA literature search from January 2015 to March 2022 was performed using the key terms breast cancer, clinical practice guidelines, gene mutations, genomic assay, immune cancer therapy, predictive and/or prognostic biomarkers, and targeted therapies.Study selection and data extractionRelevant clinical trials, meta-analyses, seminal articles, and published evidence- and consensus-based clinical practice guidelines in the English language were identified, reviewed and evaluated.Data synthesisBreast cancer is a biologically heterogeneous disease, leading to wide variability in treatment responses and survival outcomes. Biomarkers for breast cancer are evolving from traditional biomarkers in immunohistochemistry (IHC) such as estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor type 2 (HER2) to genetic biomarkers with therapeutic implications (e.g. breast cancer susceptibility gene 1/2 [BRCA1/2], estrogen receptor α [ESR1] gene mutation, HER2 gene mutation, microsatellite instability [MSI], phosphatidylinositol 3-kinase catalytic subunit 3Cα [PIK3CA] gene mutation, neurotrophic tyrosine receptor kinase [NTRK] gene mutation). In addition, current data are most robust for biomarkers in immunotherapy (e.g. programmed cell death receptor ligand-1 [PD-L1], microsatellite instability-high [MSI-H] or deficient mismatch repair [dMMR]). Oncotype DX assay remains the best validated gene expression assay that is both predictive and prognostic whereas MammaPrint is prognostic for genomic risk.ConclusionsBiomarker-driven therapies have the potential to confer greater therapeutic advantages than standard-of-care therapies. The purported survival benefits associated with biomarker-driven therapies should be weighed against their potential harms.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-16T05:20:56Z
      DOI: 10.1177/10781552221119797
       
  • Real-world analysis of tumor lysis syndrome in patients started on
           venetoclax combination for acute myeloid leukemia

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      Authors: Karin M Abernathy, Matthew A Perciavalle, Katie S Gatwood, Heidi Chen, Matthew M Zakhari, Michael Byrne
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionVenetoclax is utilized with low-dose cytarabine or a hypomethylating agent for the treatment of acute myeloid leukemia. Clinical trials report a risk of tumor lysis syndrome and the package insert recommends a venetoclax dose ramp-up at the initiation. The purpose of this study was to evaluate the risk of tumor lysis syndrome in a large population of patients with acute myeloid leukemia outside of a clinical trial and evaluate the incidence of hospital-acquired complications during inpatient ramp-up.MethodsWe performed a retrospective study of adult patients with acute myeloid leukemia receiving venetoclax with a hypomethylating agent or low-dose cytarabine. The primary outcome was the incidence of tumor lysis syndrome. Secondary outcomes included risk factors for tumor lysis syndrome, length of admission, and incidence of hospital-acquired complications.ResultsOne hundred thirteen patients were included. Although all patients were given some form of prophylaxis, the incidence of tumor lysis syndrome was 8.8%. All were laboratory tumor lysis syndrome; one with hyperuricemia, nine with hypocalcemia, and ten with hyperphosphatemia. Six patients received sevelamer. Tumor lysis syndrome was resolved in all cases. No clinical tumor lysis syndrome occurred. Hepatic dysfunction, tumor lysis syndrome high-risk stratification, higher baseline white blood cell count, and lactate dehydrogenase levels were more common in the tumor lysis syndrome group. Hospital-acquired complications reached 13% in those directly admitted for dose ramp-up.ConclusionsTumor lysis syndrome was uncommon and manifested as minor lab abnormalities. White blood cell count continues to be an indicator of risk for tumor lysis syndrome. Those who present with an elevated white blood cell or are otherwise at high risk for tumor lysis syndrome should be admitted for ramp-up. Otherwise, initiation and monitoring of venetoclax are feasible in the outpatient setting.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-10T06:41:29Z
      DOI: 10.1177/10781552221118635
       
  • Perceptions and prevalence of marijuana use among cancer patients managed
           at an outpatient department in Zimbabwe: A brief report

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      Authors: Maudy CP Manyau, Kudzanai P Changadzo, Tinashe Mudziti
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundGlobally, marijuana is becoming an acceptable complementary medicine for symptom management in cancer. At the time that the study was conducted, Zimbabwean laws only allowed for the cultivation of marijuana for medical and scientific use. As of 18 July 2022, the national medicines regulator released a circular allowing the licensing, distribution, and use of cannabidiol-based products. Anecdotes indicate there is medical marijuana use among Zimbabwean patients with cancer. We sought to determine the prevalence, patterns of use and perceptions of medical marijuana among patients with cancer.MethodsA cross-sectional survey was used to determine patterns and perceptions of marijuana use among outpatient patients with cancer. The study included adults attending the outpatient oncology clinic at Parirenyatwa Hospital Radiotherapy Treatment Center.ResultsFifty participants with a median age of 50.5 years (IQR: 41–58) completed the questionnaire, and 28.0% of them were male. The prevalence of marijuana use in the sample was 24.0% (95% CI 13.9–38.2). Most marijuana users were male (83.3%, p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-09T06:45:39Z
      DOI: 10.1177/10781552221118026
       
  • Contribution of an anticancer drug compounding robot in reducing the risks
           

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      Authors: Ali Cherif Chefchaouni, Yassine Boudina, Meryem Chennaq, Mohammed Jaouad Belahcen, Younes Rahali
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIn the last few years, pharmaceutical technology has evolved. In the field of oncology pharmacy, robots for the preparation of anti-cancer drugs have appeared to progressively replace manual preparation. The objective of this study is to evaluate the contribution of the robot in reducing the risk of manual preparation.MethodsThe study was conducted at the pharmacy of the National Institute of Oncology in Rabat (May–August 2021). The method used to compare the two types of preparation is the method of analysis of failure modes, their effects and their criticality (FMECA). It will calculate the criticality index (CI = severity × frequency × detectability). The risks have been categorized into human, technical, and environmental risks.ResultsThe anticancer drugs reconstitution step was the most critical in manual preparation (CI = 126.7) and robotic preparation (CI = 40.7). The robot has made it possible to reduce several CIs of manual preparation including: musculoskeletal disorders of pharmacy operators −93 (89%), error in cancer drug and diluent selection −72 (60%), as well as lack of traceability −145 (97%).ConclusionThe preparation robot has made it possible to reduce many of the risks of manual preparation, and constitutes an important advance in the field of oncology pharmacy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-08T07:23:02Z
      DOI: 10.1177/10781552221118846
       
  • KRAS-targeted therapy in the treatment of non-small cell lung cancer

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      Authors: Jina Yun, Reid Nakagawa, Kenneth Tham
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveKRAS mutations are one of the most common driver mutations in non-small cell lung cancer. Though previously believed to be an undruggable target, recent advances in therapeutics have seen new targeted agents against KRAS mutations. The objective of this article is to review currently available and upcoming KRAS-targeted treatments.Data sourcesCurrently available trials examining KRAS-targeted therapy in non-small cell lung cancer were examined by searching for the keyword “KRAS inhibitors.” The pivotal trials for sotorasib and adagrasib were reviewed for this article.Data summaryMutated KRAS can be challenging to target for a variety of reasons. In 2021, the US Food and Drug Administration approved sotorasib for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer with KRAS G12C mutation as determined by a Food and Drug Administration-approved test, who have received at least one prior systemic therapy. A multicenter, single-group, open-label, phase 2 trial was able to demonstrate that sotorasib was able to demonstrate objective response, progression-free survival, and overall survival in this patient population. A phase 3 trial comparing sotorasib to docetaxel in the subsequent-line treatment of KRAS G12C non-small cell lung cancer is currently ongoing. There are other KRAS-targeted agents currently under study, including adagrasib, with growing interest in targeting KRAS downstream pathways.ConclusionFurther trials need to be conducted in order to identify other targeted agents for KRAS and the appropriate place in therapy among currently approved treatments for non-small cell lung cancer.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-08T07:22:52Z
      DOI: 10.1177/10781552221118848
       
  • Nivolumab–ipilimumab combination therapy-induced seronegative
           encephalitis; rapid response to steroid plus intravenous immunoglobulin
           (IVIG) treatment

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      Authors: Kadriye Bir Yucel, Osman Sutcuoglu, Ozan Yazıcı, Yeşim Yıldız, Esin Şenol, Aytug Uner
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe efficacy of immune checkpoint inhibitors (ICIs) against malignant melanoma and numerously solid tumors has been demonstrated in several clinical studies. The incidence of immune-related adverse effects (irAEs) has increased after the rapidly expanding indications and clinical applications of ICIs. We present a case of nivolumab and ipilimumab-induced encephalitis with rapidly worsening consciousness and full recovery following ICIs suspension and high-dose steroid coupled with intravenous immunoglobulin (IVIG).Case ReportA 67-year-old woman was diagnosed with stage 4 BRAF wild malignant melanoma with metastasis to the axillary and mediastinal lymph nodes. Beyond progression with dacarbazine, ipilimumab and nivolumab combination were administered at the second-line treatment of metastatic setting. A week after the first cycle patient was reported to have a fever of more than 38°C. Subacute cognitive impairment including mild changes in behavior was reported on the third day of fever. She suddenly developed confusion, dysarthria, and motor dysfunction a few days later. Due to the altered mental status accompanied by fever, lumbar puncture was performed with a pre-diagnosis of encephalitis, meningitis, and leptomeningeal carcinomatosis.Management & OutcomeAfter excluding viral and autoimmune encephalitis, high-dose methylprednisolone was administered in addition to IVIG for 5 days with the diagnosis of immunotherapy-related encephalitis according to the recommendations for the management of irAEs. On the second day of the treatment patient's neurological status improved gradually.DiscussionBeing aware of symptoms of serious neurological irAEs associated with ICIs can prevent complications and improve survival.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-08T07:22:32Z
      DOI: 10.1177/10781552221118529
       
  • Evaluating aggressiveness of end-of-life care in patients with advanced
           cancer: A retrospective single-center analysis

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      Authors: Araceli Iglesias-Santamaría
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionOveruse of anti-cancer therapy near end of life is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on the quality of life and cost of hospital-based resources. The objective of this study was to measure indicators of potential aggressiveness of end-of-life care in a cohort of adult patients with advanced solid tumor. The secondary objective was to analyze the association between clinicopathological variables and indicators of aggressiveness.MethodsRetrospective data analysis was performed on adult patients with solid tumors who received palliative chemotherapy for advanced cancer and died in our hospital between 2017 and 2019. Indicators of aggressiveness of end of life care included chemotherapy use in the last days of life, emergency room visits and hospitalizations (including intensive care unit admissions) in this period, and referral to a palliative care unit before death. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy near end of life.ResultsOf the 571 patients included, 128 (22.4%) received chemotherapy within the last 2 weeks of life and 102 (17.8%) start a new chemotherapy regimen 30 days before death. During the last month of life, 168 patients (32.9%) visited emergency room more than once and 117 (20.5%) were hospitalized more than once. A total of 294 patients (51.5%) died in the acute care unit and 285 (49.9%) were referred to the palliative care unit. 24 of them (8.4%) died within 72h after referral.ConclusionsThe percentage of patients receiving chemotherapy near the end of life as well as the rate of emergency room visits and hospitalizations during this period are much higher than the value of the quality standard established in the literature. According to these indicators, cancer patient care at end of life can be considered overly aggressive. Optimization of palliative care at end of life is necessary.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-08T07:22:12Z
      DOI: 10.1177/10781552221117751
       
  • Smartphone-based application and nurses’ interventions for symptoms
           monitoring in patients treated with oral anticancer agents: A 1-year
           follow-up in a tertiary cancer center

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      Authors: Laura Porcher, Valérie Perron, Julie Blanc, Courèche-Guillaume Kaderbhai, Zoé Tharin, Antonin Schmitt, Matthieu Gallet
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      AimThe increasing use of oral anticancer agents over the past years has necessitated changes in monitoring toxicities to ensure patients’ adherence and tolerance at home. The aim of this study was to describe nurses’ interventions and medical changes after alerts triggered by a web-based platform designed to support the management of oral anticancer agents-related toxicities.MethodsThis retrospective study included patients undergoing oral anticancer agents in a cancer center from September 2018 to September 2019 (excluding hormonal therapy). In this cancer center, the standard of care included symptoms’ collections for 1 month thanks to a web platform based on patient-reported outcomes. Patients had to fill a weekly questionnaire (Q1 to Q4). The web-based platform triggered orange alerts when patients reported moderate symptoms and red alerts when severe toxicities were declared. The rate of orange and red alerts, the rate of patients with medical changes consecutively to an orange or a red alert, and the different types of nurses’ interventions and medical changes were assessed.ResultsA total of 524 patients were extracted but the final number of 436 patients were included in this study and 1488 questionnaires were filled in. More than 90% of patients declared that they took their medication as prescribed. Up to 60% of patients recorded all grade symptoms, including 8% of patients who recorded Grades 3–4 symptoms during the month, mostly anorexia, fatigue, and diarrhea. The web platform system triggered 700 orange and 212 red alerts: 305/700 (44%) of orange alerts resulted in nurses’ interventions, most frequently phone counseling (78%), and 65/212 (31%) of red alerts resulted in medical changes, most frequent treatment interruptions (48%).ConclusionImplementing an e-health (electronic-health) system can be helpful for monitoring symptoms in patients under oral anticancer agents, enhancing that this organization should be a standard of care in every cancer centers.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-08T07:22:08Z
      DOI: 10.1177/10781552221117731
       
  • Severe acute radiation dermatitis after palbociclib therapy in the setting
           of palliative radiotherapy

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      Authors: Kristine N Kim, Michael Salerno, Payal D Shah, Jennifer Matro, Michael J LaRiviere
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCyclin-dependent-kinase 4/6(CDK4/6) inhibitors are widely used as a first-line systemic treatment for patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer. Although many patients with metastatic breast cancer require palliative radiotherapy (RT), there are limited data on the safety of combining a CDK4/6 inhibitor with palliative RT.Case ReportPresented is a case of acute high-grade radiation dermatitis with low-dose palliative RT following administration of palbociclib. A 49-year-old woman with newly diagnosed hormone receptor-positive invasive ductal carcinoma of the left breast presented with lytic bone lesions in the left femur and lumbar spine. The patient initiated treatment with goserelin, tamoxifen, and palbociclib. She underwent prophylactic surgical fixation of the left femur and received post-operative RT encompassing the entire surgical nail (30 Gy/10 fractions) and palliative RT to the lumbar spine for pain relief (20 Gy/5 fractions). During cycle 4, palbociclib was stopped 3 days prior to the start of RT to reduce the risk of toxicity risk. However, 16 days after starting RT, she developed painful erythematous papules and bullae with moist desquamation on the left groin and lumbar spine.Management & OutcomeHer symptoms were managed with topical Aquaphor-lidocaine, silver sulfadiazine, and aluminum acetate soaks. Dermatitis subsided to dry desquamation within 2 weeks. The patient denied late toxicity at 11 months follow-up.DiscussionLarger retrospective or prospective studies are needed to further elucidate the safety of combined CDK4/6 inhibitors and RT. In the meantime, special precautions are warranted in patients receiving combined therapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-05T07:05:24Z
      DOI: 10.1177/10781552221118841
       
  • Developing wipe sampling strategy guidance for assessing environmental
           contamination of antineoplastic drugs

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      Authors: Susan Arnold, Matthew Jeronimo, George Astrakianakis, Miranda Kunz, Ashley Petersen, Carole Chambers, Darcy Malard Johnson, Emily Zimdars, Hugh W Davies
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Surveillance for environmental contamination of antineoplastic drugs has been recommended by authoritative bodies such as the United States Pharmacopeia and the National Association of Pharmacy Regulatory Authorities. Clear guidance is needed on how to develop sampling strategies that align with surveillance objectives efficiently and effectively. We conducted a series of simulations using previously collected surveillance data from nine cancer treatment centers to evaluate different sampling strategies. We evaluated the impact of sampling 2, 5, 10, or 20 surfaces, at monthly, quarterly, semi-annual, and annual frequencies, while employing either a random or sentinel surface selection strategy to assess contamination by a single antineoplastic drug (AD) or by a panel of three ADs. We applied two different benchmarks: a binary benchmark of above or below the limit of detection and AD-specific hygienic guidance values, based on 90th percentile values as quantitative benchmarks. The use of sentinel surfaces to evaluate a three-drug panel relative to 90th percentile hygienic guidance values (HGVs) resulted in the most efficient and effective surveillance strategy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-04T07:46:09Z
      DOI: 10.1177/10781552221118535
       
  • Intravenous route for folate supplementation in a patient with celiac
           disease treated by pemetrexed-based chemotherapy for non-small-cell lung
           cancer

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      Authors: Marie Beaurain, Catherine Rioufol, Nicolas Vantard, Alexandre Teixeira, Amandine Baudouin, Chloe Herledan, Pierre-Jean Souquet, Sebastien Couraud, Florence Ranchon
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionOral folic acid supplementation is essential for patients treated with pemetrexed, to prevent the risk of severe hematologic toxicity. In case of intestinal absorption disorder, no recommendations exist for intravenous folic acid supplementation.Case reportWe describe a 74-year-old patient with multimetastatic non-small-cell lung adenocarcinoma, receiving first-line chemotherapy with carboplatin AUC5, pemetrexed 500 mg/m2 and pembrolizumab 200 mg intravenously every 3 weeks. The patient presented neglected celiac disease, resulting in malabsorption syndrome with iron and folic acid deficiency. The question was how to administer folic acid supplementation during the pemetrexed-based chemotherapy.Management and outcomesIntravenous injection of 200 mg levoleucovorin on day 1 of cycle 1 of pemetrexed-based chemotherapy was administered and well tolerated. During the second cycle, the levoleucovorin perfusion was not renewed by omission. The patient was hospitalized for 7 days because of febrile aplasia. Piperacillin–tazobactam was started, and then switched to amoxicillin–clavulanate plus ciprofloxacin. After this episode of post-chemotherapy febrile aplasia, it was decided to systematically supplement the patient with intravenous levoleucovorin, with blood folate concentration monitoring at each cycle. At 16 months after start of treatment, the patient was in complete remission, indicating that the immune-chemotherapy was effective, with no further febrile neutropenia.Discussion/conclusionThis case report highlights intravenous levoleucovorin supplementation as an alternative to oral folic acid if needed during pemetrexed–antifolate-based chemotherapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-03T04:33:44Z
      DOI: 10.1177/10781552221117734
       
  • A practical method for oral administration of isotretinoin in pediatric
           oncology patient: A case study of neuroblastoma

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      Authors: Abdulrahman Alwhaibi, Miteb Alenazi, Bana Almadi, Abdulaziz Alotaibi, Sultan M Alshehri, Faiyaz Shakeel
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIsotretinoin is a synthetic vitamin A derivative, administered off-label as maintenance therapy for neuroblastoma. This report addresses the challenge of administering isotretinoin to children, given its availability as soft gelatin capsules only.Case reportA 3-year-old boy diagnosed with stage IV neuroblastoma has undergone multimodal therapy, including six cycles of chemotherapy, followed by tumor resection and radiotherapy. Later, he was initiated on immunotherapy and prescribed isotretinoin 50 mg orally twice daily for two weeks, before each immunotherapy cycle. Isotretinoin is not available in liquid formulation and the patient could not swallow isotretinoin capsules. Therefore, pharmacist counseling was required to ensure appropriate administration of the drug.Management and outcomesThe patient’s parents were instructed to pierce prescribed capsules, and empty and dilute their contents into a small glass containing olive oil after taking safety measures. Isotretinoin’s stability in olive oil for 72 h was compared using high-performance liquid chromatography to its stability in soybean oil. The recovery rates were 98.62% and 98.3%, respectively. Drug miscibility was not an issue as isotretinoin is lipophilic. Therefore, it could be administered easily without considerable remaining on the interior wall of the glass.DiscussionTo the best of our knowledge, this is the first report that suggests a practical method for administering isotretinoin in liquid form, particularly in pediatric oncology patients. Isotretinoin was noted to be stable in olive oil and its exposure to light and oxygen would not be an issue given the short time from preparation to administration and the low emphasis on exposure by the manufacturer when such a method is recommended.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-01T07:55:17Z
      DOI: 10.1177/10781552221117814
       
  • A multicentre study with real-world data of the use of palbociclib in the
           treatment of breast cancer: Treatment duration correlates with dose
           reductions

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      Authors: Felice Musicco, Ruggero Lasala, Fiorenzo Santoleri, Alberto Costantini, Paolo Abrate, Maria Teresa Carretta, Enrica Maria Proli, Alessia Romagnoli, Nicola Petragnani, Francesco De Vita, Massimo Zeuli, Patrizia Vici, Massimo Sansone, Matilde Pasquantonio, Antonia La Malfa, Chiara Fulgenzio
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectivePalbociclib, a highly selective reversible CDK4-6 kinase inhibitor, is indicated in combination with an aromatase inhibitor or in combination with fulvestrant in women who had received prior endocrine treatment. Studies have demonstrated the efficacy of palbociclib in combination with fulvestrant in increasing progression-free survival in patients who relapsed or progressed on previous endocrine therapy, or in combination with aromatase inhibitor in patients who had not received previous treatments. We analysed the prescribing patterns of palbociclib in real practice correlating it with the evidence of treatment-related toxicity management and to time-to-treatment discontinuation and treatment adherence.MethodsFor the observational, retrospective study, data were collected from five Italian hospital centres that prescribed palbociclib between April 2017 and April 2020. Each centre provided data derived from an administrative database of adult patients treated with palbociclib for the two therapeutic indications.Treatment adherence was calculated using the proportion of days covered method while time-to-treatment discontinuation was defined as the difference between the first and last date treatment was administered plus the days ideally covered by the last date treatment was given.ResultsThere were 375 patients enrolled during the study period, of whom 159 were treated with palbociclib and aromatase inhibitor and 216 were treated with palbociclib and fulvestrant. The time-to-treatment discontinuation was 8.9 months in the case of P + f (95% CI: 7.1−12.7) and 13.7 months in the case of P + ia (95% CI: 8.9−17.5). In both cohorts, treatments that received at least one dose reduction had a statistically higher time-to-treatment discontinuation than those without dose reduction (17.7 months vs. 9.2 and 16.6 vs. 7.4).The mean adherence in our study was 0.9 and remained high in treatments with one dose reduction (0.83) and this with two dose reductions (0.87).ConclusionBased on these findings, it appears that the management of toxicities through reducing doses, as required by the Summary of Product Characteristics, results in a better outcome in terms of therapy duration, and therefore time to failure due to progression or toxicity.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-29T07:13:15Z
      DOI: 10.1177/10781552221117135
       
  • Capecitabine-related neurotoxicity presenting with agraphia

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      Authors: Dilek Iscan, Rumeysa Tolay, Ertugrul Bayram, Turgay Demir, Sebnem Bicakci
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCapecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal side effects including nausea, vomiting, and diarrhea, and dermatological side effects including hand-foot syndrome and skin pigmentation change. However, neurological side effects of capecitabine are very rare. We describe herein a patient who developed neurological side effects in the form of agraphia and dysarthria on the 7th day of capecitabine treatment.Case ReportA 34-year-old male patient, who was being followed up with the diagnosis of colon cancer, presented with speech and writing disorder that developed while under capecitabine treatment. Dysarthria and agraphia were detected in his neurological examination. Diffusion-weighted magnetic resonance imaging (MRI) revealed acute diffusion restriction in the splenium of the corpus callosum and at the level of the bilateral centrum semiovale. Brain MRI revealed symmetrical T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) signal increases at the right temporoparietal medial, corpus callosum level, and bilateral white matter level.Management & OutcomeThe capecitabine treatment was terminated, and methylprednisolone treatment was administered and plasmapheresis procedure was carried out. Subsequently, significant improvement was observed in the clinical findings and neuroimaging.DiscussionCapecitabine is used as an oral agent; thus, it provides ease of use. Neurological side effects associated with the use of capecitabine reportedly occur very rarely. The findings of this case demonstrated that leukoencephalopathy can be seen during the use of capecitabine, imaging results are very important in the diagnosis of leukoencephalopathy, and improvement can be achieved with the termination of the capecitabine treatment.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-29T07:13:08Z
      DOI: 10.1177/10781552221116329
       
  • Stability of a standardized preparation of methotrexate, cytarabine, and
           methylprednisolone hemisuccinate for intrathecal use

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      Authors: Gianluca Perego, Giorgia Longobardo, Lucia Viganò, Alberta Locatelli, Cinzia Veneziano, Maria Fazio
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionData about the feasibility or stability of drugs prepared for intrathecal administration are scarce, especially concerning the possibility of mixing two or more compounds in the same syringe. We evaluated the stability of an extemporaneously prepared triple intrathecal therapy containing methotrexate, cytarabine, and methylprednisolone hemisuccinate.Materials and MethodsSix mixtures containing 12.5 mg methotrexate, 50 mg cytarabine, and 40 mg methylprednisolone hemisuccinate, diluted to a final volume of 5 ml with water for injection, were prepared in polypropylene syringes on six different days. Syringes were stored protected from light either at room temperature (20°C) (n  =  3) or refrigerated temperature (4°C) (n  =  3). Samples were analyzed immediately after preparation and again at 0.5, 2, 4, 6, 8, and 24 h. The analysis was conducted with a high-performance liquid chromatography instrument equipped with a quaternary pump and diode array detector. pH was also assessed before every sample analysis.ResultsWhen mixed in a polypropylene syringe, the three drugs were stable at both temperatures tested. No degradation>10% was observed in any sample and pH remained between 7.0 and 7.5 over time. No precipitation or color change occurred. Among the three compounds, methylprednisolone hemisuccinate was the most labile as a slight temperature- and time-dependent degradation was observed.ConclusionTriple intrathecal solution of methotrexate, cytarabine, and methylprednisolone hemisuccinate is stable for up to 24 h when stored in polypropylene syringes protected from light at 4°C and 20°C.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-27T06:32:50Z
      DOI: 10.1177/10781552221117228
       
  • Mild forms of thrombotic microangiopathy in patients with advanced
           pancreatic cancer receiving gemcitabine and nab-paclitaxel

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      Authors: Marta Garcia de Herreros, Francis Esposito, Tamara Sauri, Carme Font
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThrombotic microangiopathy (TMA) is an uncommon complication that may occur in cancer patients usually as an expression of cancer-associated coagulopathy or due to drug-related toxicity. The clinical spectrum of TMA may vary from an incidental laboratory finding in cancer outpatients to potentially severe life-threatening clinical forms with organ involvement requiring prompt recognition and multidisciplinary evaluation.Case ReportsWe present the clinical characteristics and outcomes of four patients with advanced pancreatic cancer with acute non-immune intravascular haemolysis compatible with microangiopathic acute haemolytic anaemia associated with mild thrombocytopenia during long-term gemcitabine and nab-paclitaxel treatment.Management and OutcomesAbnormal blood parameters (all four cases) and renal involvement (one case) were reversed with a conservative approach and chemotherapy discontinuation. One patient required a short hospitalization while the other three were managed as outpatients. The rapid reversibility of the blood abnormalities supported gemcitabine dose-related toxicity as the most likely aetiologic mechanism and demonstrates the current challenges in daily long-term cancer survivor care.DiscussionClinicians must take into account TMA in the differential diagnosis of acute anaemia with or without thrombocytopenia and organ damage, since adequate recognition and early treatment discontinuation allow effective outpatient management and favourable patient outcomes.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-25T11:54:10Z
      DOI: 10.1177/10781552221114653
       
  • High-dose methotrexate-related pneumonitis in a child with acute
           lymphoblastic leukemia

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      Authors: Rim Rakez, Wiem Boufrikha, Areej Cheffaï, Sarra Boukhriss, Mohamed Adnene Laatiri
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionMethotrexate is administered through different routes to treat childhood acute lymphoblastic leukemia. Toxicities of low, intermediate, or high doses of methotrexate have been described in the literature. Methotrexate-induced or related pneumonitis is a rare complication that leads, in most cases, to discontinuing this drug.Case reportWe report a case of a 17-year-old female patient with newly diagnosed B-acute lymphoblastic leukemia who received a high-dose methotrexate on an induction course. Eight days after methotrexate infusion, she developed fever, dyspnea, hypoxemia, and dry cough. Chest computed tomography showed mosaic attenuation of lung parenchyma and bilateral interstitial infiltrate in favor of hypersensitivity pneumonitis with no evidence of bacterial or fungal infections.Management and outcomeMethotrexate-related pneumonitis was diagnosed and corticosteroids were prescribed. Improvement of the symptomatology was noted within four days. Given the importance of methotrexate in the treatment of acute lymphoblastic leukemia, intrathecal methotrexate was administered without incident and high-dose methotrexate was re-introduced successfully two and a half months after the pneumonitis episode while using corticosteroids. According to Naranjo's algorithm, the reaction to the drug was found to be probable with a score of 6.DiscussionMethotrexate is the backbone of acute lymphoblastic leukemia treatment, but numerous adverse reactions have been published of which methotrexate pneumonitis can be fatal in some cases. In this case, we concluded that this drug can be successfully reintroduced after methotrexate-related pneumonitis.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-20T04:04:02Z
      DOI: 10.1177/10781552221112160
       
