Journal of Oncology Pharmacy Practice最新文献

Purpose: CDK4/6 inhibitors, such as ribociclib, are recommended in combination with hormonal therapy to treat advanced/metastatic hormone receptor-positive, HER2-negative breast cancer. The objectives of this study are to evaluate the therapeutic outcome and tolerance of ribociclib in patients treated at our institution.

Methods: The initial cohort of patients who received >1 cycle of ribociclib between December 2018 and March 2022 were included. Rates of adverse events (AEs) related dose reduction and discontinuation of ribociclib were used as a surrogate marker for intolerance.

Results: Sixty-eight female patients were included. Ribociclib was administered with letrozole or fulvestrant in the first-, second-, third-, and fourth-line palliative hormonal therapy settings in 29 (42.6%), 26 (38.2%), 12 (17.6%) and 1 (1.5%) patients respectively. Adverse events (AEs) related dose reduction was reported in 30 (44%) patients. Ribociclib was permanently discontinued in 42/68 (61.8%) patients [Disease progression 33/68 (48.5%) and AEs 9 (13.2%)]. Objective response was documented in 10/61 (16.4%) evaluable patients. The median progression free survival (PFS) was 18 months (95% CI: 11.7-24.3). The median overall survival (OS) was not reached and 84% of patients were alive at 3 years.

Conclusions: Although objective response rates were modest in this mixed cohort of heavily pretreated patients, ribociclib combined with letrozole or fulvestrant has shown robust PFS and OS in real-world practice. AEs related treatment discontinuation rate is higher than that reported in clinical trials with stringent inclusion criteria.

Introduction: Urothelial carcinoma is the prevailing type of bladder cancer, characterized by expression of the programed death-ligand-1-protein (PD-L1). Avelumab is an anti-PD-L1 monoclonal antibody used in urothelial carcinoma. It is associated with an incidence of 47.4% and 25.2% in grade 3 adverse events or greater, respectively; gastrointestinal symptoms and cutaneous affections are the most common.

Case report: A 52-year-old male with a history of rectal cancer and non-muscle-invasive bladder carcinoma. PET/CT revealed adenopathies in the pelvic region, the biopsy confirmed metastatic urothelial carcinoma. Next PET/CT indicated progression. Treatment with Cisplatin + Gemcitabine led to complete response after 4 cycles. Maintenance with Avelumab was indicated. Fifteen minutes after the first Avelumab administration, the patient experienced hypotension, presyncope, skin itching, and nasal congestion. Epinephrine, hydrocortisone, and physiological solution were administered, with resolution of symptoms.

Management & outcome: Since Avelumab is first-line maintenance therapy in this patient, a desensitization protocol was performed with (3-bag, 12-steps). The patient was premedicated with acetaminophen and chlorpheniramine. The protocol was successfully completed without hypersensitivity reactions for 6 cycles.

Discussion: Patients with hypersensitivity reactions to their first line of treatment are challenged to continue the best approach. We detail the case of a patient diagnosed with metastatic urothelial carcinoma who underwent a desensitization protocol for Avelumab after presenting a severe allergic reaction. The patient tolerated Avelumab throughout the protocol with no complications, achieving the total dosage for his maintenance therapy; drug desensitization is a safe and effective procedure in patients with hypersensitivity reactions to their first-line treatment.

Introduction: This study aims to evaluate the effect of bevacizumab treatment on the incidence of hypertension in patients with ovarian cancer.

Methods: A comprehensive search of PubMed, Scopus, Embase, Cochrane, Web of Science, and Google Scholar databases was conducted until August 2024. We included only randomized clinical trials that compared ovarian cancer patients treated with Bevacizumab to those treated with other therapies. The primary outcome was the relative risk (RR) of developing hypertension, stratified by grade. Statistical analyses were performed using a random-effects model to account for heterogeneity between studies. Subgroup analyses were conducted based on hypertension severity (grade ≥2 and grade ≥3) and disease stage. Sensitivity analyses and publication bias assessments were also performed.

Results: A total of 11 randomized trials were included, comprising 5212 patients. The meta-analysis revealed that patients receiving Bevacizumab had a significantly higher risk of hypertension compared to controls (RR = 2.91, 95% CI: 1.65-5.16, P = 0.0002). Subgroup analysis showed that the risk of grade ≥2 hypertension was 1.68 times higher (95% CI: 0.92-3.07), and grade ≥3 hypertension was 5.10 times higher (95% CI: 2.46-10.55) in the Bevacizumab group. Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected.

