Journal of Oncology Pharmacy Practice最新文献

BackgroundShortening chemotherapy infusion times is associated with improvements in resource use and patient satisfaction, as well as reductions in nursing workload and clinic wait times. Cyclophosphamide package inserts mention that the drug should be injected or infused very slowly, but the exact duration of infusion is not specified. Per literature review, there is heterogeneity in infusion times among regimens for various conditions.MethodsThe aim was to analyze the incidence of documented adverse events (AEs) temporally related to cyclophosphamide when it was administered as either a 60- or 30-minute infusion. We performed a retrospective chart review of records between January 1, 2023, and January 31, 2024, including adult patients (age >= 18 years) who received at least one cyclophosphamide infusion over 60- or 30-minutes within selected chemotherapy regimens for lymphoma (CHOP +/- R; EPOCH +/- R; CHOEP +/- R) or multiple myeloma (MM) (CyBorD or VCD +/- Dara; KCyD +/- Dara) at any inpatient or outpatient site within Mount Sinai Health System (MSHS).ResultsAmong 200 consecutive doses evaluated per disease-based group (n = 400 total doses), there were more numerical occurrences of documented AEs in the 60-minute groups compared to 30-minutes groups (n = 4 vs. n = 2), but this finding was not statistically significant (2% vs. 1%; p > 0.05). There were no documented Grade 3 or higher AEs temporally related to cyclophosphamide infusion.ConclusionThe shortening of cyclophosphamide infusion times for selected chemotherapy regimens was determined to be a safe practice change.

IntroductionMelanoma, though relatively rare, is the most aggressive form of skin cancer due to its high metastatic potential and mortality rate. Immunotherapy, such as pembrolizumab, has improved outcomes for patients. However, access to these therapies remains limited in low- and middle-income countries, including Brazil, where real-world evidence is scarce and population genetics may influence treatment response and adverse drug reactions (ADRs).ObjectiveThis study aimed to analyze the effectiveness and safety of first-line treatment for advanced melanoma with pembrolizumab, with a focus on the kinetics of ADRs.MethodsThis retrospective study included patients from the Brazilian Public Health System, with a follow-up period of 1 year (CAAE: 95157018.9.0000.5274).ResultsThe study analyzed 40 patients (57.5% male, median age 65.5 years). The most frequent primary site of melanoma was the lower limbs (47.5%), and the main histological types were acral (30%) and nodular melanoma (30%). ADRs were identified in 87.5% of the patients, with pruritus (40%) and vitiligo (37.5%) being the most common. Cutaneous reactions were observed in the early cycles and persisted until the end of treatment. The cohort exhibited a different ADR profile and fewer severe events (10.5%) compared to clinical trials. The median progression-free survival was 7.7 months, and the overall survival rate was 60%.ConclusionPembrolizumab was effective and safe as a first-line treatment for advanced melanoma patients in a real-world Brazilian public health setting. Additionally, we characterized the kinetics of ADRs, offering practical insights for healthcare teams in managing these events throughout the treatment course.

Backgroundmhealth interventions are increasingly adopted to improve cancer care in low- and middle-income countries. Despite their potential, evidence on cost-effectiveness in oncology remains limited in India. This study evaluates the cost-utility of the OncoCare mobile application for oncology patients.MethodsA trial-based cost-utility analysis was conducted alongside a six-month randomized controlled trial (n = 342; App: 168, Control: 174). Costs were estimated from the provider's perspective using a micro-costing approach, including development costs and prorated annual maintenance costs. Health outcomes were measured using the EORTC QLQ-C30 and mapped to EQ-5D-5L utilities via an ordinal-logit algorithm, applying the Indian EQ-5D-5L tariff. QALYs were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios were estimated, with uncertainty explored through bootstrap replications, cost-effectiveness planes, and cost-effectiveness acceptability curves. Sensitivity analyses assessed alternative cost assumptions.ResultsThe per-patient incremental cost of OncoCare was ₹597 (₹642 including maintenance). Mean six-month QALYs were 0.249 in the App group compared to 0.239 in the control group. The adjusted incremental QALY gain was 0.0107 (95% CI: 0.0042-0.0174). The base-case ICER was ₹55,600 per QALY, well below both the opportunity-cost threshold for India (approximately ₹2.1 lakh/QALY) and the WHO's GDP-per-capita heuristic. The probability of cost-effectiveness exceeded 82% at ₹100,000/QALY and 95% at ₹150,000/QALY. Headroom analysis confirmed the cost-effectiveness, even with per-patient costs three- to five-fold higher.ConclusionOncoCare is a cost-effective digital intervention in Indian oncology, achieving measurable QALY gains at low incremental cost. These findings support its integration into cancer care pathways and national digital health strategies.