  • Anti-cancer medicine shortages in an oncology tertiary hospital of
           Pakistan: A five-year retrospective study

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      Authors: Sundus Shukar, Caijun Yang, Shahbaz Ahmad Khan, Omar Akhlaq Bhutta
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveAnti-cancer medicine shortages are advancing challenges for patients and hospitals. This study aims to evaluate anti-cancer and supportive medicine shortages in a tertiary hospital in Pakistan and propose solutions.MethodA retrospective observational research was performed in a tertiary care hospital in Pakistan from 2016 to 2020. Data was retrieved from the hospital database using a questionnaire regarding short medicines’ generic name, brand, dosage, source, total source, frequency, causes, impact, management, and analyzed by Microsoft Excel 2013.ResultsBetween January 2016 and December 2020, 43 individual medicine shortages were observed, with an average of 8.6 shortages per year. There were shortages of 22 medicines, including 8 anti-cancer (36.4%) and 14 supportive agents (63.6%). Total shortage days were 27,100, with an average of 1232 days (SD 757) per medicine. Supportive medicines’ shortages were frequent, but oncology agents’ shortages were constant. The most affected dosage form was injection. Cardiovascular drugs and alkylating agents were the most affected class in supportive and anti-cancer medicines, respectively. The use of “alternative medicine” and “patient needs based importation” were the most common mitigation strategies.ConclusionShortages of oncology medicines are challenging in Pakistan. The most prominent causes are the lack of updated governmental regulations, registration, and import issues. The tertiary care hospital has very few sources of supply, so it imports these drugs on a need basis to manage the shortages. But it is still concerning because of the huge financial burden on patients and institutions due to expensive import, and therapy become delayed as the import process takes time. Moreover, the most affected drug class was alkylating agents, and dosage was both injectable and oral medicines.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-15T07:21:11Z
      DOI: 10.1177/10781552221114278
       
  • Adverse drug reactions associated with doxorubicin and epirubicin: A
           descriptive analysis from VigiBase

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      Authors: Deborah A. Matesun, Kofi Boamah Mensah, Peter Yamoah, Varsha Bangalee, Neelaveni Padayachee
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundCancer is one of the leading causes of death globally. Owing to high toxicity, patients using chemotherapy drugs have a higher risk for developing adverse drug reactions (ADRs). Pharmacovigilance studies are essential in oncology to evaluate ADRs caused by anticancer drugs and improve patient safety. This study aimed to analyze serious ADRs associated with the use of doxorubicin and epirubicin reported to VigiBase.MethodAll anonymized data on suspected ADRs for doxorubicin and epirubicin as ‘serious’ and ‘suspected’ or ‘interacting’ drugs between 1968 and 30 August 2021, were extracted from VigiBase. Descriptive statistics were conducted in Microsoft Excel, and data were summarized using frequencies and percentages.ResultsA total of 35,620 serious individual case safety reports was analyzed. The majority of reports were from females (Dox = 61.41%; Epi = 86.56%), while the predominant age group was 45–64 years (Dox = 42.06%; Epi = 57.39%). Physicians were the more likely group to report serious ADRs (Dox = 50.03%; Epi = 34.11%). In general, Europe reported the highest for doxorubicin (38.08%), while Asia recorded the highest reports for epirubicin (53.28%). Oceania reported the least for both drugs (Dox = 0.45%; Epi = 0.04%), followed by Africa (Dox = 0.72%; Epi = 0.29%). Blood and lymphatic system disorders were the most reported serious category (Dox = 11053 [44.47%]; Epi = 6659 [61.84%]). The most common manifestations were febrile neutropenia (Dox = 10.52%) and bone marrow failure (Epi = 23.89%).ConclusionThis study provides relevant global insights into serious ADRs for doxorubicin and epirubicin. This knowledge may assist in minimizing and proactively managing ADRs. It can also inform policies to improve patients’ quality of life.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-14T06:13:28Z
      DOI: 10.1177/10781552221113578
       
  • Anaphylaxis caused by pegylated recombinant human granulocyte
           colony-stimulating factor

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      Authors: Chen Chen, Jian Qi, Juandong Wang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF), is commonly used to prevent and/or treat neutropenia caused by tumor chemotherapy and radiotherapy with reduced clearance, increased plasma half-life, sustained biologic activity, and good safety. PEG-rhG-CSF anaphylaxis was rare.Case reportA 55-year-old male Non-Hodgkin lymphoma patient appeared with chest tightness, increased heart rate, and decreased blood pressure after taking PEG-rhG-CSF used as a primary treatment for neutropenia caused by chemoradiotherapy. The patient’s anaphylaxis is likely due to PEG-rhG-CSF.Management and outcome0.9% sodium chloride 250 mL and dexamethasone sodium phosphate injection 5 mg were carried out. After close observation, the symptoms were improved. Two months later, the patient was readministered with PEG-rhG-CSF and anaphylaxis reoccurred. After the last contact with PEG-rhG-CSF, the patient was prescribed rhG-CSF for many times and did not experience any adverse reactions.DiscussionPEGylated drugs are not free of risk and immune-mediated adverse events are of concern. PEG is a substance capable of triggering an immune response. The mechanism of PEG involved IgE-mediated anaphylaxis and non-IgE-mediated anaphylaxis, and requires further research. PEGylated drugs are not free of risk and immune-mediated adverse events are of concern.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-14T06:12:38Z
      DOI: 10.1177/10781552221112323
       
  • A case of castration-resistant metastatic prostate cancer who continued
           treatment with enzalutamide after epileptic seizure

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      Authors: Ozden Demir, Guzin Demirag
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionEnzalutamide is an androgen receptor inhibitor and is used in metastatic castration-resistant prostate cancer. Seizure is a rare side effect of enzalutamide. In this case, the patient had an epileptic seizure while on enzalutamide treatment. His treatment management and and use of enzalutamide afterwards is discussed.Case reportA 78-year-old male patient who received previous treatments for metastatic castration-resistant prostate cancer was started on enzalutamide due to progression, and had an epileptic seizure while taking enzalutamide was presented. Different pathologies such as the use of other drugs, brain metastasis, bleeding, electrolyte, liver and kidney disorders that can cause epileptic seizures were explored and not found to be the cause in this patient. No neurological pathology was found in the patient after the seizure.Management and OutcomeEnzalutamide and antiepileptic treatment were initiated simultaneously again in the patient whose treatment was interrupted after the seizure and no pathology was found in the brain magnetic resonance imaging. Under this dual treatment, the patient did not have seizures again.DiscussionAlthough observed rarely, enzalutamide-induced epileptic seizure is a known side effect. However, a review of literature did not reveal any report on patients for whom enzalutamide and antiepileptic treatment were initiated and followed up simultaneously after seizures. This case report will contribute to the literature for patients whose treatment options have been exhausted and who may benefit significantly from continued use of enzalutamide despite having a seizure.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-14T06:12:31Z
      DOI: 10.1177/10781552221112018
       
  • Pinnae and facial hypertrichosis induced by cetuximab

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      Authors: Dimitrios Alexandris, Nektarios Alevizopoulos, Kostas Palamaris, Charikleia Gakiopoulou, Stamatios Theocharis
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAnti-EGFR targeted anti-cancer treatment is associated with various skin adverse events. Cetuximab is often associated with acneiform papules and skin disorders. Hypertrichosis cited in face pinnae and eyelash trichomegaly are seldom described.Case reportA 72-year-old female cancer patient presented deteriorating facial-pinnae hypertrichosis and eyelash prolongation post cetuximab infusion.Management and outcomeConsecutive cetuximab administration led to exaggerating hairy skin side effects, fully alleviated when the drug was discontinued.DiscussionTo the best of our knowledge, this is the first reported case of an anti-EGFR-associated diffuse pinnae hypertrichosis presentation in a female patient in literature. This distinct entity can be easily diagnosed and manipulated with early drug withdrawal. An extensive review of relevant basic molecular research is provided to increase physicians’ awareness.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-13T03:46:22Z
      DOI: 10.1177/10781552221114073
       
  • Bosutinib-induced massive pleural effusion: Cross-intolerance with all
           tyrosine kinase inhibitors

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      Authors: Nevin Alayvaz Aslan, Hande Oğul Hıncal, Özde Elver, Veysel Erol, Nil Güler
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundThe discovery of tyrosine kinase inhibitors provided a breakthrough in the treatment of chronic myeloid leukemia. Nowadays, the management of tyrosine kinase inhibitor-related side effects is one of the important problems in chronic myeloid leukemia treatment. Grades 3–4 pulmonary toxicity; especially pleural effusion is mostly seen with dasatinib treatment but rarely seen with nilotinib and bosutinib. Development of cross-intolerance due to pleural effusion is not an expected situation. Pleural effusion related to tyrosine kinase inhibitors is mostly exudative in nature with abundant lymphocytes.Case reportMassive pleural effusion developed in a 59-year-old male patient with chronic myeloid leukemia, who was being treated with bosutinib. In the past, the patient had experienced massive pleural effusion also with dasatinib and nilotinib. The evaluation for differential diagnosis of pleural effusion did not reveal any additional malignancy.Management and outcomeAfter discontinuation of bosutinib and initiation of prednisolone, pleural effusion was totally resolved. Prednisolone was gradually discontinued and third-generation tyrosine kinase inhibitor ponatinib was started. After 12 months of follow-up, massive pleural effusion occurred again, leading to discontinuation of ponatinib.DiscussionCross-intolerance is an important problem in the tyrosine kinase inhibitor era. The significance of this case is the development of cross-intolerance to all second-generation tyrosine kinase inhibitors and furthermore to a third-generation tyrosine kinase inhibitor. Management strategies for pleural effusion and close follow-up are important.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-13T03:46:06Z
      DOI: 10.1177/10781552221114070
       
  • Review of novel and supplemental approvals of the targeted cancer drugs by
           the Food and Drug Administration in 2021

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      Authors: Esin Aysel Kandemir
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveThis review aims to present the most recent results from clinical trials of targeted cancer drugs that led to the Food and Drug Administration approval in 2021 and reflect the changing treatment landscape of solid malignancies.Data SourcesNovel approvals and supplemental approvals in 2021 were retrieved from the official web page of the Food and Drug Administration (Drugs@FDA). This review did not include approvals for generics, biosimilars, imaging, and diagnostics agents.Data SummaryThis review included 10 novel drugs approved for 11 indications and 10 already-approved drugs approved for 21 indications by the Food and Drug Administration in 2021. Novel approvals mainly were related to treating an orphan disease. In addition, one-third of the supplemental approvals were given for neoadjuvant or adjuvant treatment, while the number of indications for each tumor site was as follows: gastrointestinal (7), genitourinary (5), skin (3), lung (2), breast (2), thyroid (1), and cervix (1).ConclusionsTargeted cancer treatments are gaining more importance than ever in treating malignant diseases. As the approval of targeted cancer drugs provides a possibility for patients and this trend is expected to continue in the future, it remains vital for healthcare providers to stay up-to-date with newer therapeutic options.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-06T03:12:23Z
      DOI: 10.1177/10781552221112015
       
  • Development and reliability testing of a cervical cancer patients
           knowledge and practice of self-care management of treatment-related
           adverse events questionnaire

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      Authors: Aliyu Samaila, Abdulmuminu Isah, Aminu A Biambo, Nuruddeen Usman, Usman M Aliyu, Adamu Abdullahi, Maxwell O Adibe
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCervical cancer (CC) treatment-related adverse events (AEs) were found to be among the major reasons for treatments delays and medication non-adherence. Knowledge and practice of self-care management of these AEs are therefore needed to complement the pharmacotherapeutic interventions. Instruments for assessing CC patients’ knowledge and practice of self-care management of treatment-related Adverse Events (AEs) are lacking. Hence, the rational for this study.MethodsA prospective, cross-sectional study was conducted on CC patients receiving chemotherapy, radiotherapy or both, with or without surgery in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, a tertiary hospital in North-Western Nigeria. A panel of 14 experts judged the content validity of the items initially selected. Purposive sampling technique was used, 31 CC patients were recruited and interviewed for the questionnaire pre-testing. Descriptive statistics and psychometric analysis were conducted using SPSS Version 20.0 for Windows. A Cronbach’s alpha coefficient ≥0.70 was considered acceptable.ResultsA 12-domain questionnaire instrument was developed. Eight (57.1%) of the expert panelists rated the questions’ items as “Very good for the study” and none of them rated any of the content “not relevant for the study”. The reliability studies showed that the overall knowledge and practice questions response rates were 71.0% and 77.4% and Cronbach's alpha (α) values were 0.956 and 0.913, respectively.ConclusionA reliable, 12-domain cervical cancer patients’ knowledge and practice of self-care management of treatment-related adverse events questionnaire was developed. Further research on the psychometric qualities of the instrument is needed.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-06T01:43:43Z
      DOI: 10.1177/10781552221112159
       
  • Asymptomatic unilateral phrenic nerve palsy after bortezomib treatment in
           a newly diagnosed multiple myeloma patient

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      Authors: Muharrem Coşkunpınar, Batuhan Erdoğdu, Hakan Goker
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionBortezomib is the first chemotherapeutic agent of proteosome inhibitor class that can be used in newly diagnosed and relapsed/refractory multiple myeloma. It is well known that bortezomib has side effects such as peripheral sensory, motor, or autonomic neuropathy. In this paper, we will present our patient who developed unilateral phrenic nerve palsy as an autonomic neuropathy after six cycles of subcutaneous bortezomib treatment. This case differs from other cases in that our patient was asymptomatic.Case reportA 57-year-old male patient was admitted with back pain and gait disturbances. In the thorax computed tomography, a soft tissue mass causing compression on the spinal canal was observed in the T12 vertebra. Bone biopsy pathology report resulted in diffuse plasma cell infiltration. The patient was diagnosed with stage ISS-3, IgG kappa type multiple myeloma.Management and outcomeSubcutaneous bortezomib 1 × 2.2 mg (Days 1-4-8-11) + intravenous cyclophosphamide 1000 mg (Day 1) + intravenous dexamethasone 40 mg (Days 1-2-3-4) (VCD chemotherapy protocol) was started. Totally six cycles of VCD were administered. While the patient did not have any respiratory symptoms, an elevation consistent with phrenic nerve palsy was observed in the left hemidiaphragm in the thorax computed tomography that was taken during the preparation for autologous hematopoietic stem cell transplantation.DiscussionBortezomib is a frequently used chemotherapeutic agent in patients with multiple myeloma and care should be taken in terms of the risk of developing phrenic nerve palsy in patients. There are cases of autonomic neuropathy developing after bortezomib treatment.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-04T06:04:18Z
      DOI: 10.1177/10781552221112151
       
  • Understanding the differences in outcome between CART studies as
           second-line treatment in aggressive lymphoma

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      Authors: Reyad Dada
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Patients with refractory/early relapsed aggressive lymphomas belong to the most difficult-to-treat patients with hematological neoplasia. The prognosis of such patients is poor and novel treatment approches are urgently needed. Autologous chimeric antigen receptor T-cell therapy is a promising new therapy option that is approved after the failure of two lines of chemotherapy. Recently, the results of three different CART studies (ZUMA-7, TRANSFORM, and BELINDA) were published. Two of them were positive and one was negative, which created a mix of disappointment, confusion, and irritation. In this article, we are analyzing the data of all three trials and shed light on the differences between the studies which may facilitate an easier understanding of the results and relevance of CART in aggressive large B-cell lymphoma.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-04T06:03:58Z
      DOI: 10.1177/10781552221110806
       
  • Rituximab biosimilar HLX01 versus reference rituximab in the treatment of
           diffuse large B-cell lymphoma: Real-world clinical experience

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      Authors: Weishang Deng, Sensen Yang, Changyuan Yang, Haitao Chen, Guoning Huang, Hanbiao Wu, Jisheng Chen
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionHLX01 is the first rituximab biosimilar produced in China and the first monoclonal antibody biosimilar marketed in China. The purpose of this study was to comprehensively evaluate whether HLX01 is clinically consistent with the original drug based on real-world data to provide evidence for the clinical substitution of biosimilars in China.MethodsA single-center retrospective study was conducted to select patients with diffuse large B-cell lymphoma who met the inclusion criteria and were treated with HLX01 or reference rituximab. Baseline characteristics, efficacy and safety results were recorded, and the corresponding statistical analysis was performed for various indicators.ResultsThirty-three patients diagnosed with diffuse large B-cell lymphoma were included and divided into two groups that received HLX01 or reference rituximab. The results showed no significant difference in the overall response rate (86.7% vs. 88.9%; p = 1.000) or complete response rate (46.7% vs. 55.6%; p = 0.889) between the two groups. Kaplan–Meier survival curves also showed no significant difference in time-to-event variables between the two groups (log-rank = 0.244). Safety was also comparable in both groups.ConclusionsHLX01 is a suitable replacement for reference rituximab in the treatment of diffuse large B-cell lymphoma and is relatively inexpensive, thereby reducing the economic burden of patients. Nevertheless, the conclusion of this study still needs to be further validated by large-sample real-world data and explored for HLX01 in other indications, such as follicular lymphoma.Clinical trial registrationNot applicable.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-07-04T06:03:49Z
      DOI: 10.1177/10781552221110470
       
  • Corrigendum to Role of sacituzumab govitecan in solid tumors

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      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-30T06:33:40Z
      DOI: 10.1177/10781552221110947
       
  • What patient assessment skills do pharmacist independent prescribers
           require to prescribe immunomodulators in myeloma'

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      Authors: Anton Slavin, Amanj Kurdi, Mandy Wilson
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      AimTo gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing immunomodulators in myeloma across National Health Service Scotland.MethodsThis was a two-phase study which used nominal group technique to gain local consensus followed by a two-round eDelphi questionnaire to gain national consensus across all cancer networks.SettingThis project was conducted across the three cancer networks within NHS Scotland: South East Scotland Cancer Network; West of Scotland Cancer Network and North Cancer Alliance.SubjectsParticipants were invited from each cancer network (South East Scotland Cancer Network, West of Scotland Cancer Network and North Cancer Alliance) and included haematology consultants, haematology specialist registrars, haematology advanced nurse practitioners and haematology pharmacists.ResultsThere were five participants in the nominal group technique. Twenty-two out of 31 patient assessment skills gained local consensus, seven patient assessment skills did not gain consensus and two patient assessment skills were deemed irrelevant. There were 12 and 14 participants in round one and two of the eDelphi questionnaire, respectively. Twenty-nine patient assessment skills were included in the first-round questionnaire and 21 gained consensus. The remaining eight patient assessment skills were included in round two where seven did not achieve consensus and one achieved disagreement consensus.ConclusionThis research outlines 21 patient assessment skills required for pharmacist independent prescribers to prescribe immunomodulators for myeloma patients according to haematology specialists in Scotland. Discussion on patient assessment skills without consensus showed that the pharmacist independent prescribers would have a shared responsibility with the consultant. This work should inform the development of a competency framework to allow training of pharmacist independent prescribers in Scotland. Some patient assessment skills could be transferrable for pharmacist independent prescribers prescribing systemic anti-cancer therapy for other haematological malignancies.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-29T05:07:59Z
      DOI: 10.1177/10781552221110467
       
  • Orbital myeloid sarcoma treated with low-dose venetoclax and a potent
           cytochrome P450 inhibitor

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      Authors: Fernando De la Garza-Salazar, Samantha P Peña-Lozano, David Gómez-Almaguer, Perla R Colunga-Pedraza
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Case reportWe report the first case of orbital myeloid sarcoma that was successfully treated with a standard venetoclax dose of 25%. A 38-year-old man with acute myeloid leukemia (AML) post-haplo-hematopoietic stem cell transplantation (HSCT) presented with a nine-month history of progressive right proptosis and a visual acuity deficit. The patient was treated with venetoclax (100 mg orally on days 1–28), cytarabine (40 mg subcutaneously, days 1–10), and itraconazole (100 mg twice daily orally on days 1–28).Management and outcomeThe present case report shows that using cytochrome P450 (CYP) inhibitors is a helpful strategy to reduce the cost of expensive treatments.DiscussionThere are limited data on the use of CYP inhibitors as a strategy to reduce the costs of expensive drugs (i.e. venetoclax). This approach has some advantages over standard dose venetoclax (400 mg/day) such as significantly reduced costs (which is relevant for patients in low-income countries). In this case, we used itraconazole—a potent CYP3A4 inhibitor—which can theoretically reduce the dose to 100 mg/day without losing serum therapeutic concentrations.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-24T06:14:50Z
      DOI: 10.1177/10781552221110826
       
  • Tamoxifen induced maculopathy presenting like macular telangiectasia type
           2 in a patient with breast cancer

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      Authors: Mohammad Reza Ansari Astaneh, Saeed Shokoohi Rad, Seyed Hossein Ghavami Shahri, Hamid Reza Heidarzadeh
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionDrug-induced crystalline maculopathy has been reported secondary to tamoxifen use for breast cancer treatment. It could be misdiagnosed as macular telangiectasia type 2 (MacTel type 2).Case ReportA 56-year-old woman with a history of diabetes mellitus and breast cancer was referred to our clinic with painless, bilateral, gradual onset of central vision loss for several months. The fundus examination showed the macular pigmentary change in both eyes and a few refractile crystalline deposits in the parafoveal area in the left eye. However, the rest of the retina was normal in both eyes.Management and OutcomeWith the diagnosis of tamoxifen-induced maculopathy, the drug was discontinued and supplementary treatment was started.DiscussionIn this report, patient medical and drug history was an important and powerful measure. Due to the side effects of long-term use of tamoxifen, we need further studies on the need for retinal screening in these patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-22T07:14:37Z
      DOI: 10.1177/10781552221110472
       
  • Alpelisib induced interstitial lung disease in a patient with advanced
           breast cancer

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      Authors: Aysun Isiklar, Gul Basaran, Beyza Sepin, Ozge Gumusay, Ayse Sesin Kocagoz, Caglar Cuhadaroglu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundInterstitial lung disease interstitial lung disease is a group of respiratory diseases that causes progressive fibrosis. Many of the recently approved oncology drugs are associated with the development of interstitial lung disease as an adverse event. We report an alpelisib-induced interstitial lung disease in a patient with advanced breast cancer.Case reportA 65-year-old breast cancer patient who had multiple bone metastases and had been previously treated with letrozole and ribociclib, started alpelisib and fulvestrant combination upon the development of liver metastases. Her past medical history was not significant except the history of hypertension. She developed fatigue and progressive dyspnea 3, 5 months after starting alpelisib and was hospitalized due to rapidly deteriorating hypoxia within 2–3 days.Management and outcomeNaranjo Algorithm calculated score was 4 (probable Adverse Drug Reaction). Her thoracic computed tomography and angiography scan were consistent with interstitial infiltrate ground-glass appearance. She had no fever. Her workup for COVID-19 (coronavirus disease), other respiratory infectious agents, and pulmonary embolism was negative. There was a rapid clinical and radiologic response to corticosteroid therapy within one week. She was discharged from the hospital with a tapered steroid dose and complete resolution of her lung infiltrations. Alpelisib was discontinued despite radiological partial response in her liver metastases and a decline in her tumor marker.DiscussionDrug-induced interstitial lung disease is usually a diagnosis of exclusion, difficult to identify particularly during the COVID-19 pandemic for patients with cancer. Differential diagnosis includes infectious pneumonia, radiation pneumonitis, diffuse alveolar hemorrhage, pulmonary edema, and pulmonary lymphangitic metastasis.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-22T07:14:30Z
      DOI: 10.1177/10781552221107532
       
  • Pharmacy considerations: Use of anti-CD38 monoclonal antibodies in
           relapsed and/or refractory multiple myeloma

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      Authors: Bhavesh Shah, Joy Gray, Ivo Abraham, Melody Chang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveThis article reviews current evidence for the approved anti-CD38 monoclonal antibodies, isatuximab and daratumumab, for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) and the implications for pharmacists.Data sourcesWe conducted a literature search on PubMed/Medline and other sources using the drug names and the terms CD38, multiple myeloma, and pharmacists.Data summaryMonoclonal antibodies targeting the CD38 transmembrane glycoprotein offer a promising treatment approach for patients with RRMM. Isatuximab and daratumumab bind to different epitopes on CD38. In this review, we describe the similarities and differences in their mechanism of action, regulatory labeling, and the current guidelines for isatuximab and daratumumab use in RRMM. We review the current evidence for the efficacy and safety of these agents in combination with pomalidomide or carfilzomib and dexamethasone from the landmark phase 3 clinical trials that led to their approval. We discuss key differences in the eligibility criteria between the clinical trials, and differences in dosing, administration, available formulations, and pre- and post-infusion medications for the two agents. We outline recent data from pharmacoeconomic analyses comparing the cost-effectiveness of isatuximab-based regimens with that of daratumumab-based regimens. A brief overview of other anti-CD38 agents in the pipeline for the treatment of patients with RRMM is presented.ConclusionsGiven that pharmacists play an integral role in driving cost-effective use of drugs without compromising efficacy and safety for the end user, educating pharmacists on the key differences between isatuximab and daratumumab can guide the selection of the appropriate anti-CD38 antibody.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-21T05:25:41Z
      DOI: 10.1177/10781552221107850
       
  • Perspectives toward biosimilars among oncologists: A Malaysian survey

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      Authors: Soon Cien Chong, Retha Rajah, Poh Lee Chow, Hsio Ching Tan, Chin Man Chong, Kar Yee Khor, Wan Ping Lee, Wan Ying Tan
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionBiosimilars confer significant cost-saving advantages and expand patients’ access to biologic therapies in cancer care. In line with the increasing availability of antineoplastic biosimilars, it is pertinent to understand the oncologists’ view on the adoption of biosimilars in their clinical practice. The study aimed to assess (i) the prevalence of biosimilar use, (ii) perception towards biosimilars, (iii) factors influencing the use of biosimilars and (iv) knowledge about biosimilars among Malaysian oncologists.MethodsA cross-sectional survey was conducted among clinical oncologists and medical oncologists in Malaysia between January 2020 and February 2021 using a structured 31-item questionnaire.ResultsAmong the 121 oncologists registered in the country, 36 responded (response rate  =  30%). A total of 64% of the respondents prescribed biosimilars either often or always. Most oncologists (72%) agreed or strongly agreed that switching will not have a significant effect on the treatment benefit, with lower percentages saying that they agreed or strongly agreed that it will not lead to the emergence of additional adverse effects (56%) or harmful immunogenicity (64%). Patients’ preferences (40%) and the non-availability of biosimilars in hospitals (34%) are the major barriers cited to the prescribing of biosimilars. Cost differences and robust pharmacovigilance activities are the two most important factors that would influence the prescribing of biosimilars. The mean score of knowledge in biosimilar among respondents was 3.81 (± 0.86) out of a maximum possible score of 6.ConclusionsThe identified gap in prescribing and the use of biosimilars among Malaysian oncologists warrant educational intervention and robust pharmacovigilance activities to facilitate the prescribing of biosimilars and ultimately increase the accessibility to biologics in cancer treatment.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-14T06:09:15Z
      DOI: 10.1177/10781552221104773
       
  • Using an online journal club to improve Asian speakers’ comfort in using
           English to discuss and understand research papers written in English

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      Authors: Masami Tsuchiya, Manit Saeteaw, Suphat Subongkot, Trai Tharnpanich, Jitprapa Konmun, Izumi Nasu, Yumiko Shimanuki, Toshiaki Tsuchitani, Mio Ezura, Koji Hashiguchi, Jeffrey C Bryan, Hitoshi Kawazoe
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThis study aimed to evaluate the participants’ comfort in understanding research papers written in English and discussing such research in English via an Asian online journal club.MethodsA self-administered online survey was delivered to seven journal club meeting attendees from July 2020 to July 2021. A customer satisfaction analysis was performed to assess the association between the participants’ perspectives on program logistics and satisfaction.ResultsThe recovery rate was 37.0% (44/119). After participating in the journal club, the median scores of critical appraisal skills, knowledge and/or pharmaceutical care skills in clinical practice, and discussion skills in English (assessed using a seven-point Likert scale) improved significantly (compared to pre-participation median scores) from 4 (interquartile range [IQR]: 3–5) to 5 (IQR: 4–6), 5 (IQR: 4–5) to 5 (IQR: 5–6), and 4 (IQR: 2–5) to 5 (IQR: 3–5), respectively (P 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-13T06:39:42Z
      DOI: 10.1177/10781552221107548
       
  • Toxicity analysis of busulfan pharmacokinetic therapeutic dose monitoring

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      Authors: Kelly J Gaffney, Theresa A Urban, Mariana Lucena, Faiz Anwer, Robert M Dean, Aaron T Gerds, Betty K Hamilton, Deepa Jagadeesh, Matt E Kalaycio, Jack Khouri, Brad Pohlman, Ronald Sobecks, Allison Winter, Lisa Rybicki, Navneet S Majhail, Brian T Hill
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Busulfan-based conditioning regimens are associated with serious toxicities and literature reports increased risk of toxicities when daily area under the curve concentrations exceed 6000 µM-minute. We implemented real time pharmacokinetic-guided therapeutic drug monitoring of busulfan for myeloablative conditioning regimens. The objective was to compare toxicity of intravenous busulfan before and after therapeutic drug monitoring implementation. The primary endpoint was incidence of hepatotoxicity. Medical records were retrospectively reviewed with weight-based dose Busulfan/Cyclophosphamide (BuCy) conditioning from August 2017 through March 2018 (N = 14) and therapeutic drug monitoring from April 2018 through December 2018 (N = 22). Recipients of busulfan therapeutic drug monitoring were younger than those receiving weight-based dose (median: 45 vs. 58 years, p = 0.008). No other baseline differences were observed. There was no difference in hepatotoxicity between therapeutic drug monitoring and weight-based dose (median 1 vs. 0 days, p = 0.40). In the therapeutic drug monitoring group, 45% of patients had increases and 41% had decreases in busulfan dose after Bu1. Repeat pharmacokinetic after Bu2 were required in 32% of patients. A pharmacokinetic dose monitoring program for myeloablative conditioning intravenous busulfan regimens may be considered a safe practice in stem cell transplant recipients. The majority of patients receiving pharmacokinetic-guided therapeutic drug monitoring required dose changes and therapeutic drug monitoring patients had no significant difference in toxicity compared to those receiving weight-based dose.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-08T06:04:08Z
      DOI: 10.1177/10781552221104422
       
  • Nivolumab-induced pneumonitis and cardiopathy in a patient with relapsed
           Hodgkin's lymphoma

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      Authors: Laurence Bonhomme-Faivre, Valentina Guarino, Srimanta C Misra
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionNivolumab, the monoclonal antibody inhibitor of programmed cell death protein 1, enhances the T-cell response, including anti-tumour responses, by blocking the attachment of programmed death-ligand 1 and programmed death-ligand 2 ligands to the programmed cell death protein 1 receptor, which in turn leads to a reduction in tumour growth. Nivolumab has been approved in relapsed or refractory classic Hodgkin's lymphoma after autologous transplantation of haematopoietic stem cell and treatment with brentuximab as monotherapy.Case reportWe herewith report a case of 65-year-old woman who developed an interstitial pneumonitis and a global cardiac hypokinesis following a treatment with Nivolumab for a refractory Hodgkin's Lymphoma. Nivolumab was administered as the fifth line of therapy. Some concomitant patient treatments include drug with known autoimmune toxicities. Although the patient had a persistent complete remission following the sixth infusion, it was discontinued as she developed dyspnea of NYHA stage IV and orthopnea. The chest tomography revealed a bilateral micronodular pattern of organizing pneumonia with bilateral pleural effusion. The forced expiratory volume was decreased to 50%. In parallel her transthoracic echocardiography revealed a global hypokinesis with a left ventricular ejection fraction of 20%.Management and outcomeThe patient was treated with empiric antibiotics although the microbial assessments were negative. She was also treated with beta-blocker and angiotensin-converting enzyme inhibitors. The cardiac magnetic resonance imaging performed after 4 months confirmed the hypokinetic cardiopathy with an ejection fraction of 48%. The patient had a significant clinical improvement. The tomography emission positron scan conducted 8 months after interruption of Nivolumab showed complete remission with some moderate activation of residual lesion basal posterior lobe of left lung field.DiscussionEarly and effective diagnosis of immune-related adverse events through the search for predictive biomarkers like drug factors and individual risk factors will allow targeted surveillance leading to a better tolerance.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-06T05:10:40Z
      DOI: 10.1177/10781552221105572
       
  • Acute lymphocytic leukemia in a patient with long-term carbamazepine
           exposure: Acute lymphoblastic leukemia that develops in a patient who has
           been using carbamazepine for a long time

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      Authors: Serhat Sayin, Metin Bagci
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCarbamazepine is an antiepileptic drug used in the treatment of epilepsy, trigeminal neuralgia, and bipolar disorder. Hematological effects that may develop with this anticonvulsant; agranulocytosis, thrombocytopenia, leukopenia, aplastic anemia, eosinophilia, or pancytopenia.Case reportIn this article, we wanted to present a case diagnosed with acute lymphoblastic leukemia after long-term use of carbamazepine because of epilepsy.Management and outcomeBone marrow smear was evaluated and blastic cell infiltration was observed. The carbamazepine treatment was discontinued and standard chemotherapy was started for acute lymphoblastic leukemia (CALGB protocol). Levetiracetam was started for epilepsy.DiscussionCarbamazepine is an iminostilbene derivative. Carbamazepine is an antiepileptic drug that exhibits a number of side effects such as headache, abdominal pain, high blood pressure, as well as hematological disorders. In addition to causing thrombocytopenia, hypogammaglobulinemia, leukopenia, and neutropenia, it can have serious effects such as agranulocytosis, aplastic anemia, pure red cell aplasia, leukemia, or DRESS syndrome. The incidence of serious side effects from carbamazepine pharmacotherapy is low, and their exact mechanism of action is still unknown.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-03T08:12:37Z
      DOI: 10.1177/10781552221105856
       
  • Life threatening hepatotoxicity induced by Nilotinib

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      Authors: Latifa Khelifa, Imen Ben Amor, Olfa Kassar, Moez Mdhaffer, Sondes Hdiji, Moez Elloumi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionTyrosine kinase inhibitor had changed the prognosis of chronic myeloid leukemia (CML) and the overall survival had reached 95%. Unfortunately, adverse events (AEs) remain an obstacle to following successful treatment in CML impairing the quality of life and sometimes endangering the lives of patients. To this end, we show this clinical case to discuss strategies to deal with rare AEs in a way to preserve the patient's life and to maintain not only a good response to treatment but also confidence and compliance of the patient.Case reportWe report the case of a 57-year-old woman diagnosed with CML at the chronic phase who developed rare life-threatening hepatotoxicity (major cytolysis and prothrombin time fall) secondary to Nilotinib used as second-line treatment. This complication settled despite an optimal molecular response.Management and outcomeWe discuss below the follow-up and management in our center and according to the literature with more sophisticated pharmacological methods.DiscussionAlthough we used to monitor disease molecular response to treatment, we need solutions and manuscripts for monitoring drug dose parameters to avoid unusual dangerous effects risking the patient life. We conclude that monitoring the disease as well as the treatment pharmacokinetics is mandatory to better carry on CML patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-02T05:31:08Z
      DOI: 10.1177/10781552221102588
       
  • Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for
           advanced breast cancer: Integrating ASCO/NCODA patient-centered standards
           in a community pharmacy

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      Authors: Alexandre Marineau, Catherine St-Pierre, Roxanne Lessard-Hurtubise, Marie-Ève David, Jean-Philippe Adam, Isabelle Chabot
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundOutpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use.MethodsThis retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate.ResultsOf the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8–21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels.ConclusionA structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-01T05:57:58Z
      DOI: 10.1177/10781552221102884
       
  • Pharmacy practitioners’ adherence to safe-handling practices of
           chemotherapeutic drugs: A cross-sectional study in Saudi Arabia

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      Authors: Azieb Ogbaghebriel, Majed Alshamrani, Alnada Ibrahim, Wed Al-Masaary, Sarah Hakami, Shahad Alrasheed, Nada Al-Sayed
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundChemotherapy drug handling and occupational exposure are topics of concern for a variety of oncology health care professionals. Inappropriate handling can pose health risks to practitioners particularly, those who handle them on a daily basis. Therefore, this study aimed to assess chemotherapy handling practices among oncology pharmacists and pharmacy technicians in Saudi Arabia.MethodsA cross-sectional study was conducted using an online survey with a structured pre-validated questionnaire. Data was collected from pharmacists and pharmacy technicians who handle chemotherapeutic agents in Saudi Arabia, and analyzed using descriptive and inferential statistics.ResultsA total of 79 oncology pharmacy practitioners responded to the survey. The majority (92.4%) had written chemotherapy guidelines at their workplaces. Almost all participants (98.7%) reported the availability of protective gloves and gowns, however, the availability of eye protection was only 57%. Most used chemotherapy-designated gloves (83.6%), and gowns (86.1%). However, 54.4% have reused disposable gowns. The extent of utilization of most protective equipment ranged from 70% (always using closed system transfer device) to 98% (always using shoe cover); while the practice of always using eye protection and face shield was only 30.4% and 38%, respectively. With regard to cleaning practice, the work area was cleaned at least once a day by 35%; monthly decontamination (77%); certification by the biomedical department every 6 months (67%) and at least yearly (95%). Accidental exposure was reported by 28%, and the most common adverse effect was skin irritation (82%). There was no workplace medical surveillance available for 50%. The majority (88.6%) received relevant training, but not periodic updates on their training (38%). The main barriers against the use of personal protective equipment were: that some personal protective equipments were not always available (38%), and personal protective equipments were too uncomfortable to use (30.4%). The demographic variables did not have a statistically significant effect (p > 0.05) on the responses except for type of institution (workplace) on some of the cleaning practices that showed significant differences namely, the monthly decontamination and certification by the biomedical department.ConclusionsMost protective equipment and chemotherapy guidelines were available, and the majority of pharmacy practitioners adhered to many aspects of chemotherapy safe-handling practices. Nevertheless, some areas such as medical surveillance programs, use of eye protection and face shields, the practice of re-using disposable gowns, some of the barriers against personal protective equipment use, and the provision of periodic training need improvement for better protection of the health care professionals.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-01T05:46:56Z
      DOI: 10.1177/10781552221105584
       
  • Comparison of different decision support software programs in perspective
           of potential drug–drug interactions in the oncology clinic

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      Authors: Muhammed Yunus Bektay, Zehra Seker, Hatice Kubra Eke, Haci Mehmet Turk, Fikret Vehbi Izzettin
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionOne of the most intriguing situations for healthcare providers is cancer therapy. Drug–drug interactions (DDIs) account for 20–30% of all adverse effects. Cancer patients are more likely to have potential-DDIs since they are taking other drugs with anticancer treatments to prevent the side effects of chemotherapeutic agents. The purpose of this research is to compare various decision support software (CDSS) programs in terms of potential DDIs.MethodsA cross-sectional study was carried out. A clinical pharmacist assessed the treatment regimens of 231 cancer patients. pDDIs were evaluated using three sources: Lexicomp®, Medscape®, and Micromedex®. The ethical approval was given in November 2017 with decision number 21/286.ResultsA total of 231 participants who were receiving therapy and had a median age of 61.5 ± 9.18 years were assessed. Almost half of the patients (49%) were female, and 155 had at least one comorbidity in addition to cancer. Medscape had a substantial pDDI ratio of 7.09%, Micromedex had a ratio of 11.15%, and Lexicomp had a ratio of 19.50%. The total number of pDDIs for major/X/contraindicated were 363–2716 (1.56–11.7 pDDI/patient) for Medscape®, 60–1723 (0.26–7.4 pDDI/patient) for Micromedex, and 145–984 (0.62–2.24 pDDI/patient) for Lexicomp®. One of the most common pDDI found was diclofenac and dexamethasone. Interactions between escitalopram and granisetron were also common, and different CDSSs made different recommendations.ConclusionsIn this study, significant disparities in the quantity and severity of CDSS across distinct CDSS were discovered. One of the major finding of our study was suboptimal prescribing. To address this issue, regulatory organizations should establish and verify validation and reporting mechanisms.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-06-01T05:46:25Z
      DOI: 10.1177/10781552221104814
       
  • Use of long-term corticosteroids in patients treated with CAR T-cell
           therapy

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      Authors: Hamza Hashmi, Mary McGann, Brian I Greenwell
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common toxicities associated with chimeric antigen receptor (CAR) T-cell therapy. Severe grade 3 or higher ICANS is less common and requires the use of corticosteroids with or without an Interleukin (IL)-6 receptor antagonist. Although corticosteroids are effective in the management of CRS and ICANS, their impact on CAR T efficacy remains unknown.Case reportWe present the case of a 65-year-old male who received CAR T-cell therapy with brexucabtagene autoleucel for stage I/II Mantle Cell Lymphoma (MCL) and achieved complete remission despite receiving a prolonged course of corticosteroids for severe ICANS.Management and outcomeThe patient received treatment with high-dose corticosteroids, tocilizumab, and anakinra, in addition to multiple antiepileptic agents. Despite a remitting relapsing pattern of ICANS, the patient not only recovered from the life-threatening complication but also achieved a complete remission at three months post CAR T.ConclusionThis case describes the successful use of corticosteroids for the management of ICANS in a patient treated with CAR T-cell therapy for MCL.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-30T06:40:48Z
      DOI: 10.1177/10781552221104816
       
  • Perception, knowledge, and handling practice regarding the risk of
           exposure to antineoplastic drugs in oncology day hospitalization units and
           compounding unit staff

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      Authors: Hubert Benoist, Amandine Busson, Audrey Faveyrial, Karine Bouhier-Leporrier, Fabienne Divanon, Cécile Breuil, Sophie Roger-Leenaert, Agnès Palix, Pascal Odou, Nicolas Simon, Guillaume Saint-Lorant
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundAntineoplastic drug exposure is a major problem in regard to caregivers’ health. The aim of the present study was to assess the perception, knowledge, and handling practices of all occupation level categories of two oncology day hospitalization units and two compounding units regarding the risk of exposure to antineoplastic drugs.MethodsThis descriptive study, performed through face-to-face interviews, concurrently assessed the perception, knowledge, and handling practices of antineoplastic drugs in five different job categories in four different settings. This work was part of a larger comprehensive project examining surface and blood contamination. Different scores were assigned to evaluate responses to a questionnaire about the perception, knowledge, and handling practices of healthcare workers, a risk global score including a risk perception score, and education/knowledge and handling practices scores.ResultsIn the survey, continuous training was associated with the global risk score (p = 0.03), particularly with the handling practices risk score (p = 0.01). Job category was also significantly associated with the global risk score (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-30T06:40:29Z
      DOI: 10.1177/10781552221103803
       
  • Adherence to oral anti-cancer therapies in older patients is similar to
           that of younger patients

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      Authors: Pauline Lory, Louise Perche, Julie Blanc, Bastian Fouquier, Audrey Giroux, Amélie Thomassin, Madeline Devaux, Amélie Renaudin, Cyril Di Martino, Valérie Quipourt, Leïla Bengrine-Lefèvre, Antonin Schmitt
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe use of oral anti-cancer therapies is becoming increasingly common in the management of cancers, raising the question of adherence. The objective of this study was to assess adherence to oral anti-cancer therapies, as well as the impact of various factors that may influence it.MethodsPatients starting oral chemotherapy (tyrosine kinase inhibitor or cytotoxic) were followed up for 3 months using a medication diary, which was given to the patient by the pharmacist during a multidisciplinary consultation. Adherence was assessed using the diary, as well as by counting the tablets they brought back.ResultsOne hundred and fifty patients were included in the study. The main oral chemotherapy agents prescribed were palbociclib (23.3%), everolimus (18.7%), and capecitabine (13.3%). The adherence at the end of the 3 months, by means of dose intensity (i.e. percent of the dose prescribed that has been taken), was 95.5%. No significant difference in adherence was found based on age, sex, family circumstances, health status, co-medication, type of oral therapy, tumor location, number of previous treatment lines, or presence of toxicity. The main reasons for non-adherence were forgetting (50%) and toxicity (21%). Fifty-seven patients prematurely discontinued the study: 40.3% for toxicity and 36.8% for disease progression.ConclusionAdherence in this study is high in comparison to literature, which can be explained by close multidisciplinary follow-up. Moreover, no significant difference was observed between younger and older patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-30T06:40:09Z
      DOI: 10.1177/10781552221103547
       
  • Avascular necrosis during alectinib treatment: Case report

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      Authors: Pınar Gürsoy
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Non-small cell lung cancer is the most common cause of cancer-related death worldwide. The incidence of anaplastic lymphoma kinase constitutes 3%–5% of all non-small cell lung cancer patients. Alectinib is a second-generation anaplastic lymphoma kinase inhibitor.Case reportWe present our patient who used alectinib due to anaplastic lymphoma kinase positivity and developed avascular necrosis in the femoral head.Management and outcomeIn our patient who had been taking alectinib for a long time due to anaplastic lymphoma kinase positivity, avascular necrosis of the femoral head was detected as a result of the examination performed due to hip pain. Due to the responsıbılıty of the disease, her treatment contınued by making profit and loss account.DiscussionFemoral head avascular necrosis can be seen with tyrosine kinase inhibitors, although it is very rare. This is the case in the literature to develop avascular necrosis due to alectinib. We think that femoral head necrosis may develop in the patient group using alectinib and care should be taken in this regard.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-30T06:39:44Z
      DOI: 10.1177/10781552221102370
       
  • Management of immune-related hepatitis in patients being treated with
           checkpoint inhibitors for metastatic melanoma, a review and case series

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      Authors: Alice Tew, Leila Khoja, Lalit Pallan, Neil Steven
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionImmune-related hepatitis is an adverse effect following treatment with immune-checkpoint inhibitors, such as ipilimumab, nivolumab and pembrolizumab. International guidelines advise on the use of corticosteroids as first-line treatment, although guidance on how to treat cases resistant to corticosteroids is limited. We aimed to evaluate the presentation and management of patients with grade 3-4 immune-related hepatitis, following treatment with immune-checkpoint inhibitors for stage 4 or unresectable or stage 3 melanoma, with a particular focus on steroid-refractory cases.MethodsA retrospective observational review of patients developing immune-related hepatitis whilst undergoing treatment with immune checkpoint inhibitors for advanced melanoma from July 2014 to February 2020 at a tertiary oncology centre.ResultsForty-one patients developed immune-related hepatitis, of which 83% had been treated with the combination of ipilimumab and nivolumab. The median time to onset of IR-hepatitis was 47 days (range: 4–476), and the median time to peak alanine aminotransferase was 71 days (range: 4–478). Four patients had resolution of grade 3 immune-related hepatitis without the introduction of corticosteroids. A total of 37 patients were treated with corticosteroids. A total of 12 required oral treatment only and 13 were successfully managed as outpatients. Six patients had steroid-refractory immune-related hepatitis; and all received tacrolimus, with one also receiving mycophenolate mofetil and infliximab.ConclusionsThis study describes the largest UK series of immune-related hepatitis patients in the literature. We present two important deviations from current guidelines. Firstly, there is some evidence that withholding steroids is possible in grade 3-4 immune-related hepatitis. Secondly, tacrolimus can be used successfully to manage patients resistant to corticosteroids, with the early introduction most beneficial to reduce time on steroids.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-24T05:39:21Z
      DOI: 10.1177/10781552221103548
       
  • Life-threatening altered mental status secondary to memantine in an
           adolescent undergoing cranial radiotherapy for medulloblastoma

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      Authors: Kristine N Kim, Yash B Shah, Colleen Croy, Robert A Lustig, Michael LaRiviere, Chelsea Kotch
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionMemantine is used for neurocognitive protection in patients undergoing cranial radiotherapy for central nervous system tumors and is reported to be well-tolerated.Case reportPresented is a case of memantine-induced altered mental status requiring an intensive care unit admission. An 18-year-old male with relapsed, progressive medulloblastoma presented with severe altered mental status shortly after the first fraction of palliative whole brain radiotherapy. At the time, the patient was on day five of memantine therapy, which had been prescribed to reduce neurocognitive toxicity risk.Management & outcomeMemantine was withheld while dexamethasone, valproate, and morphine were continued for headache. Approximately 50 h after admission, the patient's confusion significantly improved. Evaluation of acute altered mental status was unrevealing, including but not limited to negative urinary toxicology screen and lack of disease progression on imaging. Whole brain radiotherapy was resumed after a two-day cessation and he was discharged home after four days with complete resolution of symptoms.DiscussionClinicians should be aware of and consider the risk of altered mental status with memantine, given the increased utilization and upcoming clinical trials in pediatric patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-24T05:39:13Z
      DOI: 10.1177/10781552221102883
       
  • Central nervous system neurotoxicity associated with nelarabine in T-cell
           acute lymphoblastic leukemia

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      Authors: Umur A Pehlivan, Emel Gürkan, İbrahim H Açar, Yunus K Bıçakcı
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionNelarabine, a prodrug of arabinosylguanine has lineage-specific toxicity for T lymphoblasts and is used to treat refractory or relapsed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma patients. The most commonly observed adverse effects associated with nelarabine are mainly hematological, i.e. neutropenia, anemia, and thrombocytopenia. Additionally, neurological, and gastrointestinal toxicities have been reported. Central nervous system neurotoxicity associated with nelarabine is very rare.Case descriptionA 37-year-old man patient diagnosed with T-cell acute lymphoblastic leukemia had experienced generalized tonic-clonic seizure which lasted for a few seconds and upper extremity weakness after three weeks of the nelarabine infusion. Computed tomography and magnetic resonance imaging have shown periventricular and nucleus caudatus abnormalities. Radiological findings suggested toxic leukoencephalopathy and acute infarct of right nucleus caudatus.Management and outcomeAfter high-dose steroids, intravenous immunoglobulin, and support treatment, his neurologic symptoms disappeared except for mild peroral numbness. However, radiological sequelae persisted despite clinical improvement.ConclusionPhysicians involved in the care of these patients who use nelarabine should be aware of the fact that cerebral toxicity of the nelarabine may occur especially in the presence of predisposing factors. It is crucial to monitor closely those patients receiving nelarabine and also those who have additional predisposing factors for neurotoxicity.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-20T08:40:00Z
      DOI: 10.1177/10781552221102591
       
  • Trousseau’s syndrome in a non-small cell lung cancer patient
           aggravated by pembrolizumab

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      Authors: Lihong Zhao, Hong Zheng, Liqin Zhu, Ping Jiang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionWe present a case of Trousseau’s syndrome in a non-small cell lung cancer patient recurrently aggravated by pembrolizumab. The adverse events related to immune checkpoint inhibitors (ICIs) on thrombogenesis remain unclear.Case reportA 48-year-old woman was diagnosed with right lung adenocarcinoma (cT1bN3M1a, IVA) and with programmed cell death-1 positive. Brain magnetic resonance imaging (MRI) showed multiple asymptomatic bilateral cerebral infarctions as Trousseau’s syndrome. After the patient was administered pembrolizumab, bilateral cerebral infarctions were aggravated.Management and outcomeAlthough the patient was given prophylactic anticoagulant therapy respectively before two doses of pembrolizumab, Trousseau’s syndrome still aggravated recurrently.DiscussionTrousseau’s syndrome is rarely reported following the administration of ICIs. It is possible that pembrolizumab may trigger disorders of the coagulation–fibrinolysis system in cancer patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-20T08:23:51Z
      DOI: 10.1177/10781552221102311
       
  • Tafasitamab and lenalidomide for relapsed/refractory diffuse large B-cell
           lymphoma in a patient on chronic intermittent hemodialysis

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      Authors: Donald C Moore, Keren A Eagers, Amanda Janes, Mauricio Pineda-Roman
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionTafasitamab is an anti-CD19 monoclonal antibody indicated for the treatment of relapsed/refractory diffuse large B-cell lymphoma to be given in combination with lenalidomide. Experiences with tafasitamab in the setting of hemodialysis are limited and the efficacy and safety of this agent in this setting are unknown.Case ReportWe describe a patient with relapsed/refractory diffuse large B-cell lymphoma with hemodialysis-dependent end-stage renal disease who successfully received tafasitamab/lenalidomide.Management and OutcomeTafasitamab and reduced dose lenalidomide were initiated for relapsed diffuse large B-cell lymphoma. Tafasitamab was administered on non-dialysis days. Follow-up imaging for disease response assessment demonstrated a complete response. Therapy was well tolerated; the only major toxicity experienced was grade 4 neutropenia that resolved with dose adjustment to lenalidomide. Over a year from initiating therapy, the patient remains in a complete response.Discussion/ConclusionThe combination of tafasitamab and dose-reduced lenalidomide produced a complete response in the treatment of relapsed/refractory diffuse large B-cell lymphoma in the setting of chronic intermittent hemodialysis.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-19T04:41:06Z
      DOI: 10.1177/10781552221102318
       
  • Vortex keratopathy associated with ribociclib

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      Authors: Alper Türkel, Sibel Özdoğan, Emre Yekedüz, Erdoğan Şeyran, Cengiz Karaçin, Öztürk Ateş
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors are the new generation drugs that have been started to be used in our clinical practice recently. These drugs have been shown to have better progression-free survival compared to standard therapy in patients with hormone receptor-positive (HR) and human epidermal growth factor receptor 2 (HER-2)-negative breast cancer. The most common side effects of CDK 4-6 inhibitors are neutropenia, nausea, leukopenia, fatigue, and diarrhea. This case demonstrated vortex keratopathy in both eyes, a rare condition in patients with breast cancer treated with ribociclib.Case reportA 68-year-old female patient was diagnosed with locally advanced HR (+)/HER2 (−) breast cancer in March 2015. In June 2021, bone metastases were detected. The patient was started on ribociclib and fulvestrant. After three cycles of ribociclib and fulvestrant treatment, she was admitted with the complaint of blurred vision in her left eye. Slit-lamp biomicroscopy examination revealed subepithelial haze with central subepithelial whorls in both corneas, more in the left eye, and also a mild punctate epithelial staining was observed with the application of fluorescein dye.Management and outcomeRibociclib treatment was immediately discontinued and no changes were observed in the cornea and vision levels during the one-month follow-up.DiscussionRoutine and regular follow-up eye examinations in breast cancer patients treated with ribociclib may benefit patients in our daily clinical practice and may help us to detect side effects at an early stage and to manage them more effectively.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-16T07:25:45Z
      DOI: 10.1177/10781552221101799
       
  • Associations of readiness for hospital discharge with symptoms and
           non-routine utilization of post-discharge services among cancer patients
           receiving oral chemotherapy at home: A prospective study

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      Authors: Yongfeng Chen, Yanrong Chen, Ting Qin, Guifen Fu, Jinbing Bai
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundReadiness for hospital discharge is associated with patients’ health outcomes after they return home. However, little is known about this association among cancer patients receiving oral chemotherapy at home. This study aimed to examine whether patients’ reported readiness for hospital discharge was associated with symptoms and non-routine utilization of post-discharge services among cancer patients receiving oral chemotherapy at home.MethodsA prospective study was conducted, and 151 cancer patients receiving oral chemotherapy were recruited from a provincial level hospital in South China between October 2018 and December 2019. The primary outcome was readiness for hospital discharge assessed by the Readiness for Hospital Discharge Scale-Short Form on the day of discharge. The secondary endpoints were symptoms assessed by MD Anderson Symptom Inventory and non-routine utilization of post-discharge services within one cycle of chemotherapy at home (21 days).ResultsAmong these 151 participants, 74.2% of them reported as ready for discharge. Patients who were employed, lived in suburban area or villages, had a higher Eastern Cooperative Oncology Group score, took Tegafur as oral chemotherapy, and took oral chemotherapy for the first time reported lower readiness for hospital discharge. These five factors explained 28.1% of variance in readiness for hospital discharge. Patients who were not ready for discharge were prone to report higher symptom severity (p = 0.038). No differences in non-routine utilization of post-discharge services were found between the readiness versus non-readiness for discharge groups (p = 0.891).ConclusionsMost cancer patients receiving oral chemotherapy at home were ready for discharge, which was influenced by employment status, residence status, Eastern Cooperative Oncology Group score, type of oral chemotherapy drug, and the experience of taking oral chemotherapy at home. Patients with lower readiness reported worse symptom severity at home. Routine assessment was suggested to recognize unready patients, and more extensive preparations for discharge were recommended to help them manage symptoms at home.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-12T01:02:07Z
      DOI: 10.1177/10781552221100720
       
  • Monoclonal-induced cardiotoxicity in patients with non-Hodgkin's lymphoma
           and breast cancer: A retrospective study in an oncology clinic

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      Authors: Paula Nogueira da Silva, Patrícia Marques Soares Valente, Selma Rodrigues de Castilho
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Monoclonal antibodies, such as trastuzumab and rituximab, significantly contribute to the oncological therapeutic arsenal. However, they may be associated with the development of cardiotoxicity. This study collected data from clinical records of patients in the use of rituximab and trastuzumab in a private oncology clinic from 2017 to 2019. It also investigated cardiovascular adverse drug reactions and associated risk factors. Cardiotoxicity was defined as symptomatic in the presence of signs and symptoms suggestive of heart failure (HF) such as dyspnea, nocturnal cough, and fatigue, among others. Asymptomatic HF was confirmed by the decline in the left ventricular ejection fraction (LVEF) ≥10% of baseline or LVEF ≤50%. Among the 57 patients undergoing trastuzumab, 12 patients (21%) had cardiotoxicity and 8 patients (67%) had extreme or high-risk scores in the cardiotoxicity risk assessment algorithm. Among the 37 patients treated with rituximab, 3 patients (8%) had cardiotoxicity. The presence of previous diabetes mellitus significantly increased the risk of trastuzumab-induced cardiotoxicity (p = 0.02). However, none of the other risk factors influenced the incidence of trastuzumab- and rituximab-induced cardiotoxicity, which the sample size may explain. More studies are needed to investigate the association of risk factors with cardiotoxicity induced by trastuzumab and rituximab, aiming to establish strategies to prevent and manage this effect early.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-11T07:43:40Z
      DOI: 10.1177/10781552221098426
       
  • Erythema nodosum after azacitidine in a patient with acute myeloid
           leukemia