IntroductionThere is limited guidance available to indicate next steps when a child vomits after taking an oral medication. Vomiting is a frequent problem in pediatric oncology.MethodsThe primary objective was to describe factors influencing healthcare practitioners' decisions to re-dose oral medications, including chemotherapy, after vomiting in pediatric oncology patients. The primary outcome was the proportion of respondents who list a factor influencing their decision as "very important". Secondary objectives were to describe protocols and practice. An online survey was distributed via email networks to approximately 3600 nurses and 1470 pharmacists at pediatric oncology and Stem Cell Transplant centers in North America. Survey responses were analyzed using descriptive statistics and content and thematic analyses for the open-ended questions.ResultsOf the 110 responses received, 87 were included. Response rate could not be calculated, which has implications for non-response bias. Participants reported patients vomiting after oral medication occurred either weekly (41%) or monthly (33%). Seventy-four participants indicated they followed a general rule for re-dosing oral chemotherapy medications after vomiting, with 62% indicating they would re-dose if vomiting occurred within 30 min of the dose. The most important factors impacting the decision to re-dose were time after dose ingestion (77%), type of medication (67%) and whether the medication is an investigational drug (54%). Twenty-four participants reported that their institute had a guideline to assist with making the decision to re-dose a medication after vomiting.ConclusionsThe problem of vomiting after the administration of an oral medication is prevalent; however, there are few guidelines available.

IntroductionHigh-dose systemic methotrexate (HD-MTX) in doses ≥ 3 g/m² is the cornerstone of treatment for central nervous system (CNS) lymphomas and prophylaxis for patients with high-risk of CNS relapse. Its administration requires extensive supportive care until serum clearance is achieved. Risk factors for delayed methotrexate (MTX) clearance and renal injury are well-characterized and include baseline renal function, age, and hypoalbuminemia. Data assessing characteristics associated with slow terminal clearance are lacking.MethodsWe performed a single-center, retrospective cohort study between 1/2015 to 10/2023 to evaluate characteristics associated with the rate of MTX clearance in the 72 h after serum MTX levels decline to below 0.2 µmol/L in adult patients with lymphoma who received MTX at doses ≥ 3 g/m². MTX administration was evaluated at the cycle level with slow terminal clearance (STC) defined as > 72 h to clear from < 0.2 µmol/L to < 0.05 µmol/L.ResultsOverall, 135 patients were included with a total of 462 cycles, median of 3 cycles, and 76 (56.3%) experienced at least one cycle of STC. Of 462 cycles, 138 (29.9%) were STC. Multivariable analysis, based on variables significant by univariable analysis, identified that age ≥ 80 years, BMI > 30 kg/m², first MTX level > 10.0 µmol/L, and acute kidney injury (AKI) after MTX administration were significantly associated with STC.ConclusionUtilizing clinically and statistically significant variables from our analyses, we advocate for the development and validation of a model to inform supportive care management once MTX levels decline below 0.2 µmol/L.

Introduction: Immune checkpoint inhibitors (ICIs) can trigger cutaneous immune-related adverse events (irAEs), including rare follicular eruptions such as lichen planopilaris (LPP).

Case report: We report a 75-year-old woman with stable, biopsy-proven LPP who developed disease reactivation after ten cycles of pembrolizumab for stage IIC melanoma.

Management & outcome: Despite ongoing treatment with hydroxychloroquine and topical clobetasol, disease activity progressed. Oral doxycycline was added. After ten months of adjunctive therapy and completion of pembrolizumab, the disease stabilized, though areas of scarring alopecia persisted. The patient remains under multidisciplinary follow-up.

Discussion: LPP is an underrecognized follicular irAE. The timing, clinical course, and histopathologic findings suggest pembrolizumab-induced exacerbation. Causality was assessed using the Naranjo Algorithm, with a score of 6, indicating a probable adverse drug reaction. This case reinforces the importance of early recognition and tailored dermatologic care in patients receiving ICI therapy.