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      Authors: Elham Nasrollahi, Alessio Giubellino, Armin Rashidi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionNodular skin lesions in patients with acute myeloid leukemia (AML) raise clinical suspicion for leukemia cutis versus fungal infections. Here, we report a rare case of treatment-related erythema nodosum (EN) in a patient with AML.Case ReportApproximately 5 weeks after the initiation of sorafenib and one week after azacitidine initiation, a 32-year-old man with primary refractory AML presented with several painful red nodules on the lower extremities. Histological examination established a diagnosis of EN.Management and OutcomeTreatment with topical and oral steroids led to complete resolution of the nodules. However, once the dose of steroids was reduced, the lesions rapidly recurred. Higher dose steroids were reinitiated, again with a resolution of the nodules, confirming steroid responsiveness of the underlying process.DiscussionGiven the onset of lesions one week after the initiation of azacitidine and 5 weeks after the initiation of sorafenib, azacitidine was considered the more likely culprit. Only 2 cases of EN-like eruption after azacitidine and 1 case after sorafenib have been reported. Although fungal infections and leukemia cutis are the top differentials considered for skin nodules in a patient with AML, EN should be considered as an alternative diagnosis. Correct diagnosis is critical because it will guide treatment.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-03T04:19:43Z
      DOI: 10.1177/10781552221098422
       
  • Erratum to Evaluation of antibiotic appropriateness at an outpatient
           oncology centre

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      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-02T07:38:13Z
      DOI: 10.1177/10781552221099327
       
  • Incidence of bleeding events in patients on concomitant tyrosine kinase
           inhibitors and selective serotonin reuptake inhibitors

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      Authors: Vinayak Venkataraman, John R Bales, Jessie Signorelli, Gabriela S Hobbs
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIn this study, we aim to determine the risk of bleeding or thrombosis with concurrent use of tyrosine kinase inhibitors (TKIs) used to treat CML, and serotonin reuptake inhibitors (SSRIs).MethodsWe conducted a retrospective cohort study of patients with CP-CML cared for at Massachusetts General Hospital (MGH) between April 2016 to February 2021. Participants were included if diagnosed with CP-CML and began TKI treatment (imatinib, dasatinib, nilotinib, bosutinib, or ponatinib) after April 2016.ResultsOne hundred patients were evaluated, eighty of whom were taking TKIs only (median age 55, 40% female), and twenty were taking TKI and SSRI concomitantly (median age 53.5, 55% female). Baseline demographics between these groups were similar across all variables. Patients in the TKI only group had 9 bleeding events and 3 thrombotic events. Patients in the combination group had 6 bleeding events and 1 thrombotic event. There was no difference between overall rates of major bleeding (4% v. 10%, p = 0.26) or thrombotic events (4% v. 5%, p = 1). However, patients in the combination group were more likely to have major intracranial bleeding events (0% v. 10%, p = 0.04), and there was a trend to significance for minor bleeding events (7.5% v. 20%, p = 0.11).ConclusionsConcomitant use of TKIs and SSRIs does not appear to increase the total risk of bleeding or thrombotic events compared to patients on TKIs only. However, concomitant use of TKIs and SSRIs may increase risk of intracranial bleeding. Further work is needed to fully assess this risk.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-02T07:37:21Z
      DOI: 10.1177/10781552221098044
       
  • Lichenoid drug eruption associated with imatinib mesylate therapy

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      Authors: Dimitrios Alexandris, Nektarios Alevizopoulos, Leonidas Marinos, Georgios Kanellis, Charikleia Gakiopoulou
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionImatinib Mesylate (IM), a tyrosine kinase inhibitor, has been reported to cause several adverse reactions, most of them with cutaneous involvement. Non- Lichenoid IM associated skin reactions have been sufficiently- recorded. To our knowledge, Lichenoid Drug Eruption (LDE) is recorded in a minority of registries.Case reportTo describe an LDE induced case by IM treatment.Treatment and outcomeHistological Confirmation and promptly dermatological consultation relieved successfully the cutaneous adverse event.DiscussionOngoing expansion of IM usage in a wide spectrum of new indications is more likely to make physicians experience such LDE cutaneous side effects more often. Hence, they should be highly suspicious to early detect these distinct histologic entities, handle these undesired complications and guarantee satisfactory immediate outcomes, avoiding frivolous IM dosage modifications.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-27T08:02:02Z
      DOI: 10.1177/10781552221096846
       
  • Antineoplastic extravasation management: Consensus of the Spanish Oncology
           Pharmacy Group (GEDEFO)

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      Authors: Asunción Albert-Marí, Inmaculada Jiménez-Pulido, Begoña San José-Ruiz, David Conde-Estévez, Mª Ángeles Gil-Lemus, Ana Cristina Cercós-Lletí, Mª Jesús Esteban-Mensua, Mª Sacramento Díaz-Carrasco
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-26T07:15:47Z
      DOI: 10.1177/10781552221091914
       
  • Pulmonary embolism and bradycardia in a NSCLC patient treated with
           crizotinib for a rare mutation

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      Authors: Yunjing Shi, Zeping Qiu, Yongjie Ding, Yanjia Chen, Andi Zhang, Wei Jin
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionLung cancer is a major global health problem because of its high incidence and mortality. Targeted therapies have transformed treatment of driver-mutated metastatic non-small cell lung cancer (NSCLC). Nevertheless, recent studies demonstrated that cardiovascular disease (CVD) was the second leading cause of mortality in cancer survivors now, management of patients’ cardiovascular health during the course of anticancer therapy has become a great challenge faced by the oncologists. Anticancer related cardiovascular (CV) complications are not limited to traditional chemotherapy, but are also increasingly recognized in targeted therapy.Case ReportWe present a case of pulmonary embolism (PE) and bradycardia in a 91-year-old NSCLC patient treated with crizotinib for a rare MET Y1003S mutation. To our knowledge, this is the second report to show antitumor response of crizotinib in lung cancer patients with such a rare mutation. However, the patient complained chest tightness and shortness of breath after a month of standard dose crizotinib therapy. Non-invasive examination revealed new onset bradycardia and PE.Management & OutcomeSuch clinical manifestations were associated with targeted therapy-related CV toxicity, on which the emerging discipline cardio-oncology focused, and a multidisciplinary investigation and treatment was conducted.DiscussionThis case highlights the CV adverse events of novel therapies and the current challenges to be tackled in cardio-oncology.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-25T05:55:23Z
      DOI: 10.1177/10781552221091595
       
  • The efficacy and safety of alpelisib in breast cancer: A real-world
           analysis

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      Authors: Jenn Miller, Emily Armgardt, Alison Svoboda
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Published trials of alpelisib + fulvestrant demonstrate efficacy and high rates of adverse effects as a first-line treatment option for metastatic breast cancer and as an option after cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i). The purpose of this analysis is to determine the real-world efficacy and safety of this regimen in heavily pretreated patients. This is a retrospective cohort analysis evaluating patients receiving alpelisib + fulvestrant for hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer who previously received ≤ 2 lines of therapy in the metastatic setting and those who previously received ≥ 3 lines of therapy in the metastatic setting. Adverse effects, specifically hyperglycemia, rash, and diarrhea, were reported for the entire population. Thirty-three patients were included in this analysis. Progression-free survival (PFS), overall survival, time to change in therapy, and time to discontinuation were similar in the two groups. Forty-nine percent of patients discontinued alpelisib + fulvestrant due to progression of disease, and 27% of patients discontinued treatment due to adverse effects. Hyperglycemia, rash, and diarrhea occurred at high rates: 66.7%, 45.5%, and 72.7%, respectively. All three of these adverse effects required hospitalizations and pharmacological treatment. This analysis demonstrates that the outcomes of alpelisib + fulvestrant were worse in the real-world salvage setting in HR+, HER2- metastatic breast cancer as compared to the front-line setting. The real-world tolerability of this regimen is still of great concern.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-22T07:02:29Z
      DOI: 10.1177/10781552221096413
       
  • Pharmacists’ practices and views regarding management of sexual
           health in patients with cancer

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      Authors: Alisha Shivji, Melanie Danilak, Reanne Booker, Deonne Dersch-Mills, Sunita Ghosh, Katherine Fung
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionSexual health issues associated with cancer can significantly impact patients’ psychosocial well-being and overall quality of life. These issues are frequently medication-related, placing pharmacists in an opportune position to manage sexual health concerns in patients with cancer. Currently, no literature exists exploring pharmacists’ practices related to the management of sexual health in oncology patients.MethodsAn anonymous, descriptive, cross-sectional, web-based survey was conducted to elicit pharmacists’ views and practices regarding managing sexual health in oncology patients. Pharmacists practicing in Canada who provide care to adult malignant hematology or oncology patients were eligible to participate. The survey was disseminated through the Canadian Association of Pharmacy in Oncology and through informal oncology pharmacy practitioner networks.ResultsOf the 102 pharmacists who participated, 96 completed the survey in its entirety. Most respondents were female, practiced in Alberta, and primarily saw oncology patients in outpatient cancer facilities. Although 85% of participants felt pharmacists should be involved in giving patients an opportunity to discuss sexual health, only 8% reported managing sexual health in at least 50% of their oncology patients. The most commonly agreed upon barriers to this were presence of family members and friends at appointments, lack of knowledge or training, limited time, and the belief that sexual health is not applicable to all oncology patients.ConclusionsThis study explored pharmacists’ views and practices regarding managing sexual health in patients with cancer. Several barriers were identified, which may aid in future development of resources to assist pharmacists in routinely addressing sexual health in oncology patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-20T06:33:16Z
      DOI: 10.1177/10781552221089667
       
  • Acute pancreatitis secondary to tamoxifen-associated hypertriglyceridemia:
           A clinical update

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      Authors: Muhammad Hassan Naeem Goraya, Ehsan ul Haq Abbasi, Muhammad Kashif Amin, Faisal Inayat, Muhammad Junaid Ashraf, Mahrukh Qayyum, Nadeem Hussain, Gul Nawaz, Muhammad Adnan Zaman, Adnan Malik
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionDrug-induced pancreatitis has been increasingly recognized, but it is frequently encountered as an inconspicuous etiology. The underlying mechanisms of injury vary with different drugs. Tamoxifen is a frequently used anticancer drug that acts by selective modulation of the estrogen receptor in patients with breast cancer. Tamoxifen-induced hypertriglyceridemia is a relatively rare etiological factor for acute pancreatitis. However, acute pancreatitis secondary to this adverse effect remains an exceedingly important clinicopathologic entity.Case reportWe hereby delineate a rare case of acute pancreatitis secondary to hypertriglyceridemia in a patient who was on tamoxifen treatment for the past 3 years. Her serum lipase and triglyceride levels were markedly elevated at 14,285 IU/L and 20,344 mg/dL, respectively. The diagnosis was considered based on the findings of a standard diagnostic workup and exclusion of alternative causes of acute pancreatitis.Management and outcomeThe patient was instituted prompt treatment with intravenous insulin infusion and gemfibrozil. The clinical outcome was favorable with no complications. Tamoxifen was permanently discontinued and was replaced with letrozole.DiscussionThis article illustrates that acute pancreatitis should be considered in the differential diagnoses of abdominal pain and elevated pancreatic enzymes in patients undergoing tamoxifen treatment. It also underscores the importance of pre- and post-tamoxifen lipid screening, especially in patients with a history of dyslipidemia and diabetes mellitus. It will facilitate an expedient detection of hypertriglyceridemia, potentially saving patients from associated morbidity and mortality.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-12T07:57:57Z
      DOI: 10.1177/10781552221093969
       
  • Pharmacological profile and potential drug interactions in ovarian cancer
           hospitalized patients

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      Authors: Rebeka Caribé Badin, Carolina Souza Machado Martins, Liliane Rosa Alves Manaças
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      The aim of this study was to identify the main therapeutic classes prescribed to ovarian cancer patients and the potential drug interactions (PDI) during hospitalization. This descriptive retrospective work was carried out in a referral gynecological cancer hospital from the Brazilian public health system. The first 24 h inpatients’ prescriptions were evaluated to obtain the pharmacological profile data. Clinical and epidemiological characteristics were collected through the analysis of electronic medical records. A total of 236 patients were included in the study, of which 154 (65.25%) had PDI, with a mean of 1.43 ± 1.76 interactions per patient. The main therapeutic classes prescribed were analgesics and antiemetics (35%), compatible with the oncologic supportive care. All PDI identified (n = 331) were categorized by severity, using the Micromedex database, resulting in: 1.51% contraindicated, 67.67% major, 24.77% moderate, and 6.04% minor. The more prevalent PDI were ondansetron/tramadol (22.05%) and metoclopramide/tramadol (7.25%), both major. An association between PDI and polypharmacy was observed, which did not occur between age or length of stay. Ongoing prescription review by the pharmaceutical team is necessary to identify, monitor, and manage PDI-related adverse events and carry out required interventions with patients, physicians, and nurses. Taken together the data showed that even in a specialized hospital, the complexity of the pharmacotherapy can cause harm to the ovarian cancer patient. The clinical pharmacist acting in a multidisciplinary team is important for improving patient safety in oncology services.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-11T02:40:52Z
      DOI: 10.1177/10781552221091298
       
  • An investigation of the use of app technology to support clinical
           management of patients with chronic myeloid leukaemia (CML)

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      Authors: Saffiya Khadam, Teresa Chu, Nigel Deekes, David FitzGerald, Andrea Preston, Nick Duncan
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe availability of healthcare apps to support patient self-management of various medical conditions, including cancer, has increased considerably in the past decade. However, there are limited published data on the role of apps in the management of chronic myeloid leukaemia (CML). The primary aim of this study was to investigate the current and future role of apps as a means of supporting patients with CML.MethodsA 31-item questionnaire was developed and distributed to patients via three on-line CML support groups.ResultsResponses were received from 286 patients. There was an approximate 2:1 female: male split and the majority (54%, n = 155) resided in the United Kingdom. 91% (n = 260) of respondents were currently receiving drug treatment for their CML. 23.4% (n = 67) of respondents were aware that apps were available to support their CML management and 11.5% (n = 33) had experience of using such an app. 94.1% (n = 238) of those who had not used a patient support app in the past stated that they would consider using an app in the future to help manage their disease. App awareness was significantly higher amongst male patients (30.3% vs. 19.9%). Likelihood of being a current or previous app user was higher amongst younger patients (16.3% for
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-11T02:40:43Z
      DOI: 10.1177/10781552221090904
       
  • Adherence to practice guidelines for the management of febrile neutropenia
           in patients undergoing hematopoietic stem cell transplantation: An
           observational study in a referral center in Iran

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      Authors: Seyedeh Reyhaneh Ekhtiari Kolour, Bita Shahrami, Mona Kargar, Hamidreza Taghvaye Masoumi, Shahideh Amini, Mohammad Vaezi, Molouk Hadjibabaie, Mehdi Mohammadi, Kourosh Sadeghi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPatients undergoing hematopoietic stem cell transplantation (HSCT) are suspected to develop febrile neutropenia (FN) and severe infections. Therefore, appropriate prescription of antibiotics in these patients is crucial to reduce the rates of morbidity, mortality, and antimicrobial resistance. The present study aimed to evaluate the physicians’ prescription and adherence to the FN clinical guidelines among patients undergoing HSCT.MethodsThis prospective observational single-center study was conducted during a 15-month period in a tertiary referral hospital in Iran. The patients with at least one episode of FN following HSCT were included in the current study. The physicians’ adherence to the Infectious Diseases Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) clinical guidelines for the management of FN was evaluated using prescription data and medical record reviews.ResultsTwo hundred and fifteen patients with 297 FN episodes were evaluated. The timing of antibiotics and the selection of the initial regimen were considered guideline-based therapy. However, antibiotic dosing and initial regimen modification were not followed in terms of the guideline recommendations in 58.1% of the patients. In particular, vancomycin was inappropriately given in 83.1% of patients. The overall adherence of physicians to the guidelines was 35.8%.ConclusionNon-adherence to clinical guidelines is high particularly in initial regimen modification and administration of vancomycin, which affects hospital stay and patient's outcome. Implementation of guideline-review sessions to raise the awareness of the physicians and to improve the rational use of antimicrobial agents may be crucial.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-08T05:54:00Z
      DOI: 10.1177/10781552221092158
       
  • Impact of low- and high-risk operators handling irinotecan on the blood
           contamination of health care workers in oncology day care units

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      Authors: C. Pirot, H. Benoist, S. Lagadu, R. Delépée, G. Saint-Lorant
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionHealth care workers handling antineoplastic drugs (ADs) are at risk of mutagenicity and adverse reproductive effects. Despite protective equipment and AD handling guidelines, AD levels are still detected in caregivers in oncology units. This study attempted to assess blood contamination by irinotecan and its metabolites in all health care workers in oncology day hospital units according to activities specific to each employment category.MethodsThe study was performed at two different hospitals: a university hospital and a comprehensive cancer centre. Forty-four participants were categorized according to their daily activity as a high-risk operator (29 nurses/ward aides and 5 cleaning staff) and a low-risk operator (7 doctors and 3 secretaries). The collected blood samples were subjected to UHPLC–MS/MS. The plasma and red blood cell (RBC) levels of irinotecan and its metabolites (SN-38; APC) were determined using a validated analytical method detection test.ResultsTwo hundred sixty-four assay results were collected (132 plasma results and 132 RBC results). The comparison between low- and high-risk operator-contaminated workers was not significant (18.33% positive results in low-risk operators vs. 25.98% positive results in high-risk operators; P = 0.22). This homogeneity showed overall contamination within the unit. Positive results were obtained in 21.43% of physicians, 11.11% of secretaries, 25.86% of nurses/ward aides and 26.67% of cleaning staff. These results could be explained by the lack or failure of personal and collective protective equipment. A lack of protection and inadequate decontamination procedures can result in surface contamination.ConclusionsThis study evaluated blood contamination with irinotecan and its metabolites in health care workers from day hospital care units. Among the 24.24% of contaminations observed in care units, the difference between low- and high-risk operator contamination was not significant (P = 0.22). The impact on blood contamination found is the same between low- and high-risk caregivers. This implies that the protective precautions associated with the handling of anticancer drugs must therefore be followed by all staff, including those believed to be at low risk of exposure.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-06T06:56:40Z
      DOI: 10.1177/10781552221090965
       
  • International society of oncology pharmacy practitioners (ISOPP) position
           statement: The role of oncology pharmacy practitioners in immunotherapy
           treatment with immune checkpoint inhibitors for malignant conditions

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      Authors: Andrew Walker, Alexandre Chan, Constanza Cortés Labra, Mario L. de Lemos, Marc Geirnaert, María Asunción Albert-Marí, Elif Aras Atik, Jared Borlagdan, Andrea Crespo, Melanie Danilak, Esin Aysel Kandemir, CheaXin Lim, Ramatu Mas’ud Alabelewe, Rina Mutiara, Karunrat Tewthanom, Barbara Yim, Lynne Nakashima
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Oncology pharmacists, pharmacy technicians and assistants are key members of the multidisciplinary health care team (MHT) caring for patients receiving immunotherapy with immune checkpoint inhibitors. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on the role of oncology pharmacy practitioners in caring for patients receiving immune checkpoint inhibitors.Four key recommendations were identified: 1) participation as an integrated, collaborative member of the MHT;2) provision of education and training for patients, students, residents, fellows and other members of the MHT;3) involvement in clinical governance to optimise the use of immune checkpoint inhibitors and4) involvement in research and development in the field of immunotherapy.In summary, oncology pharmacy practitioners play essential roles within the MHT in caring for patients receiving immune checkpoint inhibitors.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-06T06:56:14Z
      DOI: 10.1177/10781552221090199
       
  • Clinical utility of a regional precision medicine molecular tumor board
           and challenges to implementation

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      Authors: Keng Hee Peh, Daniel J Przybylski, Michael J Fallon, Jason J Bergsbaken, Paul R Hutson, Menggang Yu, Dustin A Deming, Mark E Burkard
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeMolecular tumor boards provide precision treatment recommendations based on cancer genomic profile. However, practical barriers limit their benefits. We studied the clinical utility of the precision medicine molecular tumor board (PMMTB) and described challenges with PMMTB implementation.MethodsAn observational cohort study included patients reviewed by the PMMTB between September 2015 to December 2017. Patients who had consented to the registry study were included. The primary endpoint of this study was time on treatment (ToT) ratio. Clinical utility was established if the primary endpoint had least 15% of patients achieving a ToT ratio of ≥1.3.ResultsOverall, 278 patients were presented to the PMMTB and 113 cases were included in the final analysis. The PMMTB identified at least one nonstandard of care (SOC) clinically actionable mutation for 69.0% (78/113) of cases. In patients who received non-SOC treatment, 43.8% (7/16) achieved a ToT ratio of 1.3 or more (p < 0.001). Fifty-nine patients did not receive non-SOC recommendations. Reasons for not pursuing treatment included 35.6% having response to current treatment, 20.3% died prior to starting or considering PMMTB recommendations, 13.6% pursued other treatment options based on clinician discretion, another 10.2% pursued other treatment options because clinical trials recommended were not geographically accessible, 8.5% had rapid decline of performance status, 6.8% lacked of financial support for treatment, and 5.1% were excluded from clinical trials due to abnormal laboratory values.ConclusionThe regional PMMTB non-SOC recommendations benefitted a majority of patients and additional processes were implemented to assist with non-SOC treatment accessibility.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-04T08:51:56Z
      DOI: 10.1177/10781552221091282
       
  • A simple extemporaneous oral suspension of aprepitant yields sufficient
           pharmacokinetic exposure in children

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      Authors: A Laura Nijstad, Evelien de Vos-Kerkhof, Catherine F Enters-Weijnen, Marianne D van de Wetering, Wim J E Tissing, Lidwien M Hanff, Rogier Lange, Matthijs M Tibben, Hilde Rosing, Arief Lalmohamed, C Michel Zwaan, Alwin D R Huitema
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAprepitant is used for the treatment of chemotherapy induced nausea and vomiting. A liquid formulation is needed for treatment of young children. However, the commercial (powder for) suspension was not available worldwide for a prolonged period of time and, therefore, a 10 mg/mL aprepitant oral suspension was extemporarily prepared to prevent suboptimal antiemetic treatment. The current pharmacokinetic study was developed to investigate whether this extemporaneous oral suspension offers an appropriate treatment option.MethodsFrom 49 pediatric patients (0.7–17.9 years) 235 plasma concentrations were collected. Patients were either treated with our extemporaneous oral suspension (n = 26; 53%), commercially available capsules (n = 18; 37%), or the intravenous prodrug formulation of aprepitant (fosaprepitant, n = 5; 10%). Pharmacokinetic analyses were performed using nonlinear mixed effects modelling.ResultsA one-compartment model adequately described the pharmacokinetics of aprepitant in children. The bioavailability of the extemporaneous oral suspension was not significantly different to that of the capsules (P = 0.26). The observed bioavailability throughout the total population was 83% (95% CI 69%-97%). The absorption of the extemporaneous oral suspension was 39.4% (95%CI 19.5–57.4%) faster than that of capsules (mean absorption time of 1.78 h (95%CI 1.32–2.35), but was comparable to that of the commercial oral suspension. The median area under the curve after (fos)aprepitant was 22.2 mg/L*h (range 8.9–50.3 mg/L*h) on day 1.ConclusionOur extemporaneous oral suspension is an adequate alternative for the commercially (un)available oral suspension in young children. An adequate exposure to aprepitant in children was yielded and the bioavailability of the extemporaneous suspension was comparable to capsules.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-04T04:04:04Z
      DOI: 10.1177/10781552221089243
       
  • Health professionals’ practice to care cytotoxic drug handling and
           

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      Authors: Wudneh Simegn, Baye Dagnew, Henok Dagne
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundHealth care professionals are potential to be in contact with cytotoxic drugs during their daily work activ­ities. The study aimed to assess the practice of health professionals to care for cytotoxic drugs and associated factors in the University of Gondar Specialized Hospital.MethodsCross-sectional study design was employed. EPI Info 7 was used for data entry and then exported into SPSS 20 for statistical analysis. Frequencies and mean with standard deviation were computed. Logistic regression had been performed to find out associated factors. Crude’ and adjusted Odds’ ratio with 95% uncertainty interval was done. Variables with a p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-29T08:05:11Z
      DOI: 10.1177/10781552221090200
       
  • Evaluation of antibiotic appropriateness at an outpatient oncology centre

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      Authors: Cindy Chew, Vivianne Shih, Zhe Han
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T08:45:09Z
      DOI: 10.1177/10781552221087604
       
  • Case reports of acquired thrombotic thrombocytopenic purpura attributed to
           pembrolizumab

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      Authors: Peter J Gilbar, Marcus SR Dickey
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.

      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T08:45:04Z
      DOI: 10.1177/10781552221088025
       
  • The efficacy and cost-impact of rasburicase 3 mg versus 6 mg for the
           management of tumor lysis syndrome: A multicenter analysis

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      Authors: Dennis Marjoncu, Kori Holman
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Purpose: Hyperuricemia is a complication arising from tumor lysis syndrome (TLS). Literature has shown that a single 3 mg dose was just as efficacious as a single 6 mg dose when the uric acid (UA) levels were ≤12 mg/dL. Here, we present a multi-center analysis rasburicase utilization and its effect on healthcare costs. Methods: This is a multi-center, retrospective analysis of adult cancer patients who were admitted to Methodist Le Bonheur Healthcare hospitals and received rasburicase from February 2020 to February 2021. The primary endpoint was to test whether rasburicase 3 mg had similar rates of uric acid normalization (defined as uric acid ≤7.5 mg/dL) within 24 h as a dose of 6 mg. Results: Seventy-nine patients were included in the study. While the baseline uric acid was lower in the 3 mg arm compared to the 6 mg arms, there was no difference in the uric acid normalization at 24 h between the 3 mg arm (95%) and 6 mg arm (82%) (p = 0.134). A cost-savings of over $300,000 annually can be achieved with the proposed protocol. Conclusion: A single, fixed rasburicase dose of 3 mg was effective in normalizing uric acid levels within 24 h, and is associated with significant cost-savings.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T08:44:44Z
      DOI: 10.1177/10781552221087978
       
  • EGFR-mutated advanced lung cancer. Data from a single institution, the
           Hospital of Leon, in Spain

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      Authors: Irene Delgado Sillero, Nerea Lopetegui Lia, Luis Felipe Sánchez Cousido, Mariam Rojas Piedra, Blanca Távara Silva, Maria Luisa Garrido Onecha, Soledad Medina Valdivieso, Nieves Alonso Horcajo, Cristina Díez Tascón, Ana López González, Carmen Castañón López, Manuela Pedraza Lorenzo, Andrés García Palomo, Vicente Martín, Pilar Diz Tain
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction10–16% of non-small cell lung cancer (NSCLC) cases have the epidermal growth factor receptor (EGFR) amplified and/or mutated. Studies show that EGFR tyrosine kinase inhibitors (TKIs) significantly prolong progression-free survival (PFS) in patients with advanced NSCLC compared to those treated with platinum-based chemotherapy (CT) doublets. Our aim is to perform a real-world survival analysis of patients treated with TKI as first-line therapy at the Hospital of Leon (CAULE) in Spain. The impact on global survival rates and responses to clinical and histopathological factors were also analyzed.Material and methodsWe retrospectively reviewed patients diagnosed with EGFR-mutated NSCLC who received treatment with EGFR-TKI in the Department of Oncology at the University of Leon Health Center complex between March 2011 and June 2018. Data was analyzed with Kaplan-Meier and Cox regression models to show overall survival (OS), progression-free survival (PFS), and the associated variables.Results53 patients were included in the study, 50% (n = 27) were treated with gefitinib, 32% (n = 18) with erlotinib and 10% (n = 6) with afatinib. The median OS and PFS were 27.7 months (95% CI: 21–33.8 months) and 18 months (95% CI 14.25–21.89 months), respectively. The variables associated with OS and with PFS were exon19 deletion as a protective factor and presence of extrathoracic metastasis as a risk factor. The most frequent adverse effects were rash, diarrhea, asthenia, and conjunctivitis.ConclusionsReal-world analysis of this data confirms that treatment with TKI is beneficial for patients diagnosed with EGFR-mutated NSCLC. Our OS outcomes were similar to those reported in clinical trials.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T08:43:24Z
      DOI: 10.1177/10781552221085253
       
  • Physicochemical stability of PF-06439535 (bevacizumab-bvzr; Zirabev®), a
           bevacizumab biosimilar, under extended in-use conditions

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      Authors: Sarah Weiser, Chris Burns, Edward R. Zartler
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPF-06439535 (bevacizumab-bvzr; Zirabev®) is a bevacizumab biosimilar. The stability profile and functional activity of PF-06439535 after dilution for intravenous infusion was evaluated following extended storage conditions.MethodsPF-06439535 drug product was diluted in 0.9% sodium chloride to produce final concentrations of 1.4 and 16.5 mg/mL of PF-06439535, representing clinically relevant low and high doses for intravenous infusion. Three drug product lots and three infusion bag types (polyolefin, ethylene vinyl acetate, and polyvinyl chloride) were tested. To simulate the potential preparation and administration conditions encountered in a clinical setting, prepared drug solutions were initially stored at 25 ± 5°C for 24 ± 2 h, and then at 5 ± 3°C for up to 6 weeks. Extended storage was followed by storage at 25 ± 5°C for 24 ± 2 h before testing. Physicochemical and biological stability were evaluated according to visual characteristics and pH, protein concentration, particulate content, the proportions of molecular weight variants and charge variants, and relative potency. A wide range of analytical techniques optimized for PF-06439535 assessment were employed, such as size-exclusion chromatography, non-reducing sodium dodecyl sulfate capillary electrophoresis, cation-exchange chromatography, far-UV circular dichroism spectroscopy, differential scanning calorimetry, and an in vitro cell-based bioassay.ResultsFor all concentrations, drug product lots, infusion bag types, and time points tested, there were no significant changes in protein concentration and no notable differences in visual characteristics (color, clarity, and visible particulates). The abundance of molecular weight variants and charge variants remained stable over the 6-week study period. There were no stability concerns with regard to sub-visible particles. There were no significant changes in primary, secondary, or tertiary structure. Finally, the in vitro relative potency of PF-06439535 was maintained throughout the study period.ConclusionsThe stability and biological activity of PF-06439535 was maintained after dilution and storage for up to 6 weeks at 2–8°C, demonstrating the integrity of diluted PF-06439535 under extended in-use conditions.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T04:35:32Z
      DOI: 10.1177/10781552221088020
       
  • Evaluation of the efficacy of ursodiol for prevention of hepatotoxicity in
           patients receiving gemtuzumab ozogamicin and inotuzumab ozogamicin

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      Authors: David Sabatino, Amrita Henneman, Samrah Ahmad, Erin Jou, Bradley Goldberg
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Gemtuzumab ozogamicin (GO) and inotuzumab ozogamicin (InO) are indicated for newly diagnosed or relapsed/refractory CD33-positive acute myeloid leukemia and relapsed/refractory B-cell precursor acute lymphoblastic leukemia respectively. Patients undergoing therapy with these agents are at increased risk for hepatotoxicity. Forty-nine patients received either GO or InO with concomitant ursodiol (n=14) or no ursodiol (n=35) for hepatotoxicity prophylaxis. Hepatotoxicity occurred in 2 (14%) patients in the ursodiol group compared to 15 (43%) patients in the no ursodiol group (p=0.10). Median days (17 versus 11; p=0.66) and doses (4 versus 2; p=0.28) to development of hepatotoxicity were higher in the ursodiol versus no ursodiol group. After adjusting for concomitant hepatotoxic medications and prior chemotherapy, ursodiol did not significantly reduce the incidence of hepatotoxicity. Ursodiol prophylaxis was associated with a similar incidence of hepatotoxicity compared to no ursodiol, but may delay the time to occurrence.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-16T09:20:03Z
      DOI: 10.1177/10781552221084000
       
  • Late side effects of cancer treatment in childhood cancer survivors

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      Authors: Bijan Keikhaei, Mohammad Bahadoram, Amin Keikha, Sara Bahadoram, Shakiba Hassanzadeh, Mohammad-Reza Mahmoudian-Sani
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionChildhood cancers are usually treated with chemotherapy and radiation. Therefore, understanding the late side effects of such treatments is important to improve the quality of life in childhood cancer survivors. The present study aimed to investigate the late complications of treatments in childhood cancer survivors.MethodsThis study is a retrospective descriptive study. A total number of 93 cases were enrolled in this study. These cases had a history of childhood cancer documented in their medical records at the Shafa Hospital, Ahvaz, Iran. The age range was 5.9–21.3 years and included 62 males and 31 female patients.ResultsMany of the patients at this hospital with childhood cancer had experienced chemotherapy side effects as well as late effects of cancer therapy. Hypothyroidism is a late complication of therapy in thoracic cancers and head/neck tumors with relative frequencies of 23.1% and 12.5%, respectively. Scoliosis was observed in the patients undergoing the ABVD + COPP and 8/1 regimens with relative frequencies of 4% and 50%, respectively. Lower growth percentiles were also late side effects of cancer therapy. The highest relative frequency of growth retardation was observed in the
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-15T09:05:27Z
      DOI: 10.1177/10781552221087611
       
  • Evaluation of voriconazole related adverse events in pediatric patients
           with hematological malignancies

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      Authors: Ozge Ertem, Ozlem Tufekci, Hale Oren, Yesim Tuncok, Mahmut Cem Ergon, Mukaddes Gumustekin
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundDespite therapeutic drug monitoring and pharmacogenetic-guided dose selection are recommended for pediatric patients, safety of voriconazole is mostly monitored by clinical assessment. Having comprehensive knowledge of safety profile and distinguishing incidental events from the reactions that are truly related to voriconazole use are crucial for safer and uninterrupted treatment.ObjectivesThis study aimed to address adverse reactions during the first month of voriconazole use by systematically evaluating retrospective records of all adverse events. Patients/Methods: It is a single-center, retrospective analysis of patients who received voriconazole from 1 September 2010 to 1 September 2020. Severity of abnormal findings in medical records were systematically graded. Causality between voriconazole and the events was evaluated by Liverpool Causality Assessment Tool (LCAT), Naranjo Algorithm and World Health Organization Causality Assessment System. The events with possible or probable causal relation to voriconazole are classified as adverse reaction.ResultsRecords of 45 patients included in the study. The overall frequency of adverse reactions was 51.1%. Hepatobiliary laboratory adverse reactions identified in 48.9% of the patients and led to treatment discontinuation in 20.0%. Amylase and lipase elevation (2.2%), ventricular extra systoles (2.2%), hallucination and nightmares (2.2%) were other adverse reactions.ConclusionsHepatobiliary abnormalities were the most common adverse reactions and the most common cause of treatment discontinuation. For safer treatment in critically ill patients, the dose should be personalized. To clearly identify the accurate frequency and the causality of all adverse reactions, prospective studies with much larger sample size are needed.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-14T01:31:38Z
      DOI: 10.1177/10781552221086887
       
  • Oral cancer awareness and education within the pharmacy profession

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      Authors: Soheyl Saadat, Nicholas Longridge, Richard Shaw, Andrew Walker, Caroline McCarthy
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      The incidence of oral cancers are rising in the UK, with early detection a significant positive prognostic factor. The Covid-19 pandemic has negatively impacted patients access to dental services, reducing a potential avenue to diagnosis. Community pharmacists are well positioned to play an expanded role in supporting earlier detection. This study seeks to identify levels of awareness and knowledge of oral cancer amongst community pharmacists, to inform development of educational resources.A cross-sectional digital survey was distributed via social media between August and September 2021. Data were collected on participant's demographics, oral cancer awareness and educational resources relevant to oral cancer. The results obtained were analysed using descriptive statistics in IBM SPSS software.61 pharmacists completed the survey. The majority were female (n = 40; 65.6%) aged 18–30 (n = 33; 54.1%). Less than half of respondents reported feeling confident in recognising risk factors (37.7%; n = 23). A substantial minority (n = 8; 13.1%) incorrectly selected fluoride toothpaste use as a risk factor for oral cancer. Most respondents correctly suggested signposting patients with signs or symptoms of oral cancer to a General Medical or General Dental Practitioner (GDP) (n = 35; 57.3%, n = 46; 75.4%). 91.8% of respondents (n = 56) would welcome an educational resource to support professional development.This study demonstrates a need for further educational resources regarding oral cancer, specifically aimed at community pharmacists. Community Pharmacists have a crucial role in efforts to improve rates of early detection of oral cancers. Work should be completed to explore the establishment of direct referral pathways from community pharmacy to secondary care.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-09T11:54:14Z
      DOI: 10.1177/10781552221081387
       
  • Real-world incidence of venetoclax toxicities in British Columbia

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      Authors: Cassandra Lee, Adeline Markarian, Fatima Ladha, Lynne Nakashima, Mario de Lemos, Kimberly Schaff, Stephanie Woo, Alina Gerrie
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionVenetoclax is used to treat relapsed/refractory chronic lymphocytic leukemia (r/r CLL). Tumour lysis syndrome (TLS) is a serious toxicity associated with venetoclax, and real-world studies suggest that the incidence may be higher than in clinical trials. The purpose of this study is to describe the incidence of venetoclax toxicities in British Columbia (BC).MethodsRetrospective review of electronic medical charts for patient characteristics and clinical outcomes of patients treated with venetoclax for r/r CLL in BC. Patients were classified according to their risk for developing TLS. The incidence of TLS was categorized based on laboratory metrics or clinical diagnosis. Other non-TLS toxicities were also collected.ResultsOf 33 patients identified, 40%, 33%, and 27% were at low, intermediate, and high risk for TLS, respectively. Laboratory TLS occurred in 1/33 patients (3%), and no clinical TLS was reported. Grade 3 or 4 toxicities occurred in 19/33 patients (58%). Of these, neutropenia was the most common, occurring in 16 patients (84%) followed by thrombocytopenia, which occurred in 8 patients (42%).ConclusionsThe incidence of TLS in patients treated with venetoclax for r/r CLL in BC was lower than in other real-world studies. Findings may warrant further investigation to determine if the higher incidence of TLS in real-world reports may be mitigated through modifying TLS risk categorization and associated prophylactic measures. Neutropenia was the most common grade 3 or 4 venetoclax toxicity reported, and the incidence in BC is comparable to other centres.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-07T11:57:06Z
      DOI: 10.1177/10781552221084616
       
  • Community pharmacists preparedness and barriers for cancer health
           promotion in North Cyprus

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      Authors: Dubem Henry Bosah, Nevzat Birand, Bilgen Başgut, Abdikarim Abdi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe role of a community pharmacist is well recognized in the literature as the most accessible health care provider that promotes health wellness and disease prevention. Evidence supports their role in cancer health promotion though this is not seen yet in practice. The aim of the study was to assess community pharmacists’ preparedness in terms of knowledge, role perception and barriers for providing cancer health promotion in North Cyprus.MethodsA cross-sectional face-to-face questionnaire-based study was carried among a randomly selected representative sample of community pharmacists in North Cyprus between June 2020 and August 2020. A pre-validated 31-item questionnaire tool was revised by an expert panel and adopted for purpose of this study.Results200 (64.5%) out of 310 approached community pharmacists’ have accepted and responded to the questionnaire of which 183 were fully answered. The community pharmacists’ awareness of cancer was moderate, as 70% answered correctly. Most respondents (93.4%) agree that pharmacists should be involved in cancer health promotion. Most respondents (> 90%) agree that pharmacist's lack of interest in oncology, lack of educational material and pharmacist's hesitancy about their knowledge of cancer are respectively the most important barriers for cancer health promotion.ConclusionThe study shows that community pharmacist well perceives their role in cancer health promotion despite moderate awareness of cancer related facts and hesitancy of their knowledge necessary for assuming their role. Lack of interest, motivation and cancer educational materials availability are also major barrier to address.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-02T01:23:46Z
      DOI: 10.1177/10781552221084920
       
  • Development of a decision tree for the pharmacy-led consultation of
           elderly patients with haematological malignancies

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      Authors: Mathilde Strumia, Jean-Baptiste Fargeas, Elodie Marcellaud, Mathilde Del, Audrey Dintilhac, Liliane Remenieras, Nataliya Dmytruck, Stéphane Moreau, Arnaud Jaccard, Jeremy Jost
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionElderly patients with haematological malignancies are a population at risk of iatrogenic for whom these activities could optimize therapeutic management. However, the limitation of human resources requires optimization of the process in order to improve the efficiency of pharmaceutical activities. The objective was to build a decision tree to optimize the pharmaceutical consultation in these population within a multidisciplinary team in haematology.MethodPharmaceutical consultations were proposed to elderly subjects with haematological malignancies followed up in a haematology day hospitalization at the University Hospital of Limoges. Risk factors for prescribing risky drugs in this population were determined by logistic regression models. A decision tree was constructed based on these results and by agreement between pharmacist, geriatrician and hematologist.ResultsFemale gender (aOR[CI95%] = 1.71 [1.14–2.57]), polypharmacy (aOR[CI95%] = 1.89 [1.14–3.13]), hyper-polypharmacy (aOR[CI95%] = 5.73 [3.03–10.84]) and moderate cholinergic load (aOR[CI95%] = 2.15 [1.04–4.45]) were risk factors for the prescription of inappropriate medicine. Female gender (aOR[CI95%] = 1.55 [1.02–2.35]) and hyper-polypharmacy (aOR[CI95%] = 6.19 [1–1.28]) were risk factors for prescribing anticholinergic drugs or anticoagulants; in contrast, frailty status was a protective factor for prescribing anticholinergics (aOR[CI95%] = 0.51 [0.33–0.81]). Prioritization of pharmaceutical consultations is based on frailty status, prescription of a target drug and polypharmacy.DiscussionPharmaceutical consultations during the day hospitalization of elderly subjects with hematological diseases allow to propose therapeutic optimizations. The prioritization proposed in our study would increase the efficiency of pharmaceutical activities in order to improve quality and safety throughout the care pathway of these patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-28T12:43:33Z
      DOI: 10.1177/10781552221080419
       
  • Perceptions of PGY-2 Oncology Programs on Financial Toxicity Education and
           Preparedness

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      Authors: Gaines Kyna Gania, Monica Tadros, Benny Fernandez, Aisha Shokoya, Nicholas Chow
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Cancer patients experience a rising monetary burden due to increased direct and in-direct costs associated with cancer treatment. This as a result has an adverse effect on the financial well-being of a cancer patient, also known as financial toxicity. Currently, there is a lack of literature surrounding the implementation of financial toxicity in post-graduate oncology residency training for pharmacists. The objective of this study was to describe the perceptions of PGY-2 oncology pharmacy residents and residency program directors on the incorporation of financial toxicity within their training programs and to assess self-perceptions of their level of abilities and experience managing financial toxicity for patients.A qualitative RedCap electronic survey was emailed in December 2020 to resident and directors of PGY-2 oncology programs in the United States.Out of 40 respondents, 64% of residency program directors were highly comfortable with the concept of financial toxicity, while 73% of pharmacy residents were uncomfortable with the concept of financial toxicity within their program. Furthermore, a majority of residents were either uncomfortable or highly uncomfortable managing financial toxicity for patients. In addition, the most commonly utilized method of incorporating the concept of financial toxicity in all programs was through specialty pharmacy and patient assistance programs (PAPs); residents also preferred these methods along with guest speakers to provide this training.Financial toxicity concepts should be considered as an educational standard and incorporated through unique methods of education. We suggest introducing the concept through guest speakers, followed by practical applications integrated in specialty pharmacies and PAPs.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-23T05:25:19Z
      DOI: 10.1177/10781552221082214
       
  • Atopy, allergen sensitization and development of hypersensitivity
           reactions to paclitaxel

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      Authors: Sandra Nora González-Díaz, Alejandra Canel-Paredes, Alejandra Macías-Weinmann, Oscar Vidal-Gutiérrez, Rosalaura Virginia Villarreal-González
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundPaclitaxel is a chemotherapeutic agent used in the treatment of multiple types of malignant tumors which was discovered from the Taxus brevofilia tree. In some patients, anaphylaxis develops during the first exposure to paclitaxel, suggesting that primary sensitization may have occurred through hidden or unidentified allergens that produce cross-reactivity. Skin testing may be useful in identifying sensitization to these allergens. Atopy has also been reported in patients with hypersensitivity reactions (HSR) to paclitaxel.The aim of this study is to evaluate the association between atopy and sensitization to allergens with the development of immediate HSR to paclitaxel.MethodsSkin prick tests (SPT) for environmental and food allergens were applied to 76 patients recently diagnosed with cancer. A SPT to paclitaxel was applied and if negative, an intradermal test was performed. After paclitaxel's infusion, the development of immediate HSR was observed.ResultsOf 76 skin tests, 43% of patients had allergen sensitization and 57% did not. HSR occurred in 12.1% and 11.6% of each group, respectively. Five percent of patients tested positive to paclitaxel and only one had an immediate HSR. Eighty-nine percent of patients who developed an HSR had a family or personal history of atopy.ConclusionsSensitization to environmental or food allergens does not appear to be a risk factor for the development of immediate HSR to paclitaxel, suggesting that there are other non-IgE-mediated immunologic mechanisms responsible for their development, however, a personal and family history of atopy increases 8x the risk of developing anaphylaxis.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-21T05:56:30Z
      DOI: 10.1177/10781552221080415
       
  • Investigating the efficacy of osimertinib and crizotinib in phase 3
           clinical trials on anti-cancer treatment-induced cardiotoxicity: are
           real-world studies the way forward'

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      Authors: Hasan Kobat, Islam Elkonaissi, Emma Foreman, Mary O’Brien, Mehmet Tevfik Dorak, Shereen Nabhani-Gebara
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Background.Oncology clinical trials demonstrate the risk of cardiotoxicity but are not sufficient to reveal the true risk. In this article, we compared the incidence of cardiotoxicity of crizotinib and osimertinib from a real-world study to data reported by phase 3 clinical trials.Methods.Data from an ongoing real-world lung cancer study was used as a comparator. Patients were recruited retrospectively with the criteria of being diagnosed with non-small cell lung cancer and having received at least a course of treatment of tyrosine-kinase inhibitor and/or immune check-point inhibitor. Characteristics of the patients who developed cardiotoxicity associated with osimertinib and crizotinib in the real-world lung cancer study were analysed against the inclusion criteria of the corresponding phase 3 clinical trials. Variations of cardiotoxicity incidence among the real-world lung cancer study and clinical trials were investigated.Results.18%, n = 37/206, of the patients developed cardiotoxicity. QTc prolongation was the most frequently observed cardiotoxicity (n = 12/37). Osimertinib and crizotinib were the most cardiotoxic agents, each responsible for seven cases of cardiotoxicity. FLAURA, AURA3, PROFILE 1007 and PROFILE 1014 were the included clinical trials for analysis. None of the patients who developed cardiotoxicity in the real-world study would have been eligible to participate in FLAURA and PROFILE 1014 study whereas n = 4/7 and n = 5/7 patients were eligible to participate in AURA3 and PROFILE 1007 trials, respectively.Conclusion.Although phase 3 clinical trials play an important role in understanding the effectiveness and give insights on side-effect profiles, real-world studies can show the real risk of cardiotoxicity more accurately and realistically.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-15T05:47:52Z
      DOI: 10.1177/10781552221077417
       
  • Impact of electronic interventions on guideline concordant ordering of
           rituximab infusion rate

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      Authors: Katherine A Moser, Randall W Knoebel, Connor Roth, Sandeep Parsad, Zachary Schlei
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionRituximab carries a boxed warning for severe or fatal infusion reactions; most occurring with the initial infusion. Prior studies established that if the initial rituximab infusion is tolerated, subsequent infusions can be given safely over 90 min. The University of Chicago Medicine (UCM) did not have a standardized method to document infusion reactions for outpatient chemotherapy patients, making it challenging for providers to know a patients’ eligibility for rapid infusion. This quality improvement project focused on a series of interventions to improve documentation and electronic ordering of rituximab.MethodsA flowsheet for nurses to record patients’ tolerance of chemotherapy infusions was created within the electronic health record (EHR). Following results of flowsheet impact, a second intervention was implemented to modify ordering of rituximab. The primary endpoint was the incidence of guideline concordant rate ordering of rituximab. Secondary endpoints included the incidence of accurate chair time scheduling pre- and post-interventions and nursing compliance with flowsheet documentation.ResultsPrior to flowsheet implementation, 85% of patients were infused at the guideline concordant rate, compared to 79% post-implementation. Prior to modification of rituximab ordering in the EHR, 85% of patients were infused at the guideline concordant rate, compared to 87% after implementation. Complete nursing documentation was done 89% of the time when the flowsheet was utilized, compared to 11% pre-interventions.ConclusionNo difference in primary or secondary endpoints was found following our interventions. However, the infusion documentation flowsheet, when used, provided more complete reaction data compared to when it was not used.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-15T05:47:42Z
      DOI: 10.1177/10781552221080722
       
  • Pembrolizumab for advanced non-small cell lung cancer (NSCLC): Impact of
           autoimmune comorbidity and outcomes following treatment completion

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      Authors: Sonam Ansel, Robert Rulach, Nicola Trotter, Nicola Steele
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPembrolizumab, an immune-checkpoint inhibitor, is approved for first-line treatment of metastatic NSCLC in patients with tumours expressing programmed death-ligand 1 (PD-L1) with tumour proportion score (TPS) of ≥50%. We aimed to clarify some uncertainties regarding use of immunotherapy in patients with previous autoimmune (AI) disorders and assess real-world outcomes following treatment completion.MethodsWe performed a retrospective case record review of 82 patients with tumours expressing PD-L1 at TPS ≥ 50% and receiving first-line Pembrolizumab. Survival was estimated using the Kaplan Meier method.ResultsAfter 36.93 months (IQR: 34.37–40.20) median follow-up, median OS was 13.6 months (95% CI 8.9–19.3). There were 10 patients (12%) with AI co-morbidities and there was a trend toward improved median OS for this group versus those without AI comorbidity, 42 months (14.87-NR) versus 10.7 months (7.3–17.8), p = 0.073. Sixteen patients (20%) with nonprogressive disease at 2 years had significantly better median OS compared to those who did not complete 2 years of treatment, NR (42- NR) and 8.7 (5.8–14.1), p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-15T05:47:38Z
      DOI: 10.1177/10781552221079356
       
  • Evaluation of a Pharmacist-Developed, Nurse-Driven Protocol for Management
           of Parenteral Anticancer Therapy Infusion Reactions in an Ambulatory
           Infusion Center

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      Authors: Julianna Cebollero, Jennifer A. LaFollette, Suzanne M. Walton, Marjorie Adams Curry
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeIntravenous anticancer therapy can be associated with hypersensitivity- and/or infusion-related reactions (IRRs) which may result in life-threatening symptoms. As part of a quality improvement project, oncology pharmacists developed and implemented a nurse-driven, symptom-based IRR protocol. The objective of the evaluation was to evaluate IRR treatment failure after implementation of a symptom-based protocol in an ambulatory infusion center. Secondary objectives included determining the most common anticancer agents requiring IRR treatment, documentation of ED visits or hospital admissions within 72 h of treatment, documentation of mortality due to an IRR, and evaluating whether there were multiple documented IRRs to the same medication.MethodsA total of 456 patients, who received an infusion of anticancer therapy at Grady Health System (GHS) between February 2014 and March 2018, were retrospectively evaluated. Patients were included if they received a protocol-specific medication for infusion reaction management of a parenterally administered anticancer agent. The primary outcome was the rate of treatment failure within 72 h of treatment for an IRR.ResultsSeventy-eight patients experiencing 108 IRRs were included in the analysis. Five percent of IRRs consisted of rigors only, 57% of IRRs were mild/moderate severity, 31% of IRRs were severe/anaphylactic severity and 7% of IRRs were rigors in addition to a mild/moderate/severe reaction. Of the 108 IRRs, treatment failure within 72 h was observed in eight reactions; six were evaluated in the emergency department and two required a hospital admission. Overall, 93% of reactions resolved in the infusion center and patients were discharged home; there were no patient deaths. The most common offending agents were paclitaxel and oxaliplatin.ConclusionFollowing implementation of a novel pharmacist-developed, symptom-based nurse-driven protocol, infusion reaction treatment failure occurred in 7% of IRRs evaluated. Although the failure rate was low, additional nurse education and improved access to protocol-directed medications may optimize use of the protocol.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-15T02:05:16Z
      DOI: 10.1177/10781552221079855
       
  • Evaluation of a pediatric pre-chemotherapy rapid hydration protocol: A
           quality assurance project

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      Authors: Krista McKinnon, Tracey Tran, Victor Lewis
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionIntravenous hydration may be utilized to prevent nephrotoxicity and facilitate drug elimination in patients receiving high-dose chemotherapy. Prolonged hydration protocols may lead to delayed initiation and completion of therapy, lengthening hospital admissions. Rapid hydration protocols have been implemented to reduce the time required for patients to meet parameters for chemotherapy administration. This study aims to evaluate a rapid hydration protocol implemented at the Alberta Children's Hospital (ACH).MethodsStarting January 2018 through May 2018, data was prospectively collected for pediatric oncology acute care and ambulatory patients at ACH receiving methotrexate (MTX), cisplatin, cyclophosphamide, or ifosfamide. The primary outcome was the time to achieve pre-determined urine parameters prior to chemotherapy administration. Secondary outcomes included the proportion of cycles that achieved urine parameters and the efficacy of each rapid hydration step.ResultsA total of 22 cycles were included, 13 for MTX and 9 for non-MTX chemotherapy. Median time to meet all urine parameters was 120 min (range 30–600 min). Two cycles (15%) failed rapid hydration in the MTX group, while no cycles required further hydration in the non-MTX group. Adverse events potentially attributable to hydration were mild and did not require intervention.ConclusionThe ACH rapid hydration protocol resulted in reduced time to meet target urine parameters. The results of this quality assurance review support the continued use of rapid hydration prior to chemotherapy administration.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-14T04:18:10Z
      DOI: 10.1177/10781552221078207
       
  • Improved home management of oral pediatric anticancer drugs as a result of
           an intervention comprising practical training, written instructions and
           movie clips: A pilot study

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      Authors: Ranaa Akkawi El Edelbi, Staffan Eksborg, Jennie Ekman, Synnöve Lindemalm
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundLong term treatment of pediatric patients with oral anticancer drugs (OADs) requires the parents/caregivers to prepare the drug at home. The handling procedures in the home setting are, however, not regulated by Swedish law and the parents are often left without guidance on how to handle OADs in a safe way.AimThe aim of this study was to increase understanding of how OADs are handled by parents/caregivers in the home setting before and after an intervention.MethodsParents of pediatric cancer patients were observed and videotaped during their handling of OADs in the home setting before and after the intervention. During the intervention, the parents were provided with written instructions, movie clips and practical training on handling the OADs. Four checklists were used to compare and score the four handling procedures (measuring an oral suspension, cutting tablets, dissolving tablets, and opening capsules) for each parent before and after the intervention.ResultsThe intervention significantly improved the OAD handling procedures among the studied parents. The median score for correct handling was 19% (IQR: 3.6 to 30%) before the intervention and 89.5% (IQR: 71.5 to 94.5%) after the intervention (p < 0.0001).ConclusionsAn intervention comprising practical training and information presented in different forms improved the handling of OADs at home by parents. There is an urgent need to implement this method in all oncology centers in Sweden, educate HCPs to standardize the presentation of information. There is also a great need to provide parents with age-appropriate oral drug formulations from the local hospital pharmacies in Sweden.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-14T04:17:29Z
      DOI: 10.1177/10781552221080445
       
  • A comprehensive evaluation of the safety of ipilimumab, nivolumab and
           their combination therapy: A systematic review and network meta-analysis

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      Authors: Mahanjit Konwar, Debdipta Bose, Miteshkumar Maurya, Renju Ravi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundImmune checkpoint inhibitors (ICIs) have changed the landscape of management of advanced cancers. It is imperative to evaluate the safety of nivolumab and ipilimumab based therapies. This study was aimed to assess the comparative safety profiles of ipilimumab, nivolumab and their combinations.Materials and MethodsWe searched PubMed, Embase, and the CENTRAL for randomised controlled trials of ipilimumab and nivolumab. The outcome measures were treatment-related adverse events [TRAEs], TRAEs of grade 3–5, treatment discontinuation due to TRAEs [TDTRAEs], TDTRAEs of grade 3–5, serious adverse events [SAEs] and SAEs of grades 3–5. We performed a network meta-analysis using the Bayesian approach in R version 4.0.3.ResultsWe identified 42 RCTs for final analysis. The treatment ranking for TRAEs revealed that nivolumab 240 mg/week and nivolumab 3 mg/kg/week were safer (0.84 and 0.81 in SUCRA); for TRAEs of grade 3–5, nivolumab 3 mg/kg/week and nivolumab 240 mg/week were safer (0.83 and 0.75 in SUCRA); for TDTRAEs nivolumab 3 mg/kg/week and ipilimumab in combination with other drugs were safer (0.87 and 0.64 in SUCRA) and for TDTRAEs of grade 3–5, nivolumab 3 mg/kg/week was safer (0.85 in SUCRA). Nivolumab 3 mg/kg/week and nivolumab 240 mg/week were safer (0.79 and 0.76 in SUCRA) for SAEs and nivolumab 3 mg/kg/week was safer for SAEs of grade 3–5 (0.78 in SUCRA).ConclusionNivolumab 3 mg/kg biweekly, nivolumab 240 mg weekly and nivolumab 3 mg/kg plus ipilimumab 1 mg/kg triweekly could be preferred due to the relatively low risk of TRAEs, TDAEs and SAEs.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-11T01:46:47Z
      DOI: 10.1177/10781552221074315
       
  • Incidence and management of patients with methotrexate delayed elimination
           in the clinical practice: A Delphi study

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      Authors: Luis Gros, Alicia Roldán, Almudena Cabero-Martínez, Nerea Domínguez-Pinilla, Adolfo de la Fuente, Eva González-Barca, María Tasso, Montserrat Torrent, Eva Gallardo, Inés del Cerro, Ariadna Giró-Perafita, Xavier Badia
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionHigh-dose methotrexate (HDMTX) is administered for the treatment of some cancers. HDMTX is usually safe but may crystallize in renal tubules causing acute kidney injury (AKI). Consequently, MTX elimination is delayed, resulting in a severe and life-threatening condition. No studies have been published about the impact of MTX toxicity in Spain. This study aims to estimate the incidence and management of MTX delayed elimination and toxicity.MethodsA two-round Delphi study was performed to reach consensus between 10 medical experts on haemato-oncology and paediatric oncology with experience in the management of HDMTX treated patients from leading Spanish hospitals. An online questionnaire was developed based on national and international guidelines and previous evidence regarding HDMTX-related toxicity. Consensus was established at 80% agreement. Median and interquartile ranges were calculated, and incidence data were extrapolated to the Spanish general population.ResultsOut of 1.475 patients estimated to receive HDMTX treatment annually in Spain, 27.5% present MTX delayed elimination and 11.6% develop HDMTX-induced AKI (35.4% with severe systemic toxicities (>grade 3) and 18.8% develop chronic renal disease). Mortality is estimated in 4.2%. Immuno-enzymatic assay is used in most of the hospitals (90%) for MTX serum level monitoring. All experts use increased supportive care and high leucovorin as first-line treatment. Available treatments in experts’ hospitals in case toxicity persists are haemodialysis (90% of hospitals), glucarpidase (60%) and hemofiltration (50%). Most prevalent non-renal systemic toxicities are haematologic and mucositis (21–40% of patients). Patients with HDMTX-induced AKI require from intensive care (5% of patients), more than 3 sessions and 4 days of dialysis, and about 8.5 days of hospitalization (non-ICU patients) and 12 days in case of patients requiring ICU.ConclusionsThese results are the first evidence regarding HDMTX-induced AKI in Spain. Incidence and mortality results are in line with previous studies. Clinical management is based on preventive measures and the treatment depend on the availability in the hospital. The need for effective, safe and rapid treatment for the reduction of MTX toxic levels and the improvement of monitoring methods were noted by experts as urgent needs. Further observational studies to validate these results would be needed.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-11T01:34:49Z
      DOI: 10.1177/10781552221079568
       
  • Toxicity profile, adverse drug reactions and drug-drug interactions among
           geriatric cancer patients under metronomic chemotherapy in a South Indian
           tertiary care hospital

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      Authors: Kaoshik Sureshkumar, Kaviya Srinivasan, Gingee Prabu Lingeshwaran, Mahesh Durairaj, Gayathri Thiruvengadam, Priya Jovita Mary Martin Daniel, Rajanandh Muhasaparur Ganesan
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveThe study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy.Patients and MethodsPatients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs.ResultsOf 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-08T11:23:27Z
      DOI: 10.1177/10781552221078934
       
  • Health care seeking behaviors and perspective on indigenous palliative
           care among cancer patients in Kenya

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      Authors: Solomon Cheboi, Peris Kariuki, Joseph Mutai, Staline Kibet, Philemon Nyamanga
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionHolistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya.MethodsA cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0.ResultsA total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families.ConclusionsUse of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-08T04:59:05Z
      DOI: 10.1177/10781552221078204
       
  • The association between patient satisfaction with information and
           adherence to oral anticancer agents

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      Authors: Eward J Melis, Jeannette EF Zwart-van Rijkom, Toine CG Egberts, Bart JF van den Bemt, Petronella O Witteveen, Helga Gardarsdottir
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAdherence to anticancer agents is a critical factor in achieving adequate clinical response, and became a major challenge for patients and caregivers since the increased substitution of parenteral cytostatic by oral drugs. One of the factors that influences adherence is how well informed patients are about their therapy. This study assesses the association between patient satisfaction with information about oral anticancer agents and adherence.Materials and MethodsThis study was conducted among patients (≥18 years) who began oral anticancer therapy. Patients satisfaction with information and adherence were assessed using validated questionnaires. Adherence was also assessed using refill data. Logistic regression was applied to assess the association between overall patient satisfaction with information and both self-reported adherence and adherence based on an MPR value of above 80%.ResultsIn total, 124 patients were included in the study. The median (IQR) satisfaction with information was 15.0(4) on a scale of 0–17. Eighty-two percent of participants reported adherence, while the refill data demonstrated that 64.5% of patients had an adherence rate of 80% or higher. Overall satisfaction with information was not significantly associated with self-reported adherence (OR adj 0.98 [95% CI 0.85–1.15]) or refill-based adherence (OR adj 1.11 [95% CI 0.99–1.24]).ConclusionThe findings indicate no significant relationship between patient satisfaction with information and adherence. The population was highly satisfied with information about the oral anticancer agents, which indicates a high level of satisfaction with usual care. However, the refill data reveals that 35.5% of patients were not adherent.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-07T05:42:36Z
      DOI: 10.1177/10781552221077258
       
  • Rasburicase induced methemoglobinemia: A systematic review of descriptive
           studies

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      Authors: BH Vidhyashree, Mohammed Zuber, Shifa Taj, Rajesh Venkataraman, BP Sathish Kumar, Nihala Jabeen
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeThere is an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes.MethodologyPubMed, Scopus and grey literature databases were searched from inception to January 2022 using search terms “rasburicase” and “methemoglobinemia” without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer.ResultA total of 24 reports including 27 patients (23 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 5 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia.ConclusionRasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-04T02:03:41Z
      DOI: 10.1177/10781552221075239
       
  • A cost analysis of sorafenib for desmoid tumors

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      Authors: Michael S Johns, William T Merritt, Lori Rhodes, Candice N Ford, Mark Thompson, William M Lee, Yarrow Sheldon, Nicholas J Petrelli, Gregory J Tiesi
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionA recent randomized trial demonstrated that sorafenib improved progression free survival (PFS) in patients with desmoid tumors despite many patients experiencing stable disease or spontaneous regression without treatment. Utilizing these trial data, we performed a cost analysis of sorafenib efficacy through two years of treatment.MethodsCurrent Medicare Part D rates for sorafenib were utilized (dose 400 mg/day, cost $309/day). Annual costs per progression and objective response were calculated. Radiologic progression and response were defined using RECIST criteria. Patients with disease progression were separately analyzed in two groups: both clinical and radiologic (CAR), and radiologic alone.Results84 previously randomized patients were analyzed (placebo: 35, sorafenib: 49). At one year, sorafenib was associated with a 43% absolute risk reduction (ARR) of CAR progression and number-needed-to-treat (NNT) of 2.3 patients/year, costing $259,406. At two years, ARR was 48% and NNT of 2.1 patients/year, costing $473,697. When evaluating only patients with RECIST defined radiologic progression, sorafenib patients experienced ARR of 13.9% with NNT 7.2 and estimated costs of $812,052 at one year. Two-year ARR was 17.5% with NNT 5.7 and estimated costs $1,285,052. Sorafenib patients experienced improved RECIST partial response rates at 1 and 2 years of 14.7% and 14.3%, with NNT 6.8 and 6.9, and costs of $766,938 and $1,556,433; respectively.ConclusionFor the treatment of desmoid tumors, Sorafenib led to improved PFS, but at a significant cost per patient. Favorable RECIST outcomes were less likely and costlier. Patients should be informed of possible benefits of treatment versus potential financial burden.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-03T02:19:06Z
      DOI: 10.1177/10781552221077927
       
  • Poor tolerability of lenvatinib in elderly patients ≥80 years old with
           hepatocellular carcinoma: A multicenter observational study

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      Authors: Akiyoshi Kinoshita, Noriko Hagiwara, Akiyuki Osawa, Takafumi Akasu, Yoshihiro Matsumoto, Kaoru Ueda, Chisato Saeki, Tsunekazu Oikawa, Kazuhiko Koike, Masayuki Saruta
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionManagement of elderly patients with cancer has become a global issue. We investigated the safety and tolerability of lenvatinib in hepatocellular carcinoma (HCC) patients ≥80 years old.MethodsWe retrospectively evaluated 61 HCC patients and divided them into 2 groups: an elderly group (n = 13, ≥80 years old) and a younger group (n = 48,
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-03T02:18:25Z
      DOI: 10.1177/10781552221077039
       
  • Preservation of cognitive function after brain irradiation

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      Authors: Haripriya Parapparambil Surendran, M P Narmadha, Sruthi Kalavagunta, Ajay Sasidharan, Debnarayan Dutta
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveApproximately 50–90% of brain metastatic patients who receive radiation therapy (RT) exhibit cognitive decline which may affects the quality of life of cancer survivors. Hence preservation of cognitive functions in brain metastatic patients becomes important. This review aims to evaluates the pathology or mechanism of cognitive function impairment after brain irradiation and strategies available to preserve cognitive function after radiation therapy.Data SourcesPublished articles evaluating the pathology behind radiation induced cognitive impairment and strategies to resolve or preserve cognitive impairment were searched for in scientific databases (eg: PubMed, Scopus, Cochrane database, Google scholar) using keywords including memantine, brain metastases, radiation therapy, pathophysiology, pathogenesis, mechanism and preventionData SummarySeveral hypotheses have been offered to explain the mechanism of radiation induced cognitive decline. Among them, vascular hypotheses play a significant role. Some pharmacological agents have been also tested in patients receiving radiotherapy, memantine was found beneficial based with the reference to existing data.ConclusionFuture studies are required to evaluate the impact of memantine in different types of radiation therapy procedures and its effects on quality of life of brain metastatic survivors.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-03T02:18:18Z
      DOI: 10.1177/10781552221077037
       
  • The physical exam’s role in determining dose-limiting toxicity prior to
           immunochemotherapy administration in lymphoma

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      Authors: John S. Runge, Anna B. Brown, Tycel J. Phillips, Mark S. Kaminski, Shannon A. Carty, Ryan A. Wilcox
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe COVID-19 pandemic has introduced new challenges to healthcare access and delivery. It is critical to identify areas for innovation within oncologic clinical practice to maintain high quality care. We evaluated the potential utility of telemedicine initiatives for patients with lymphoma undergoing immunochemotherapy. We conducted a retrospective review of adult lymphoma patients receiving R-CHOP  +  /- R, R-ICE, R-GEMOX, and R-DHAP at our institution in the last three years (2017-2019) and identified cycles for which dose modifications were required.MethodsWe reviewed 1290 total treatment cycles in 301 unique patients, 1102 cycles (85.4%) were R-CHOP  +  /- R, 105 (8.1%) were R-ICE, 71 (5.5%) were R-GEMOX, and 12 (0.9%) were R-DHAP. We identified that 144 cycles (11.2%) were subject to dosing adjustments. We retrospectively reviewed laboratory results, patient history, and/or physical exam findings that informed dose modifications.ResultsOf the 144 dose adjustments, 11% of cycles contained dose increases due to a well-tolerated previous dose noted in the clinical assessment. The remaining 128 modified cycles were dose reductions. Notably, only 7/128 dose reductions were based on physical exam findings alone, due solely to a change in patient body weight. As patients are routinely weighed immediately prior to chemotherapy administration, effectively no dose modifications (0/144) were exclusively based on abnormal physical exam finding during a pre-infusion assessment.ConclusionThese findings suggest that pre-infusion assessments may be amenable to virtual visits for lymphoma patients undergoing immunochemotherapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-02T06:00:50Z
      DOI: 10.1177/10781552221075224
       
  • Duration of sweat cyclophosphamide excretion in patients undergoing a
           conditioning regimen of high-dose cyclophosphamide for hematopoietic
           stem-cell transplantation

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      Authors: Hiromu Tanigawa, Masayoshi Hirohara, Yoshinori Marutani, Yuji Suzuki, Makoto Onizuka, Shiori Oda, Mutsuko Orita, Masayo Sato, Kazuki Kushida
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeTo investigate the duration of cyclophosphamide (CPA) excretion in the sweat after administration when receiving high-dose CPA therapy as a conditioning regimen for hematopoietic stem-cell transplantation (HSCT).MethodsShirts and pillowcases samples (changed once a day) from 12 patients, categorized as groups 1 (n  =  6), 2 (n = 4), and 3 (n  =  2), receiving high-dose CPA therapy were collected, sealed, stored at 4°C, and mailed to an analytical facility for CPA estimation using LC-MS/MS. CPA was administered intravenously at a dose of 60 mg/kg on days 1, 2 (closed-system delivery for group 3), and samples were collected during days 1–4 (groups 1,3) or days 1–9 (group 2).ResultsCPA was detected in all 126 shirts and pillowcases. In 9 patients, excluding 1 patient who had fever during the study period and group 3 patients, the mean (range) rate of CPA excretion in sweat was 0.03% (0.01–0.12%). The mean CPA excretion in 9 patients adjusted for body weight was 19.9 μg/kg on day 1 and 0.3 μg/kg on day 4.ConclusionsThis study showed that CPA was excreted for an extended duration in the patient's sweat, receiving a high-dose CPA therapy as a conditioning regimen against HSCT.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-28T02:11:14Z
      DOI: 10.1177/10781552221077035
       
  • Cecal volvulus associated with carfilzomib use for al amyloidosis

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      Authors: Shahaf Tuler, Jaspreet Kaur, Constantin A. Dasanu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionProteasome inhibitors have emerged as quintessential therapies for light-chain (AL) amyloidosis and multiple myeloma in the last decade. While these agents are highly effective, reports have also documented toxicities affecting various organ systems. Whereas gastrointestinal (GI) toxicities are a relatively common occurrence with proteasome inhibitors, severe GI complications are exceedingly rare.Case ReportWe describe a unique case of a patient with AL amyloidosis who developed cecal volvulus after four weeks of treatment with carfilzomib. This severe GI manifestation has not been previously described in the literature.Management and OutcomeThe patient required right hemicolectomy. After clinical recovery, she restarted reduced-dose carfilzomib. She did not have any severe GI side effects following dose reduction, and continues with the current treatment regimen to the present day.Discussion/ConclusionThe causality between volvulus and the treatment with carfilzomib was probable, with a documented score of 6 on the Naranjo probability nomogram. The exact mechanism behind this effect of carfilzomib has yet to be elucidated.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-28T01:52:04Z
      DOI: 10.1177/10781552221074719
       
  • Prevalence and risk factors of trastuzumab induced cardiotoxicity in
           Tunisian HER2-positive breast cancer patients

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      Authors: Imen Toukabri, Azza Ben Said, Adel Hamdi, Aziza Aloulou, Wiem Ben Ayed, Ines Cherif, Imen Limayem
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionCardiotoxicity is the most important side effect of Trastuzumab treatment. The purpose of this study is to evaluate the prevalence of Trastuzumab induced cardiotoxicity and to analyze risk factors associated with this side effect.Materials and MethodsA retrospective institutional study was carried out from June 2018 to December 2018 at the department of Medical Oncology of Salah Azaiz institute, Tunis, Tunisia. Demographic, clinical characteristics (menopausal status, breast cancer stage, anthracyclines exposure, comorbidities presence…) and left ventricular ejection function (LVEF) measurements, were collected from patient records.ResultsTwenty-three women (20%) had Trastuzumab induced cardiotoxicity.65.2% (N = 15) experienced a decrease in LVEF more than 10% with a decrease below normal value and 34.8% (N = 8) experienced a decrease in LVEF more than 20%. Obesity is a risk factor for the occurrence of Trastuzumab induced cardiotoxicity (adjusted odds ratio (OR) = 2.919 (95% confidence interval (CI) [1.0411–8.186]; p = 0.042).ConclusionOur study highlighted that obesity is associated with a high risk of cardiotoxicity in women treated with Trastuzumab. Therefore, close monitoring of cardiac function is recommended especially for obese women during Trastuzumab administering.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-28T01:21:33Z
      DOI: 10.1177/10781552221076407
       
  • A pilot study to explore societal, patient, and public authority
           perception on ‘Value-Added Tax’ system for healthcare financing in
           Zimbabwe: A case for cancer treatment

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      Authors: Martin Tavengwa, Kofi Boamah Mensah, Amos Marume, Peter Yamoah, Neelaveni Padayachee, Varsha Bangalee
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundMany of the cancer cases in Zimbabwe are HIV related, making it a significant health concern in the country. This concern requires innovative ways, such as implementing Value-Added Tax (VAT) to finance cancer management through health insurance. The study explores the general public, cancer patients, and public authorities' perception regarding using the VAT system for financing cancer treatment.MethodA qualitative cross-sectional study was conducted to explore the perception of study participants on ‘Value Added Tax’ as a source of healthcare financing in Harare. This was done through the use of in-depth interview guides. A total of 25 participants took part in the study. Fifteen were members of the general public, 5 were cancer patients, and 5 were key informants representing public authority. Members of the general public and cancer patients were conveniently selected, while key informants were purposively selected. Data were analyzed descriptively and by grounded theory whereby codes were developed by induction.ResultsThe general public and cancer patients perceived cancer treatment as generally unaffordable and showed readiness to pay for a cancer levy through VAT. Cancer patients expressed disappointment at the low support for cancer treatment compared to HIV treatment concerning the already established AIDS levy. Public authorities also perceived the VAT system as an appropriate programme for health care financing.ConclusionThis preliminary study found that a ‘Value-Added-Tax’ system could potentially be an acceptable model to finance public healthcare, including cancer treatment in highly informal settings like Zimbabwe.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-27T02:29:00Z
      DOI: 10.1177/10781552221075543
       
  • Complete response following treatment of plasma cell leukemia with
           venetoclax and dexamethasone: A case report

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      Authors: Kim Vo, Tiffany Guan, Rahul Banerjee, Mimi Lo, Rebecca Young, Nina Shah
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPlasma cell leukemia (PCL) is a rare but aggressive variant of multiple myeloma (MM) with a poor prognosis. Due to the limited number of prospective clinical trials studying PCL, treatment options are often extrapolated from data available for the treatment of MM. Venetoclax has recently demonstrated antimyeloma activity in patients with relapsed/refractory MM carrying the t(11;14) translocation. However, few cases have reported the analogous efficacy of venetoclax in PCL.Case ReportA 64-year-old Caucasian male developed relapsed PCL despite treatment with hyperCD (hyperfractionated cyclophosphamide and dexamethasone) and Dara-KRd (daratumumab, carfilzomib, lenalidomide, dexamethasone). Due to the refractory nature of his disease and the presence of a t(11:14) translocation, the patient was subsequently initiated on venetoclax 400 mg daily and dexamethasone 4 mg once weekly.Management and outcomeThe patient achieved a complete response by International Myeloma Working Group criteria three months after initiating venetoclax-dexamethasone, including a repeat bone marrow biopsy that showed no abnormal plasma cells. He successfully underwent consolidation with melphalan-based autologous stem cell transplantation. He remains disease-free 9 months after venetoclax initiation.DiscussionCombination all-oral therapy with venetoclax and dexamethasone can induce deep hematologic responses in patients with relapsed/refractory PCL carrying the t(11;14) translocation.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-27T02:24:19Z
      DOI: 10.1177/10781552221074269
       
  • QTc prolongation during levofloxacin and triazole combination
           chemoprophylaxis: Prevalence and predisposing risk factors in a cohort of
           hematopoietic cell transplantation recipients

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      Authors: Rima Moghnieh, Ahmad Khalil, Nazih Bizri, Nadine Francis, Sabine Imad, Maria Mezher, Zahraa Mrad, Jad Ibrahim, Kamal Zahran, Farah Farroukh, Malak Itani, Amani Assaad, Loubna Sinno, Dania Abdallah, Ahmad Ibrahim
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundQTc interval prolongation has been reported when combining fluoroquinolones and triazoles for chemoprophylaxis in cancer patients. Herein, we aimed to identify the prevalence and contributing factors to QTc prolongation in hematopoietic cell transplantation (HCT) recipients who received these agents during the neutropenic phase.MethodsThis is a retrospective medical chart review conducted at a university hospital in Lebanon from 2017 to 2020. It included all adult HCT inpatients on antimicrobial prophylaxis with fluoroquinolones and triazoles and whose baseline ECG monitoring done prior to chemoprophylaxis administration, then on day-3 and day-6 of therapy, were available.ResultsOverall, 68 HCT recipients met our inclusion criteria, of which 22% developed QTc prolongation. Based on bivariate analysis, female gender contributed to QTc prolongation (P = 0.001). There was a trend to QTc prolongation in patients with predisposing thyroid disease (P = 0.12), grade 2 vomiting and diarrhea (P = 0.16, P = 0.46, respectively), baseline hypokalemia (P = 0.18) and hypocalcemia (P = 0.3), hypomagnesemia on day-3 (P = 0.21) and day-6 hyponatremia (P = 0.36). Patients receiving two or more drugs with a known or probable risk of QTc prolongation (other than the fluoroquinolone/ triazole combination) were more prone to experience a prolonged QTc interval (P = 0.09). None of the patients that had QTc prolongation died or developed serious arrhythmias.ConclusionThe prevalence of QTc prolongation was 22% among HCT recipients on fluoroquinolone and triazole prophylaxis, yet we did not identify any independent risk factors for this issue. None of the patients that had QTc interval prolongation died or developed serious arrhythmias.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-25T01:05:16Z
      DOI: 10.1177/10781552221074016
       
  • Physicochemical stability of PF-05280014 (trastuzumab-qyyp; TrazimeraTM),
           a trastuzumab biosimilar, under extended in-use conditions

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      Authors: Sarah Weiser, Christopher Burns, Edward R. Zartler
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe stability and functional activity of the trastuzumab biosimilar PF-05280014 (trastuzumab-qyyp; TrazimeraTM), was assessed under extended in-use conditions.MethodsPF-05280014 was diluted in 0.9% sodium chloride to final concentrations of 0.2 mg/mL and 4 mg/mL in 3 different types of infusion bags (polyolefin, ethylene vinyl acetate, and polyvinyl chloride). Infusion bags containing diluted PF-05280014 were stored at 25 ± 5° C for 24 h, before storage at 5 ± 3° C for 0, 1, 2, 4, or 6 weeks. Following extended storage, samples of PF-05280014 were removed from the infusion bags and stored at 25 ± 5° C for 24 h before biophysical and functional characterization. In addition to the visual characteristics of each sample at the various time points, the stability of PF-05280014 was assessed using a variety of biophysical techniques, including size-exclusion high-performance liquid chromatography, non-reducing sodium dodecyl sulfate capillary electrophoresis, cation-exchange chromatography, peptide mapping, far-UV circular dichroism spectroscopy, and differential scanning calorimetry. The functional activity of PF-05280014 was evaluated using a cell-based growth inhibition assay.ResultsFor all PF-05280014 concentrations, time points and infusion bags tested, there were no significant differences in visual characteristics or in protein concentration. The were no significant changes in the relative abundance of molecular weight or charge variants throughout the 6-week study period. Similarly, there were no significant changes in primary structure or in secondary structure content during the study. The relative potency of PF-05280014 was also maintained throughout the 6-week period.ConclusionsThe stability and functional activity of PF-05280014 was maintained following dilution in 0.9% sodium chloride and storage for up to 6 weeks at 2–8° C.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-24T04:33:07Z
      DOI: 10.1177/10781552221074649
       
  • Role of Ketamine and Opioid Rotation in the Management of Opioid Induced
           Hyperalgesia in a Patient With Acute Promyelocytic Leukemia

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      Authors: Christopher Hino, Dan Ran-Castillo, Mojtaba Akhtari, Huynh Cao, Julio Silvestre
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionOpioid analgesics are commonly used to manage moderate to severe cancer related pain. However long-term use of opioids has been known to lead to several unintended side effects, including opioid induced hyperalgesia (OIH) which is defined as the paradoxical increase in pain sensitization to pain stimulus following opioid exposure. Currently there are limited reports on the association between patients with cancer and OIH, and this phenomenon is rarely described in patients with leukemia or lymphoma. Here we report a patient with acute promyelocytic leukemia who developed opioid induced hyperalgesia following rapid escalation of opioids.Case reportA 36-year-old female being treated for acute promyelocytic leukemia presented with rapidly worsening acute on chronic hip pain requiring increasing opioid requriements. Given the rapid escalation of opioid dose with minimal response and physical exam findings consistent with allodynia/hyperalgesia a diagnosis of opioid induced hyperalgesia was made.Management and outcomeFollowing recognition of opioid induced hyperalgesia, the patient was managed with opioid rotation and ketamine, which resulted in prompt alleviation of pain.DiscussionOpioid induced hyperalgesia is likely an underrecognized phenomenon in patients with cancer-related pain. A high index of clinical suspicion are necessary for diagnosis and proper management of this disease entity.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-24T01:12:08Z
      DOI: 10.1177/10781552221074285
       
  • Facial Edema Associated with Dasatinib: Case Report with Successful
           Treatment

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      Authors: Timothy Nyckowski, Austin Ambur, Alisa Vinokurov, Rajiv Nathoo
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionTyrosine kinase inhibitors (TKI) are an effective treatment option for chronic myeloid leukemia (CML). The most common associated adverse effects of TKI include thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea. Facial edema is a rare adverse reaction that may cause significant psychological burden. Treatment is life-long in many cases therefore it is vital to have options available to manage these adverse effects.Case reportWe present a 70-year-old female with a medical history of CML, diabetes, hypertension, and hypercholesterolemia who presented to our dermatology clinic for chief complaint of worsening edematous facial rash beginning after initiation of dasatinib. We were able to achieve significant improvement with a regimen that allowed her to remain on dasatinib.Management and outcomeWe treated the patient with a novel, unreported regimen of topical metronidazole 1% gel to be applied every morning and topical tacrolimus 0.1% ointment to be applied twice daily. She had significant improvement with the treatment and was continued on this topical regimen indefinitely.DiscussionPrevious reports of treatment options available for TKI-associated facial edema include topical and systemic corticosteroids, which can cause long-term side effects int the context of long-term TKI use. Our patient achieved an acceptable reduction in facial edema and rash with our combination regimen of metronidazole gel and tacrolimus ointment. We present the only such case of successful treatment of facial edema associated with a tyrosine kinase inhibitor. We encourage future studies on the efficacy and safety of this regimen to treat this adverse effect.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-24T01:11:38Z
      DOI: 10.1177/10781552221074050
       
  • Desensitization to Brentuximab Vedotin after anaphylaxis in refractory
           Hodgkin's lymphoma

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      Authors: Rosalaura V Villarreal-González, Sandra N González-Díaz, Wendy J Santos-Fernández, Perla R Colunga-Pedraza, Ana Laura Varela-Constantino, David Gómez-Almaguer
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionBrentuximab vedotin (BV) is a monoclonal antibody that targets CD30 antigen. It is indicated for the treatment of CD30 + lymphomas and classical Hodgkin lymphoma (HL), including advanced (stage III-IV) untreated disease, relapsed/refractory disease, and consolidation after autologous hematopoietic stem cell transplantation. In clinical trials the incidence of a hypersensitivity reaction is 1.2%.Cases reportWe present 3 cases of patients with refractory HL and anaphylaxis to the administration of BV ( Table 1). Symptoms are analyzed using a grading system described by Brown (2004) and a desensitization protocol was performed with a total dose of 100 mg of BV in 4 solution bags with an initial concentration of 1:1000 of total dose for cases of severe anaphylaxis, and desensitization of 3 solution bags with baseline concentration of 1: 100 for cases of moderate anaphylaxis.Management & OutcomeIntradermal skin tests were positive. Before desensitization, premedication with methylprednisolone and chlorphenamine was administered, as well as fluid therapy with 0.9% physiological solution at 100 cc/hour at induction stage, 250 cc/hour at maintenance stage, and increased to 500 cc/hour in case of hypersensitivity reaction.DiscussionDrug desensitization in 12 or 16 steps allows tolerable administration of brentuximab vedotin after moderate to severe anaphylaxis. The favorable response to treatment of these patients may indicate that desensitization is a viable strategy for patients with relapsed or refractory HL.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-21T12:45:54Z
      DOI: 10.1177/10781552221074965
       
  • A retrospective analysis of first-line PD-1 monoclonal antibodies
           treatment in patients with leptomeningeal metastasis from solid tumors

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      Authors: Zhaohui Chu, Hao Lin, Qiong Zhan, Tao Liu, Yu Wang
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPatients whose solid tumors (ST) show leptomeningeal metastasis (LM) have very poor prognosis and short overall survival. The aim of this study was to evaluate the efficacy of first-line programed death-1(PD-1) monoclonal antibody (mAb) treatment in these patients.MethodsWe retrospectively evaluated patients diagnosed with LM from ST who were treated with first-line PD-1 mAb at our hospital between April 1 and November 30, 2019. We analyzed their clinicopathological characteristics and response to the treatment.ResultsWe collected and analyzed data from 6 patients with different primary ST. 5 patients received PD-1 mAb combined with chemotherapy and/or anti-angiogenic drugs, while one received only PD-1 mAb. The median (range) number of treatment cycles was 5.5 (1-21). PD-1 mAb treatment did not cause neurotoxicity. The time period of first assessment varied from 21 to 65 days after treatment. Among 5 patients who got obvious symptoms relief, 4 patients persisted for> 3 months and even showed a reduction in the number of tumor cells in cerebrosprinal fluid. Ventriculoperitoneal (VP) shunt was used to treat hydrocephalus observed beneficial in 3 patients: 2 before and 1 after PD-1 mAb treatment. The median (range) follow-up time was 214 (57-460) days. 4 patients died. The overall survival ranged from 57 days to at least 460 days. 1 of the two alive patients continued to show no worsening of symptoms after 457 days.ConclusionsPatients with LM from ST can benefit from first-line PD-1 mAb combined treatment without additional neurotoxicity. Further research is required to validate the safety and efficacy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-21T02:40:43Z
      DOI: 10.1177/10781552221074622
       
  • Development of Monoclonal B-cell Lymphocytosis Shortly After Treatment
           

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      Authors: Arsia Jamali, Khashayar Nemovi, Jaspreet Kaur, Constantin A Dasanu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionImmune checkpoint inhibitors, such as programmed death (PD)-1 inhibitor nivolumab, are currently widely used in treatment of various malignancies. Due to their widespread application, any new potential adverse effects due to these agents necessitate careful assessment. Case report: We report a case of an 81-year-old man with recurrent high-risk malignant melanoma who underwent a 12-month adjuvant treatment with nivolumab. Shortly after the course of nivolumab, he developed monoclonal B-cell lymphocytosis (MBL) which subsequently progressed to chronic lymphocytic leukemia (CLL). Management and outcome: The patient is currently doing clinically well in Rai stage 0. Malignant melanoma remains in remission. Conclusion: Considering the pathophysiologic plausibility of nivolumab inducing B-cell dysregulation via PD-1 inhibition, we suggest further studies on potential association between nivolumab and B-cell malignancies.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-21T02:39:43Z
      DOI: 10.1177/10781552221074025
       
  • Three Cases of Lenalidomide Therapy for Multiple Myeloma and Subsequent
           Development of Secondary B-ALL

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      Authors: Urwat Til Vusqa, Zena Chahine, Palash Asawa, Santhosh Sadashiv, Yazan Samhouri, John Lister
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionMultiple myeloma (MM) is the second most common hematological malignancy, accounting for 1% of all cancers, with median age of diagnosis between 66–70 years. MM remains incurable despite advances in treatment over time. Lenalidomide is an important medication used in induction therapy for MM and is also used for maintenance therapy for standard risk patients. With its increasing use, data is emerging about its use being associated with increased risk of secondary primary malignancies (SPM), especially when used as maintenance therapy. Case series: In this case series, we describe three patients with refractory MM treated with lenalidomide maintenance who later developed sALL. All had a common presentation of pancytopenia. They developed cytopenias while being on lenalidomide which was refractory to lenalidomide cessation, prompting bone marrow biopsy. Management and outcome: Lenalidomide was subsequently stopped, and patients were treated for secondary B-ALL. However, all passed away either due to relapse of disease or complications arising from treatment. Discussion: The mechanism of lenalidomide associated SPMs is not well understood however its incidence is well documented. At least 13 cases of ALL (predominantly B-cell ALL) following Immunomodulator imide drugs (IMiDs) have been reported in literature. An analysis of a larger cohort of patients is required to determine causality of lenalidomide with sALL. However, benefits of maintenance lenalidomide in patients with MM outweighs the risk of developing SPMs. Albeit persistent pancytopenia on lenalidomide therapy should be evaluated with bone marrow biopsy since it could be caused by secondary B -cell ALL.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-21T02:38:44Z
      DOI: 10.1177/10781552211073967
       
  • Assessment of Imatinib as a Primary Treatment of Chronic Myeloid Leukemia
           in Chronic Phase: a Cohort Study

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      Authors: Dana Merin, Akshaya Krishna, Sreelekshmi Jayakumar, A Mahima, K N Anila, Neeraj Sidharthan
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      PurposeThe study aimed to assess the effectiveness of Imatinib in chronic myeloid leukaemia (CML) in our hospital population. In addition to identify which brand of imatinib (Gleevec/Veenat) is cost effective for CML patients and to assess the possible adverse drug reactions during the treatment for chronic myeloid leukaemia.MethodsA non-interventional (observational), both retrospective and prospective study was carried out in the department of Medical Oncology and Haematology of our hospital. A total of 152 patients were enrolled in the study. Patients who satisfied the inclusion and exclusion criteria were selected for the study.ResultsEvaluation of baseline characteristics of study population (n = 152) showed predominance of males (65.1%). The mean age was 49.80 ± 16.561 years. The overall clinical outcome of the sample population, BCR ABL value responses during 3,6 and 12 months are the main indicators for the prediction of outcome in CML -CP patients. Using Independent sample t test, it was found that the difference in response to Imatinib therapy during 3,6 & 12 months were statistically significant and showed a statistically significant difference between the good and adverse outcome (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-20T12:27:53Z
      DOI: 10.1177/10781552221074272
       
  • Interpersonal communication-, education- and counselling-based
           interventions to support adherence to oral anticancer therapy: a
           systematic review

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      Authors: Jennifer Elston Lafata, Bobbie Nguyen, Claire Staresinic, Morgan Johnson, Daniel Gratie, Benyam Muluneh
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Background. Many factors contribute to oral anti-cancer therapy adherence, including counselling and educational support. Objective. We systematically review the literature evaluating the effectiveness of interpersonal communication-, counselling- and education-based interventions on patient adherence to oral anticancer therapy. Methods. Using search terms pertaining to medication adherence, oral anticancer therapy, and communication, education, and counselling, we conducted a systematic search for full-text, original research articles prior to 3/13/20. Two reviewers independently reviewed each paper for inclusion and charted study information. Results. Twenty-four articles were included. All considered the use of oral anticancer therapy between two defined time points. Four studies also considered the length of time a patient persisted on therapy. Half (n = 12) of the studies reported a statistically significant relationship between the intervention and medication adherence, with no consistent pattern among intervention structure/content and effectiveness. Programmes offering in-person counselling and those targeting patients with chronic myeloid leukemia (CML), tended to report positive findings. Most studies faced substantial risk of bias, and only two reported using a behavioural theory to guide interventional content. Conclusions. Findings highlight the infancy of evidence base and need for rigorous and large-scale studies grounded in established behavioural theories to advance patient-targeted educational and counselling practices supporting adherence to oral anti-cancer therapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-20T12:27:29Z
      DOI: 10.1177/10781552211073576
       
  • Use of enfortumab vedotin in an HIV-positive patient with urothelial
           carcinoma

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      Authors: Armon Azizi, Roozbeh Houshyar, Nataliya Mar
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction: Enfortumab vedotin is an antibody-drug conjugate used in patients with pretreated advanced urothelial carcinoma. Patients with human immunodeficiency virus were excluded from clinical trials conducted with this agent. Efficacy and safety of enfortumab vedotin has not been established in this patient population. Case report: A patient with a long-standing diagnosis of human immunodeficiency virus and an undetectable viral load on antiretroviral therapy was diagnosed with metastatic upper tract urothelial carcinoma. Following disease progression on platinum-based chemotherapy and pembrolizumab, he was initiated on therapy with enfortumab vedotin. Management & outcome: The patient developed significant toxicity shortly after initiation of enfortumab vedotin. His treatment was subsequently changed to docetaxel chemotherapy and he developed similar significant toxicity. Upon changing his antiretroviral therapy regimen, he was rechallenged with enfortumab vedotin and was able to tolerate it without dose-limiting toxicity, ultimately achieving a partial treatment response. Discussion: This case describes use of enfortumab vedotin in a patient with human immunodeficiency virus, which has not previously been reported. It also underscores the importance of careful medication reconciliation in patients receiving enfortumab vedotin and antiretroviral therapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-19T11:32:55Z
      DOI: 10.1177/10781552221074309
       
  • Cytogenetic guided therapy using blinatumomab and inotuzumab ozogamicin in
           a patient with relapse/refractory acute lymphoblastic leukemia

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      Authors: Zahava Ohana, Samantha Serraes, Christopher Elder, Nikolina Katusa
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAcute Lymphoblastic Leukemia (ALL) is an aggressive cancer that requires intense chemotherapy and has a high rate of recurrence. Treatments of Relapse/Refractory (R/R) B-cell ALL are limited. Blinatumomab, a bispecific T-cell engager (CD19/CD3) monocolonal antibody, and Inotuzumab Ozogamicin, an anti-CD22 antibody conjugate, are current recommended options.Case ReportTo describe a R/R B-cell ALL patient who failed blinatumomab therapy. Subsequently she received inotuzumab ozogamicin achieving a complete response.Management & OutcomeOur patient was initially treated with CALGB 10403 regimen but did not achieve a complete response. Blinatumomab was given for relapse/refractory disease however she had an incomplete response despite having 100% expression in CD19 markers. Consequently, she received inotuzumab ozogamicin attributable to 70% expression of CD22. She responded with a complete response and transitioned to a successful hematopoietic stem cell transplant.DiscussionThere is limited clinical guidance on the preferred treatment of adult R/R B-Cell ALL. Currently, there are no randomized head-to-head trials comparing efficacy of blinatumomab and inotuzumab ozogamicin. Clinical patterns of blinatumomab resistance has been reported. Our case study remains unclear of why our patient had unsuccessful outcomes with blinatumomab regardless of having CD19 positivity of 100%. Future prospective analysis and comparative studies are needed to determine proper sequencing of these therapies.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-19T11:32:23Z
      DOI: 10.1177/10781552211073958
       
  • A case of severe vasculitis after FLOT chemotherapy in a patient with
           metastatic gastric cancer who received multiple line chemotherapy

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      Authors: Engin Hendem, Mustafa Korkmaz, Muzaffer Uğraklı, Melek Karakurt Eryılmaz, Mustafa Karaağaç, Murat Araz, Mehmet Artaç
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionLeukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV.Case ReportWe present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT.Management & OutcomeAfter discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy.DiscussionTo the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-19T03:24:49Z
      DOI: 10.1177/10781552221074046
       
  • Pro-adherence complementary audiovisual educational intervention model for
           chronic myeloid leukemia patients treated with imatinib mesylate

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      Authors: Adriana do Prado Barbosa, Marcelo Rodrigues Martins, Nathalie de Lourdes Souza Dewulf, Wilsione José Carneiro, Flávia Neri Meira de Oliveira, Guilherme Andrade Lemes, Marianna Medeiros Barros da Cunha, Alessandro de Carvalho Cruz, Luiz Carlos da Cunha
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundImatinib mesylate (IM) treatment adherence is a challenge, especially in an economic-social population neglected from developing countries.ObjectiveTo create a new complementary audiovisual educational intervention model to improve IM treatment adherence of CML patients.MethodsTwo adherence verification methods were applied before and after intervention: modified Morisky-Green test and molecular responses (BCR-ABL transcripts quantification). Adherence estimates were calculated using univariate and multivariate component analysis (MCA) for the socio-demographic and clinical characteristics of patients.ResultsModified Morisky-Green test results demonstrated a substantial increase of CML patient adherence from 23% (pre-film) to 65% (post-film). Greater improvement was obtained for patients presenting major molecular response (MMR) from 38% (pre-film) to 60% (post-film). Although slight gain for complete molecular response (CMR) from 23% (pre-film) to 26% (post-film) was achieved, it represents a total tumour regression. MCA identified that females
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-19T03:24:37Z
      DOI: 10.1177/10781552211073894
       
  • Hepatitis B reactivation after oral capecitabine treatment in a rectum
           cancer patient with isolated anti-HBc IgG positivity

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      Authors: Mukaddes Tozlu, Bilal Toka, Ahmet Tarik Eminler, Cengiz Karacaer, Ilhan Hacibekiroglu, Mustafa Ihsan Uslan, Aydin Seref Koksal
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionHepatitis B virus (HBV) reactivation in the setting of chemotherapy and immunosuppressive therapy is associated with significant morbidity and mortality. Herein we present a case of HBV reactivation after oral capecitabine treatment in a patient with rectum cancer and isolated anti-HBc IgG positivity.Case reportA 57-year-old man was consulted from the oncology clinic because of increased serum liver tests after chemotherapy. He underwent surgery for early-stage rectal cancer and received adjuvant chemotherapy with oral capecitabine. After cessation of chemotherapy, his laboratory tests revealed severe liver dysfunction. HBV markers showed positivity for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc). HBV DNA level was markedly elevated.Management and outcomeA review of medical records revealed that, before chemotherapy, the patient was positive for anti-HBc IgG but negative for HBsAg, and serum aminotransferases were within the normal limits. A diagnosis of HBV-related hepatitis due to capecitabine use was made, and the patient was put on tenofovir treatment. Six months later, HBV DNA decreased, and liver function tests were normalized.DiscussionTo the best of our knowledge, this is the first case report describing HBV reactivation after chemotherapy with capecitabine for rectal cancer in a patient with isolated anti-HBc IgG positivity. Our case shows that HBV reactivation may develop in a low-risk patient with a low degree of immunosuppression.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-18T11:58:05Z
      DOI: 10.1177/10781552221074627
       
  • Cutaneous Stevens Johnson – Toxic Epidermal Necrolysis Immunotherapy
           related Toxicities in Lung Cancer Patients

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      Authors: Dimitrios Alexandris, Nektarios Alevizopoulos, Harikleia Gakiopoulou, Nikolina Stavrinou, Christine Vourlakou
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction:New Immuno- Checkpoint inhibitors (ICIs) functioning as PD-1- PDL-1 blockers are nowadays used in a majority of anticancer treatments. Many immune- related Adverse Events (irAEs) are published daily; severe skin toxicities, Stevens Johnson/ Toxic Epidermal Necrolysis (SJS/TEN) are seldom reported.Case report:Herein, we present two interesting skin sever toxicity cases of lung cancer patients, undergoing PD-1- PDL-1 Immunotherapy. In both cases, a morbilliform rash with documented histological Toxic Epidermal Necrolysis Pattern /Stevens Johnson findings, was thoroughly studied.Management & Outcome:Both cases were therapeutically managed according to guidelines with different outcome.Discussion:Two focused cases of irAEs, is the rationale, to briefly review mechanisms of major toxicities caused by PD-1/PD-L1 blockade, and present all new data in their precise management. ICIs’ association with SJS/ TEN still remains unclear; underlying urgent need for further studies. It is important to alert physicians to promptly identify life threatening irAEs. Being familiar, provides management efficacy, safe resolve and encourage beneficial balanced cost effective treatments.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-18T09:59:25Z
      DOI: 10.1177/10781552221074623
       
  • Can pharmacotherapeutic follow-up after allogeneic hematopoietic stem cell
           transplantation improve medication compliance'

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      Authors: Maria Olívia Barboza Zanetti, João Paulo Vilela Rodrigues, Fabiana Rossi Varallo, Renato Luiz Guerrino Cunha, Belinda Pinto Simões, Leonardo Régis Leira Pereira
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundAllogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is currently one of the most effective therapies in onco-hematology. For the treatment of the disease and prevention of such complications, a complex pharmacotherapeutic regimen is employed. Non-compliance is prevalent among adolescents and young adults with chronic hematological diseases, being reported by up to 50% of the patients.ObjectiveTo evaluate the results of pharmacotherapeutic follow-up on medication compliance and on the knowledge about pharmacotherapy of patients who underwent allo-HSCT.MethodsA single-arm, open-label and non-randomized intervention study developed in an allo-HSCT outpatient clinic. The participants attended pharmaceutical consultations and had their knowledge about pharmacotherapy and medication compliance measured by MedTake and Brief Medication Questionnaire (BMQ), respectively.ResultsA total of 27 patients attended pharmaceutical consultations (4.81 consultations/patient; SD = 1.80). There was an improvement in medication compliance and in knowledge between the first and last consultations (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-18T09:59:03Z
      DOI: 10.1177/10781552211073469
       
  • Potential negative pharmacodynamic interaction of spironolactone and
           abiraterone in two prostate cancer patients

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      Authors: Juan Vicente-Valor, Vicente Escudero-Vilaplana, Roberto Collado-Borrell, Cristina López-López, Cristina Villanueva-Bueno, José Luis Revuelta-Herrero, Paula Ruiz-Briones, Beatriz Somoza-Fernández, Ana Herranz, María Sanjurjo
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionSpironolactone when combined with abiraterone in metastatic castration-resistant prostate cancer (mCRPC) may theoretically exert androgenic properties, thereby compromising the therapeutic effectiveness of abiraterone.Case reportTwo patients with a medical history of cardiovascular disease and mCRPC combined spironolactone within the course of abiraterone regimen. The abiraterone-spironolactone interaction was identified using the Lexicomp® interaction tool (classified as risk C).Management & outcomeSpironolactone treatment was maintained as it was considered beneficial due to the cardiac condition. The prostate-specific antigen (PSA) levels started to rise when these two drugs were used together. Eventually, tumour progression was observed.DiscussionThere is increasing evidence that spironolactone behaves as a selective androgen receptor modulator. Strategies to overcome abiraterone-spironolactone interaction could involve the use of eplerenone, although this drug is also controversial. The best strategy should imply a multidisciplinary evaluation by cardiologists and oncologists.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T04:10:47Z
      DOI: 10.1177/10781552221074621
       
  • Progressive Multifocal Leukoencephalopathy Among Ibrutinib Treatment In
           Chronic Lymphocytic Leukemia

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      Authors: Tuğba Çetintepe, Füsun Gediz, Işın Akyar, Lutfi Çetintepe, Ali Murat Koç
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction:Both chronic lymphocytic leukemia (CLL) itself and the drugs used for its treatment, pose a risk for progressive multifocal leukoencephalopathy (PML). Although the relationship between Rituximab and PML is well known, case reports that have been recently published, suggest that ibrutinib; which is used in the treatment of CLL, may increase the risk of PML.Case report:Here, we report a case of 64 year-old female patient with CLL who was previously treated with rituximab, fludarabine and bendamustin but developed PML after receiving monotherapy with ibrutinib. According to Naranjo’s algorithm, the causality relationship with the drug is possible with a score of 3. The patient initially exhibited neurological symptoms. Magnetic resonance of the brain revealed a bilateral asymmetric hyperintensity in the white matter involving the parietal and occipital lobules, and there was no mass effect, edema, hemorrhagic or iscemic lesions. No enhancement of contrast media was observed. The findings were consistent with demyelination and suggestive of PML.Management and outcome:Mirtazapine treatment was initiated. However, neurological sympthoms continuously progressed over the following weeks and the patient, aged 64, died six weeks after diagnosis of PML.Discussion:PML is a rare and often fatal demyelinating disease of the central nervous system (CNS) that is exclusively seen in immunocompromised patients and there is no specific agent to treat PML. The case discussed here, highlights that the use of ibrutinib in chronic lymphocytic leukemia (CLL) therapy may result in PML.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T04:10:27Z
      DOI: 10.1177/10781552221074281
       
  • Pro-BNP in the differential diagnosis of dyspnea in patients treated with
           immune-checkpoint inhibitors: Case Report

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      Authors: Jalal Baranseh, Anton Ouryvaev, Gassan Moady, Ayelet Shai
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionImmune checkpoint inhibitors (ICI) induced cardiac toxicity can present with non-specific symptoms and signs. Early recognition and treatment are important; however, diagnosis can be challenging.Case reportWe describe a 67-year-old woman with a history of ICI induced pneumonitis who presented with dyspnea, hypoxemia and pulmonary infiltrates while treated with pembrolizumab for lung cancer, initially diagnoses with relapssed pneumonitis. When her condition did not improve with steroids, NT-pro-BNP level was tested and was markedly high, prompting additional tests for heart failure.Management and outcomeThe patient was diagnosed with ICI induced left ventricular dysfunction and treated with steroids, beta blockers, diuretics, and ACE inhibitors. Her symptoms and imaging studies markedly improved.DiscussionHere, we review the literature on ICI induced cardiac toxicity and the role of NT-pro -BNP in triage of patients presenting with dyspnea in the emergency setting. We suggest that measurement of NT-pro -BNP be utilized in patients receiving ICI's and presenting with respiratory abnormalities, to rapidly assess for possible cardiac toxicity.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T04:10:07Z
      DOI: 10.1177/10781552221074007
       
  • Impact of the insertion of the clinical pharmacist in the Allogeneic
           Hematopoietic Stem Cells Transplantation team

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      Authors: Maria Olívia Barboza Zanetti, João Paulo Vilela Rodrigues, Fabiana Rossi Varallo, Renato Luiz Guerrino Cunha, Belinda Pinto Simões, Leonardo Régis Leira Pereira
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAllogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy.Methods: Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. Results: A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed.Conclusions: The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T03:55:41Z
      DOI: 10.1177/10781552211073797
       
  • Retrospective study evaluating immune-related adverse events in cancer
           patients treated with pembrolizumab

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      Authors: Ola K. Mashni, Dima W. Baba, Aseel N. Mahmoud, Tasnim O. Qur’an
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPembrolizumab has been on the market for several years, but most of the safety data is based on clinical trials with limited literature evaluating post-marketing immune-related adverse events (irAEs) associated with its use. This study aimed to evaluate the characteristics of irAEs associated with pembrolizumab.MethodsWe included adult patients who had received pembrolizumab between January 2016 and December 2020. The patient electronic profiles and the pharmacy adverse event reporting system were reviewed to identify adverse events. Patients were followed from the start of treatment until 12 months after the last dose, end of the study, or death. The characteristics of the patients and the irAEs were recorded. Univariate and multivariate logistic regression analyses were performed to identify variables associated with the development of irAE.ResultsDuring the study period, 223 patients and 1601 cycles of pembrolizumab were evaluated. A total of 67 irAEs were reported in 58 patients. The median age was 53 years (range 18–84), and most patients were males (75%) with metastatic lung cancer (62%). The most common irAEs were respiratory (30%), followed by gastrointestinal (25%), endocrine (24%), and dermatologic (21%). Among the reported irAEs, 28 were associated with hospital admission, 15 required long-term treatment, and 9 resulted in pembrolizumab discontinuation. In logistic regression, there were no significant predictors associated with irAE.ConclusionsRespiratory irAEs were the most common in our population. We were unable to identify predictors of irAE in this cohort. Further studies are necessary to identify predictors of adverse events.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T01:49:31Z
      DOI: 10.1177/10781552221074374
       
  • Evaluation of awareness about importance of high fever in leukemia and
           lymphoma patients receiving chemotherapy among healthcare professionals
           working in pharmacies other than hospital pharmacies: A survey from a
           Central Anatolian city

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      Authors: Duygu Mert, Alparslan Merdin
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionPharmacy staff are part of the healthcare delivery. In some cases, the patient goes to the pharmacy before the doctor and asks for a medicine suitable for his own complaint. The aim of this study is to evaluate the awareness about the importance of high fever in patients with leukemia and lymphoma receiving chemotherapy among healthcare professionals working in non-hospital pharmacies.Material and methodThe study is a survey study. 140 pharmacy employees working in non-hospital pharmacies in Ankara Province were included in the study. Volunteer participants were included in the study. Seven questions were asked to the participants.ResultsAbout 47.1% of the participants stated that they would advise patients to go immediately to the nearest hospital's emergency department when they presented to the pharmacy and said that they had high fever. It was stated by 56.5% of the participating pharmacy employees that high fever did not pose the same risk for a leukemia or lymphoma patient receiving chemotherapy as it did for a leukemia or lymphoma patient not receiving chemotherapy.ConclusionIn this study, it was found that awareness about importance of high fever in leukemia and lymphoma patients receiving chemotherapy among healthcare professionals working in pharmacies other than hospital pharmacies was not very high. Providing necessary information to the pharmacy personnels and increasing the awareness about importance of high fever in leukemia and lymphoma patients receiving chemotherapy among the non-hospital pharmacy staff might also contribute to the reduction of negativities associated with infections in such patients.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T01:49:01Z
      DOI: 10.1177/10781552221074045
       
  • Chemotherapy-induced neutropenia among breast Cancer patients in a
           tertiary care hospital: Risk and consequences

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      Authors: Anu Joseph, Julie Mariam Joshua, Santhosh M Mathews
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Study objectiveTo identify the risk factors that may predispose breast cancer patients to Chemotherapy-induced neutropenia (CIN) and its associated complications for the years 2018 and 2020. CIN is an established complication of breast cancer treatment. Clinical Pharmacists can play an important role in the treatment of CIN through involvement in risk assessment to identify patients for oral antimicrobial therapy, drug therapy monitoring, and development of suitable guidelines or policies.MethodologyA retrospective study was performed by collecting data of 72 breast cancer patients for the last two years from department of Medical Oncology in a tertiary care hospital.ResultsThe overall occurrence of CIN was 59.7% in our study population. Out of 72 patients studied, 43 patients were found to be neutropenic. Using Pearson Chi square test, chemotherapy-induced neutropenia was associated with older age (over 60 y) (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T01:48:31Z
      DOI: 10.1177/10781552221074004
       
  • Panitumumab Associated Acute Pancreatitis

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      Authors: Huseyin Can Arbag, Hilmi Erdem Sumbul, Mahmut Buyuksimsek, Ali Ogul, Abdullah Evren Yetisir, Tolga Koseci, Berna Bozkurt Duman, Mert Tohumcuoglu, Oguzhan Kesen, Timucin Cil
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction The addition of panitumumab to chemotherapy in wild-type metastatic colon cancer contributes to survival. While the skin related side effects of panitumumab are well known, we wanted to present a case where it was a possible cause of acute pancreatitis. Case Report: The FOLFOX regimen was started in a 67-year-old patient with sigmoid colon cancer and multiple liver metastases. After 2 cycles, genetic tests were concluded and panitumumab 6 mg/kg was added to the treatment. The patient who presented with abdominal pain 2 days after the treatment was hospitalized with acute pancreaatitis. Management & Outcome: Abdominal tomography of the patient was compatible with acute pancreatitis. Oral intake was stopped, IV hydration was started. The patient, whose complaints regressed, was discharged on the 3rd day of hospitalization. Discussion: Skin side effects related to panitumumab are observed quite frequently. Although panitumumab related gastrointestinal side effects have been reported, there is no data on acute pancreatitis. Panitumumab was added to the chemotherapy regimen he received, and it was thought that panitumumab might be the etiological factor in the case who developed pancreatitis.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T01:48:21Z
      DOI: 10.1177/10781552221073997
       
  • Multiple rechallenges with anti-PD-1 immunotherapy in patients with
           checkpoint inhibitor-related pneumonitis: A report of two cases

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      Authors: Zheng Yan, Shuna Yao, Junhui Yuan, Yanyan Liu, Zhihua Yao
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionWith the expanding use of immune checkpoint inhibitors (ICIs) in patients with various types of cancers, many more patients are experiencing checkpoint inhibitor-related pneumonitis (CIP). After recovery from CIP, some patients are rechallenged with ICI therapy. The CIP will recur in a considerable proportion of rechallenged patients. When severe or recurrent CIP (rCIP) occurs, ICI therapy is usually terminated, resulting to treatment failure and tumour progression. The feasibility of multiple rechallenges with immunotherapy in patients with rCIP is unknow.Case presentationTwo patients with refractory classical Hodgkin lymphoma (cHL) were treated with anti-programmed cell death protein 1 (PD-1) immunotherapy. The lymphoma responded well to the ICI therapy, but both patients experienced CIP. The immunotherapy was suspended and steroid was introduced to treated the CIP. When the CIP resolved, however, the lymphoma progressed.Management and outcomeThe patients were rechallenged with anti-PD-1 immunotherapy in the absence of alternative treatment options. The lymphoma responded again, but the CIP recurred. The immunotherapy was suspended again and steroid was reintroduced. These episodes repeated multiple times. At the time of submission of this manuscript, the tumour in both patients has been controlled for more than 4 years, and the immunotherapy is still continuing.ConclusionMultiple rechallenges with immunotherapy is feasible in selected patients with rCIP.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-17T01:47:11Z
      DOI: 10.1177/10781552211073962
       
  • Health-related quality of life among cervical cancer patients at Kenyatta
           National Hospital

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      Authors: Mehreen Shajahan Ahamed, Amsalu Degu
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      BackgroundPrevious study showed that health-related quality of life (HRQoL) was adversely affected during treatment of cervical cancer, with a worsening global score. Therefore, this study aimed to determine the HRQoL of cervical cancer patients at Kenyatta National Hospital.MethodsA cross-sectional study design was employed among cervical cancer patients. All eligible consecutive samples of 103 cervical cancer patients were included in the study. Following consent, patients were interviewed using The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire 30 (EORTC QLQ-30) and Cervical Cancer Module CX24 (EORTC QLQ-CX24). The data were entered and analyzed using the SPSS version 20.0 software. Univariate and multivariate binary logistic regression analysis was employed to investigate the predictors of HRQoL. A p-value of ≤ 0.05 was considered statistically significant.ResultsThe majority (69%) of the patients had a poor overall quality of life while 31% of study participants had a good quality of life. Patients with early-stage disease were 7.3 times (AOR = 7.3, 95% CI = 2.4–21.7, p = 0.000) more likely to have a good HRQoL than patients with advanced-stage disease. Patients with no comorbidities were 3.1 times (COR = 3.1, 95% CI = 1.1–9.1, p = 0.037) more likely to have a good HRQoL than patients with comorbidities.ConclusionThe overall HRQoL among cervical cancer patients was poor in the setting. Advanced stage of disease and presence of comorbidities were the significant predictors of poor quality of life.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-12T12:10:11Z
      DOI: 10.1177/10781552211073886
       
  • Vincristine induced fever in a child with embryonal rhadbomyosarcoma

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      Authors: Dr. Arul Janani, Dr. Anandkumar Shruthilaya, Dr. Jayaraman Dhaarani, Dr. Scott X Julius
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Introduction:Febrile episodes in oncology is common are mostly of infectious etiology requiring repeated investigations and escalation of antibiotics. But, drug induced fever occur more often than we think in oncological set-up.Case Report:A 5 year old male child with rhabdomyosarcoma, developed high grade fever spikes following Vincristine monotherapy. Infective etiology work up was negative and the fever responded to corticosteroids.Management and Outcome:He was treated with corticosteroids as premedication considering vincristine induced fever. The further courses of VCR- monotherapy were uneventful with steroids as premedication.Discussion:We present the case of vincristine induced fever in a child with embryonal rhabdomyosarcoma. Clinician’s should consider drug induced fever at appropriate conditions, to avoid leading to antibiotic resistance.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-12T12:10:10Z
      DOI: 10.1177/10781552221074015
       
  • Community Pharmacists’ Knowledge on Cancer and Screening Methods

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      Authors: Aysen Uygun, Nazli Dilek Caliskan, Songul Tezcan
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Background and ObjectiveThe aim of the study is to evaluate the knowledge of community pharmacists on cancer and screening methods.Setting and MethodThis study was a descriptive cross-sectional study and was conducted between January-June 2020 in Istanbul/Turkey. a structured questionnaire was applied to pharmacists as online. The questionnaire was prepared by the researchers and consisted of 49 questions; basic information about cancer (15 items), signs and symptoms (11 items), causes and risk factors (14 items), cancer screening methods (9 items).ResultsIt was determined that the majority (>90%) of the pharmacists did not receive any education on cancer and/or cancer screening methods after graduation. The sufficient knowledge level of the pharmacists about cancer basics, signs and symptoms, and risk factors were found to be as 80%, 77%, and 67%, respectively. The internal consistency level of the questionnaire was calculated (Cronbach's alpha = 0.814). The item “Every woman should perform breast self-examination and notify a health professional when there is a change in breast appearance or feeling,” was answered correctly by 98% of the pharmacists. It was determined that 71% of the pharmacists gave the correct answer to the item “Women aged 21–30 years should have a PAP smear every 3 years”.ConclusionAccording to the results of the study, while the rate of sufficient knowledge level on cancer was found to be low, knowledge on cancer screening was found to be sufficient. We think that pharmacists should receive training on cancer and screening methods and to follow the guidelines closely.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-12T12:09:47Z
      DOI: 10.1177/10781552211073822
       
  • Canadian monitoring program of the surface contamination with 11
           antineoplastic drugs in 122 centers

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      Authors: Clémence Delafoy, Claudine Roussy, Anny-France Hudon, Ciprian Mihai Cirtiu, Nicolas Caron, Jean-François Bussières, Cynthia Tanguay
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionOccupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers’ health. Environmental monitoring is conducted once a year, as part of a Canadian monitoring program. The objective was to describe contamination with 11 antineoplastic drugs measured on surfaces.MethodsSix standardized sites in oncology pharmacy and six in outpatient clinic were sampled in each hospital. Samples were analyzed by ultra-performance liquid chromatography coupled with tandem mass spectrometry (non-platinum drugs) and by inductively coupled plasma mass spectrometry (platinum-based drugs). The limits of detection (in ng/cm2) were: 0.0006 for cyclophosphamide; 0.001 for docetaxel; 0.04 for 5-fluorouracil; 0.0004 for gemcitabine; 0.0007 for irinotecan; 0.0009 for methotrexate; 0.004 for paclitaxel, 0.009 for vinorelbine, 0.02 for doxorubicine, 0.0037 for etoposide and 0.004 for the platinum. Sub-analyses were done with a Kolmogorov-Smirnov testResults122 Canadian hospitals participated. Cyclophosphamide (451/1412, 32% of positive samples, 90th percentile of concentration 0.0160 ng/cm2) and gemcitabine (320/1412, 23%, 0.0036 ng/cm2) were most frequently measured on surfaces. The surfaces most frequently contaminated with at least one drug were the front grille inside the biological safety cabinet (97/121, 80%) and the armrest of patient treatment chair (92/118, 78%).The distribution of cyclophosphamide concentration was higher for centers that prepared ≥ 5000 antineoplastic drug preparations/year (p 
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-12T12:09:07Z
      DOI: 10.1177/10781552211072877
       
  • Daratumumab infusion reaction rates pre- and post-addition of montelukast
           to pre-medications

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      Authors: Kelsey Coffman, Coby Carstens, Susan Fajardo
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Daratumumab, a CD38-directed monoclonal antibody indicated for multiple myeloma treatment in adult patients, is associated with a high incidence of infusion-related reactions (IRRs). Due to CD38 receptor presence in the lungs, many reactions present similarly to asthma or allergic rhinitis. Montelukast, a leukotriene receptor antagonist, has been hypothesized to reduce daratumumab IRRs due to its efficacy in treating allergic rhinitis and asthma and the presence of leukotriene receptors in the lungs. Recently published data reported daratumumab can be safely administered via rapid rate protocol that reduces infusion time from 195 min to 90 min after completion of two doses. This retrospective, observational cohort study examined 73 patients who received daratumumab in the outpatient setting between December 2015 and April 2020. Patients were included if they were 18 years or older, had an International Classification of Disease (ICD)-10 diagnosis code for multiple myeloma, and received daratumumab intravenously. The primary outcome was a comparison of IRRs between those who did and did not receive montelukast. Secondary outcomes included IRR symptoms, rescue medications utilized for IRRs, and rapid rate administration outcomes. Montelukast use was associated with a lower rate of IRRs (44.4% vs. 65.2%, p = 0.044). Pulmonary IRR symptoms were more common in those who did not receive montelukast. Rapid rate administration of daratumumab did not lead to any IRRs. Adding montelukast as a pre-medication for daratumumab infusions led to a reduction in IRRs, and rapid rate administration was found to be safe after completion of two full doses of daratumumab.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-12T12:08:57Z
      DOI: 10.1177/10781552211072876
       
  • Impact of the COVID-19 pandemic on new starts to oral oncology medications
           in the US

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      Authors: Lynn Neilson, Monal Kohli, Kiraat D Munshi, Samuel K Peasah, Rochelle Henderson, Vida Passero, Chester B Good
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe COVID-19 pandemic has had a significant impact on healthcare delivery. Although others have documented the impact on new cancer diagnoses, trends in new starts for oncology drugs are less clear. We examined changes in new users of oral oncology medications in the US following COVID-19 stay-at-home orders in 2020 compared to prior years.MethodsWe examined prescription data for members enrolled with a national pharmacy benefits manager in the US from January 1-October 31 of 2018, 2019, and/or 2020. This is a retrospective, observational study comparing new users per 100,000 members per month for all oral oncology drugs, and separately for breast, lung, and prostate cancer, leukemia, and melanoma oral drugs. We performed a difference-in-differences analysis for change in new users from pre-period (prior to pandemic-induced disruption, January-March), to post-period (following pandemic-induced disruption, April-October), between 2020 and 2019, and 2020 and 2018.ResultsNew oral oncology drug users per 100,000 members per month declined by an additional 11.3% in the 2020 post-period compared to 2019 (p = 0.048). New oral breast cancer drug starts declined by an additional 14.0% in the 2020 post-period compared to 2019 (p = 0.040). Similar but non-significant trends were found between 2020 and 2018. No significant differences were found between post-period monthly new starts of leukemia, melanoma, lung or prostate cancer disease-specific oral medications.ConclusionsLong-term implications of delays in cancer treatment initiation are unclear, although there is concern that patient outcomes may be negatively impacted.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-11T03:26:39Z
      DOI: 10.1177/10781552211073778
       
  • The impact of medication reconciliation and review in patients using oral
           chemotherapy

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      Authors: Emeline Darcis, Jana Germeys, Marnik Stragier, Pieterjan Cortoos
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Background and aimVerifying and reviewing a patients medication list can detect and reduce drug related problems (DRPs). However little is known about its effects in patients using oral chemotherapy. The aim of this study was to evaluate the impact of these interventions and the adapted Medication Appropriateness Index (aMAI) as a tool to carry out a medication review.MethodsA case-control study was carried out. The hospital pharmacist performed a medication reconciliation and medication review, using the aMAI tool, in 54 patients starting oral chemotherapy. Discrepancies, DRP's and associated pharmaceutical interventions were reported via the electronic patient record (EPR). After one month, the acceptance rate was measured and the aMAI score recalculated. Kappa statistics were used to test intra- and interrater reliability.ResultsThe medication list in the EPR was incomplete in 74,1% of patients with an average of 2.4 errors per patient. After medication review, the aMAI score decreased significantly from 7.2 to 5.4 (SD  =  4,7; p
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-01-04T12:39:34Z
      DOI: 10.1177/10781552211066959
       
  • New and emerging therapies for the treatment of relapsed/refractory
           diffuse large B-cell lymphoma

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      Authors: Donald C. Moore, Matthew R. Peery, Katherine A. Tobon, Farah Raheem, Grace S. Hwang, Lin Alhennawi, Mitchell E. Hughes
      First page: 1848
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin lymphoma. Approximately 40% of patients with DLBCL will experience disease relapse or will be refractory to first line chemoimmunotherapy, necessitating second-line salvage therapy. This has historically consisted of platinum-based chemotherapy regimens followed by autologous hematopoietic stem cell transplantation with curative intent for transplant-eligible patients or palliative chemotherapy for transplant-ineligible patients. In recent years there have been several new therapeutic agents approved for the treatment of relapsed/refractory DLBCL, thereby expanding the therapeutic landscape. These agents include polatuzumab vedotin, tafasitamab, loncastuximab tesirine, selinexor, and anti-CD19 chimeric antigen receptor T-cell therapies such as axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. This review summarizes the pharmacology, efficacy, safety, dosing, and administration of new agents recently approved for the treatment of relapsed/refractory DLBCL.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-26T07:15:47Z
      DOI: 10.1177/10781552221096165
       
  • Non-pharmacological integrative therapies for chronic cancer pain

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      Authors: Maanya Rajasree Katta, Sai Sudha Valisekka, Pahel Agarwal, Maha Hameed, Swadha Shivam, Jasneet Kaur, Sakshi Prasad, Lakshmi Deepak Bethineedi, Diti Vinuthna Lavu, Yamini Katamreddy
      First page: 1859
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveChronic pain is one of the most detrimental symptoms exhibited by cancer patients, being an indication for opioid therapy in up to half of the patients’ receiving chemotherapy and in 90% of advanced cases. Various successful non-pharmacological integrative therapy options have been explored and implemented to improve the quality of life in these patients. This review aims to highlight the mechanisms implicated; assessment tools used for cancer pain and summarize current evidence on non-pharmacological approaches in the treatment of chronic cancer pain.Data sourcesA review of the literature was conducted using a combination of MeSH keywords including “Chronic cancer pain,” “Assessment,” “Non-pharmacological management,” and “Integrative therapy.”Data summaryData on the approach and assessment of chronic cancer pain as well as non-pharmacological integrative options have been displayed with the help of figures and tables. Of note, non-pharmacological integrative management was divided into three subcategories; physical therapy (involving exercise, acupuncture, massage, and transcutaneous electric nerve stimulation), psychosocial therapy (e.g. mindful practices, supportive therapy), and herbal supplementation.ConclusionsThe use of non-pharmacological integrative therapy in the management of chronic cancer pain has been grossly underestimated and must be considered before or as an adjuvant of other treatment regimens to ensure appropriate care.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-09T11:26:39Z
      DOI: 10.1177/10781552221098437
       
  • Long-term follow-up and future direction on the management of chronic
           lymphocytic leukemia/small lymphocytic leukemia

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      Authors: Kirollos S Hanna, Andrew Fijalka, Ian Watson, Olivia Brown, Apiew Ojulu
      First page: 1869
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      ObjectiveChronic lymphocytic leukemia and small lymphocytic lymphoma remain the most prevalent adult leukemia in Western countries. Novel therapeutics have established long-term efficacy and have changed the landscape in patient management. In contrast, novel approaches pose opportunities for patients to be treated for finite durations. In this manuscript, we highlight long-term safety and efficacy data with Bruton's tyrosine kinase inhibitors and combination BCL2 + anti-CD20 therapies. We also offer key considerations for treatment selection and outline ongoing trials which may continue to expand therapeutic options and approaches.Data sourcesAn electronic search of the PubMed database was performed to obtain key literature in chronic lymphocytic leukemia and small lymphocytic lymphoma published using the following search terms: chronic lymphocytic leukemia/small lymphocytic lymphoma, Richter syndrome, and histologic transformation. The search results were narrowed by selecting studies in humans published in English. Results were confined to the following article types: Clinical Trial, Phase II; Clinical Trial, Phase III; Clinical Trial, Phase IV; Guideline; Randomized Controlled Trial; Meta-Analysis; Systematic Reviews; and Validation Studies.Data summaryChronic lymphocytic leukemia and small lymphocytic lymphoma are different manifestations of the same disease and are managed in much the same way. Bruton's tyrosine kinase inhibitors have demonstrated long and durable efficacy benefits in patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma and in the relapsed/refractory setting. Despite these benefits, long terms adverse events have posed challenges for patients and have led to treatment discontinuations. Additionally, the use of monotherapy Bruton's tyrosine kinase inhibitor's requires chronic use of the medications leading to added financial implications. BCL2 inhibition with venetoclax in combination with anti-CD20 monoclonal antibodies has offered a novel and finite treatment approach in frontline and relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma. Ongoing clinical trials are in investigating this modality further to enhance durable responses utilizing a combination Bruton's tyrosine kinase inhibitor's and BCL2 inhibitors.ConclusionThe treatment armamentarium of chronic lymphocytic leukemia/small lymphocytic lymphoma continues to evolve. Despite the long term, durable responses with Bruton's tyrosine kinase inhibitor's, it is likely that finite treatment durations could become the standard of care as a result of continued, long-term responses.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-05-30T03:44:54Z
      DOI: 10.1177/10781552221103820
       
  • Pharmacy utilization of electronic patient-reported outcomes in oncology
           populations

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      Authors: Lauren M Aschermann, Michael Berger, Craig Vargo, Stephanie Collins, Julie Kennerly-Shah
      First page: 1885
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      Telehealth applications are demonstrated to be useful tools for patients with cancer to facilitate improvements in quality of care. The use of electronic patient-reported outcomes is one way to leverage telehealth to better understand outcomes important to patients. However, use of electronic patient-reported outcomes and direct involvement of pharmacists is not yet a standard practice across cancer centers. The use of pharmacist-led telehealth services offers a unique opportunity for pharmacists to provide cost-effective and convenient patient care interventions. This survey work describes the current practices of pharmacy utilization of electronic patient-reported outcomes in oncology populations at National Comprehensive Cancer Network member institutions. Of survey respondents, only 33% of the institutions reported current engagement with electronic patient-reported outcomes. These initiatives largely focused on symptom management. Limitations in staff, resources, and competing priorities limit many institutions from introducing or expanding upon direct pharmacist involvement in electronic patient-reported outcomes. Further work developing the involvement of pharmacists in electronic patient-reported outcomes will be an important way to leverage the growing landscape of telehealth within oncology and highlight the value of the pharmacist.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-08-24T07:57:47Z
      DOI: 10.1177/10781552221118926
       
  • Conjunctivitis associated with capecitabine treatment in a patient with
           colon cancer: The importance on educating patients into identifying
           adverse reactions

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      Authors: Marta Bello Crespo, Abel Trujillano Ruiz, María A. Gajete Pablos, Diana Marcela Roa García, Hernán Andrés Gioseffi
      First page: 1889
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionConjunctivitis is an inflammation of the conjunctiva, a thin translucent mucous membrane, characterized by a dilatation of the conjunctival vessels. Causes leading to conjunctivitis are diverse, being drug related one of them.Case reportWe report a case of an 80-year-old man with a diagnosis of relapsed stage IV colon cancer who developed a severe conjunctivitis, scar ectropion with lack of tissue and eversion of the subconjunctival conjunctiva after being treated with capecitabine.Management and outcomeCapecitabine was discontinued and pharmacological treatment was initiated with a complete resolution of the symptoms.DiscussionOcular toxicity derived from the use of systemic fluorouracil has been widely described in the literature, as well as the relationship between the use of capecitabine and the appearance of conjunctivitis. However, the development of severe conjunctivitis with other complications has not been previously reported. Monitor patients closely and perform full medication assessment should be undertaken when a patient reports visual changes to manage toxicity in the early stages. Following the patient evaluation and evolution and based on the Karch Lasanga algorithm modified by Naranjo, the adverse reaction is considered as probable.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-04-04T08:50:23Z
      DOI: 10.1177/10781552221078790
       
  • Familial breast cancer, pregnancy and cardiotoxicity associated with the
           use of doxorubicin and reaction with trastuzumab

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      Authors: Patricia Marques Soares Valente, Magda Conceição Barbosa Gomes, Wolney de Andrade Martins, Selma Rodrigues de Castilho
      First page: 1893
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionBreast Cancer (BC) is a neoplasm with the highest prevalence in women in Brazil and worldwide. Pregnancy-associated with BC is defined as that which occurs during pregnancy or within 1 to 2 years postpartum. The objective is to present a clinical case of a young patient with a history of familial BC who had cancer during pregnancy. The patient had cardiotoxicity after using doxorubicin and trastuzumab.Case reportShe was a young patient within infiltrating ductal carcinoma in the right breast She was diagnosed within nine weeks of gestation and submitted to neoadjuvant chemotherapy with AC protocol (doxorubicina and cyclophosphamide) and mastectomy. Developed left atrial overload after treatment and still responding to hypersensitivity to trastuzumab.Management and outcomeThe patient presented an alteration in the electrocardiogram (ECG) after the use of doxorubicin. The exam was repeated and the ECG was normal. Trastuzumab was started after delivery and the patient had a hypersensitivity reaction. Administration of trastuzumab was stopped and hydrocortisone was administered. The patient showed improvement in symptoms with cessation of trastuzumab.DiscussionAlthough anthracycline-induced cardiotoxicity and hypersensitivity reactions to trastuzumab are common reactions, there are few studies on the effects of these drugs in patients with Gestational breast cancer (GBC). Monitoring cardiotoxicity in breast cancer treatment in pregnant patients is essential to avoid two complications: for the pregnant woman and the fetus.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-24T04:40:33Z
      DOI: 10.1177/10781552221080081
       
  • Venetoclax ramp-up with concurrent voriconazole in a patient with chronic
           lymphocytic leukemia

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      Authors: Aaron Krapfl, Caleb McLeod, Rebecca Myers, Parameswaran Venugopal, Amanda Seddon
      First page: 1898
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionChronic lymphocytic leukemia (CLL) is commonly treated with the B-cell lymphoma 2 inhibitor (BCL-2) venetoclax. Venetoclax is associated with an increased risk of tumor lysis syndrome in this patient population. Because venetoclax undergoes CYP3A4 metabolism, strong CYP3A4 inhibitors are contraindicated during the ramp-up phase of venetoclax in patients with CLL.Case reportOur case report describes a 58 year old male initially diagnosed with CLL in 2013, whose first-line treatment consisted of ibrutinib. The patient developed a central nervous system (CNS) aspergillosis infection in 2018, and was initiated on voriconazole. He was subsequently under active surveillance until his disease progressed. The patient was started on venetoclax therapy, while on concomitant voriconazole, for management of his CLL.Management and outcomeThe patient's initial venetoclax dose was 10 mg daily, and he received rasburicase on day 1 of therapy. He tolerated a modified ramp-up phase without complication. After receiving 9 days of inpatient therapy, the patient was discharged on 50 mg of venetoclax to continue outpatient dose escalation. His dose was ultimately escalated to 100 mg daily.DiscussionAlthough this report describes the safe administration of venetoclax with voriconazole, extreme caution should be exercised when administering venetoclax with any strong CYP3A4 inhibitor during the ramp-up phase in patients with CLL.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-18T12:33:58Z
      DOI: 10.1177/10781552221082295
       
  • Lipegfilgrastim may cause hyperleukocytosis

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      Authors: Zekeriya Hannarici, Ali Yılmaz, Mehmet Emin Buyukbayram, Aykut Turhan, Salim Başol Tekin, Mehmet Bilici
      First page: 1902
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionGranulocyte colony-stimulating factors (G-CSF) are utilized both in the treatment and prophylaxis of chemotherapy-induced neutropenia. Lipegfilgrastim is a long-acting G-CSF. Albeit it provides ease of administration compared to short-acting GCSFs, some lipegfilgrastim-related adverse events may occur. Bone pain, widespread body pain, and feeling of fever are among common adverse effects, while rare but more serious adverse effects such as leukocytosis, spleen rupture, interstitial pneumonia, acute respiratory distress syndrome, capillary leak syndrome, hypokalemia, and glomerulonephritis may occur as well.Case reportWe reported a case of hyperleukocytosis that developed due to prophylactic administration of lipegfilgrastim following the first course of neoadjuvant pertuzumab (840–420 mg), trastuzumab (8–6mg/kg), and docetaxel (75 mg/m2) in a 45-year-old female patient with a diagnosis of breast invasive ductal carcinoma. The patient, who presented with weakness, loss of appetite, and oral intake disorder, had elevated white blood cell (WBC), lactate dehydrogenase (LDH), and uric acid levels in her test results. Peripheral smear (PS) had a left shift.Management and outcomeIntravenous 0.9% NaCl and peroral allopurinol were started to be administered to the patient. On the ninth day of hospitalization, the patient's clinical manifestation improved, and her WBC, LDH, uric acid, and PS returned to normal. Besides, the progression to tumor lysis syndrome (TLS) was prevented by appropriate hydration and allopurinol treatment. In subsequent chemotherapies (CTs), lipegfilgrastim was discontinued and filgrastim was started. The patient whose hyperleukocytosis did not recur was operated on following neoadjuvant CT. The patient's routine follow-up continues without any problems.DiscussionAlthough lipegfilgrastim-induced hyperleukocytosis has not been reported in the literature, it should be borne in mind that hyperleukocytosis and related complications may occur, as in our case.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-24T03:55:03Z
      DOI: 10.1177/10781552221082645
       
  • Experiences of the combined use of Favipiravir in patients using
           Lorlatinib and Brigatinib

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      Authors: Mustafa Buyukkor, Fatih Tay, Ozturk Ates
      First page: 1906
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe SARS-COV-2 (COVID-19) pandemic is challenging the management of cancer patients. In this article, we present two patients diagnosed with anaplastic lymphoma kinase (ALK) + non-small cell lung adenocarcinoma (NSCL CA), infected with COVID-19, who had a previous multi-line therapy with Brigatinib and Lorlatinib, and received Favipiravir for their current infection.Case reportsA 58-year-old man and a 65-year-old woman were diagnosed as ALK ( + ) NSCL CA. Both patients received tyrosine kinase inhibitors (TKI) for lung cancer when diagnosed with COVID-19. No adverse effects were observed with the concurrent use of Favipiravir, an antiviral drug currently used for COVID-19 and TKI.Management and outcomeConsidering the pharmacokinetic effects of favipiravir and the ALK inhibitor TKI's used on our cases (Brigatinib-Lorlatinib), the concurrent use of these drugs was safe and prevented the delay in the primary treatment of the malignancy of our patients.DiscussionTo our knowledge, these are the only reported cases diagnosed as ALK ( + ) NSCL CA who received favipiravir because of COVID-19 while using TKI, and both patients recovered completely without any side effects.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-28T12:43:58Z
      DOI: 10.1177/10781552221083321
       
  • Interstitial pneumonitis associated with leuprorelin acetate for a
           prostate cancer: A case report

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      Authors: Paula Lucía Villalba-Cuesta, Carmen Álvaro-Vegue, Carlos Girado Carrasco-Muñoz, Carmen Gomis-Goti, Adrián García-Villa
      First page: 1910
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAndrogen deprivation therapy remains the essential treatment for disseminated prostate cancer. Interstitial pneumonitis following this therapy has been documented for just a few cases. However, reported cases frequently describe the onset of symptoms after recent administration (days or a few weeks) of both GnRH analogues and androgen antagonists, which makes the precise individual impact of each treatment difficult to estimate.Case reportThis report presents a case of a 94-year-old patient with interstitial pneumonitis whose onset started three months after the first dose of leuprorelin and bicalutamide for a metastatic prostate cancer.Management and outcomeOnce other possible diagnosis were ruled out, empiric corticosteroid treatment was initiated within 48 h of the admission. A spectacular clinical and radiological improvement was observed after 3 doses of steroids, enabling the patient to recover his basal respiratory situation. We considered that the most probable cause was toxic interstitial pneumonitis induced by leuprorelin.DiscussionTo our knowledge, it describes the longest interval between last administration of antiandrogen therapy and the development of pneumonitis. This fact may support a direct relation with leuprorelin, whose serum levels remain high for months because of its long-acting depot formulation.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-02T01:23:16Z
      DOI: 10.1177/10781552221084058
       
  • Oxaliplatin related multiple focal nodular hyperplasia mimicking
           metastasis from a gastric cancer

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      Authors: Xavier A González-Ballesteros, David Muñoz-Leija, Ana C Muñoz-Díaz, Adrián A Negreros-Osuna
      First page: 1914
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionThe FOLFOX6 scheme is a combination drug chemotherapy that contains calcium leucovorin (folinic acid), fluorouracil, and oxaliplatin, the chronic use of chemotherapy with oxaliplatin can progress to focal nodular hyperplasia (FNH), which is a benign hepatic lesion.Case reportWe present a case of a 26- year-old female diagnosed with an ovarian mixed germ cell tumor with extension to the peritoneum, treated with 12 cycles in 9 months with neoadjuvant chemotherapy FOLFOX 6 scheme and oophorectomy. A three-year follow-up CT showed three nodular and hypervascular hepatic lesions suspicious of metastatic disease; an MRI with liver-specific contrast confirmed the diagnosis of FNH.Management and outcomeThe patient continued her follow-up without other treatment and metastatic disease.DiscussionWhile most multiple liver lesions in a patient with cancer will be suspicious of metastasis, a careful drug history should be obtained, as an oxaliplatin-related side effect to develop FNH has been reported. MRI with liver-specific contrast has a positive predictive value of 95% because of the biliary excretion through OATP1B3 transporter, expressed in functional hepatocytes and overexpressed in some liver tumors such as FNH, so it should be performed when FNH is suspected.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-02-28T04:20:27Z
      DOI: 10.1177/10781552221084617
       
  • A fatal disseminated cryptococcal infection in a patient treated with
           zanubrutinib for Waldenström’s macroglobulinemia

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      Authors: Dave Patel, Megan Sidana, Xolani Mdluli, Vallari Patel, Ann Stapleton, Constantin A Dasanu
      First page: 1917
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionZanubrutinib is a second generation, irreversible small-molecule Bruton tyrosine kinase inhibitor (BTK) approved for the treatment of Waldenström's macroglobulinemia, mantle cell lymphoma, and marginal zone lymphoma. As a class, BTKs have been linked with an increased risk of respiratory infections in clinical trials.Case ReportWe describe a 75-year-old patient who presented with generalized weakness, fevers, dyspnea, and dry cough four months after starting zanubrutinib therapy for Waldenström's macroglobulinemia. He was subsequently diagnosed with pneumonia. Septic work-up led to diagnosis of disseminated cryptococcal infection, complicated by fungal pneumonia and meningitis.Management and outcomeZanubrutinib was held on admission, and the patient was started on combination oral and intravenous antifungal therapy. Despite clearance of fungemia, aggressive resuscitation, and appropriate antimicrobial therapy, respiratory status deteriorated requiring intubation. His condition progressed to septic shock, multiorgan failure, and demise.Discussion/ConclusionWe report herein a case of fatal disseminated cryptococcosis in the setting of zanubrutinib use for Waldenström's macroglobulinemia. At the time of diagnosis, his Waldenström's macroglobulinemia was in a partial response. The mechanism by which Bruton tyrosine kinase inhibitors (BTKs) lead to invasive fungal infections in these patients remains to be explored. T- and B-cell immune defects accompanying low-grade B-cell lymphomas may contribute to the severity of these infections.
      Citation: Journal of Oncology Pharmacy Practice
      PubDate: 2022-03-21T08:44:04Z
      DOI: 10.1177/10781552221087730
       
  • Fluconazole-Induced adrenal insufficiency following allogeneic
           hematopoietic cell transplant

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      Authors: Craig W. Freyer, Alison W. Loren
      First page: 1922
      Abstract: Journal of Oncology Pharmacy Practice, Ahead of Print.
      IntroductionAdrenal insufficiency (AI) is a potentially life-threatening endocrine abnormality rarely associated with azole antifungals. Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) are at high risk of invasive fungal infection and frequently receive azoles. Signs and symptoms of AI, such as gastrointestinal symptoms, lethargy, and electrolyte disturbances frequently overlap with common alloHCT toxicities, such that azole-induced AI may be u