Conclusion: Bevacizumab treatment in ovarian cancer significantly increases the risk of hypertension, particularly severe hypertension (grade ≥3). These findings underscore the need for vigilant blood pressure monitoring and management in patients receiving Bevacizumab to mitigate cardiovascular complications and optimize treatment outcomes.

Introduction: Patients diagnosed with cancer are often prescribed a wide range of medicines. In this study, it was aimed at examining the end-of-life symptoms and polypharmacy status of patients hospitalized in the palliative care unit with the diagnosis of lung cancer and other cancers.

Methods: The data for the retrospective-descriptive study were obtained from hospital records and an automation system. The sample of the study included the data of all patients (n = 201) who were hospitalized in the palliative care unit between 2016-2021 in Turkey.

Results: The most common symptoms of end-of-life patients were dyspnea (85.1%) and pain (67.7%). The mean number of medications used by the patients on the day of death was 10.89 ± 3.16, it was 12.50 ± 3.11 on the third day before death, 13.24 ± 3.07 on the 6th day before death, 13.50 ± 3.03 on the 9th day before death. There was a statistically significant difference between the mean number of medications used by the patients according to the presence of dyspnea on the day of death (t = 1.997; p = .047) and pain on the day of death (t = 3.781; p = .001). There was a statistically significant difference between the mean number of medications used by the patients according to the presence of pain on the sixth day before death (t = 2.613; p = .010) and the ninth day before death (t = 2.940; p = .004).

Conclusion: The number of medications used by the patients decreased from the 9th day before death to the day of death and their polypharmacy status continued.

Background: Patients with Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL) ineligible for Hematopoietic Stem Cell Transplantation (HSCT) may benefit from a second line anticancer drug regimen but real-life outcomes are lacking.

Objective: To describe the efficacity of 3 anticancer drug regimens (Gemcitabine and Oxaliplatin GEMOX; Ifosfamide and Etoposide IE; Cyclophosphamide, Etoposide, Procarbazine and Prednisone CEPP) combined with Rituximab (R-) in terms of progression-free (PFS) and overall survival (OS).

Patients: Retrospective study including R/R DLBCL patients HSCT ineligible who received at least one cycle of R-GEMOX, R-IE or R-CEPP between 2010 and 2022. Demographic, clinical, biological and survival data were collected. Univariate and multivariate analysis were performed to identify associated variables with survival outcomes.

Results: Sixty-two patients (median age 78 [40-102] with predominantly stage III-IV DLBCL (n = 49, 79%), non-germinal center-B like (n = 27, 44%) were included. Median OS and PFS were 9 (CI95% [3-10]) and 4 months (CI95% [2-13]) for R-GEMOX, 4 (CI95% [2-6]) and 1 month (CI95% [1-4]) for R-IE and 5 (CI95% [3-6]) and 3 months (CI95% [2-15]) for R-CEPP, respectively. Univariate analysis selects ECOG, aa-IPI scores, LDH rate and Ann-Arbor stage with no independently association in multivariate analysis.

Conclusion: All three regimens show modest survival benefit especially between last anticancer treatment course and death. Emergence of bispecific antibodies and Cart-cells for which real-life benefits have yet to be demonstrated could be coupled with improved access to early palliative care.

Cancer presents significant physical and mental challenges to patients. Therefore, psychological assessment is important following a cancer diagnosis, as well as during and after chemotherapy. In cancer treatment, the goal of healthcare providers, including pharmacists, should be to deliver holistic care that addresses important aspects of patients' health, with particular emphasis on their psychological readiness to combat their diseases. This article reviews published literature from Google Scholar and PubMed to examine the relevant pharmacotherapy and psychotherapy approaches to managing psychological issues in cancer patients. This article also discusses how pharmacists can be integrated into cancer patients' mental health care, while highlighting the potential benefits and challenges associated with this approach. We conclude that the integration of pharmacists into psychological care and support for cancer patients holds promise due to their knowledge of cancer chemotherapy, their ability to improve their knowledge about psychological care, and their capacity to collaborate with other healthcare professionals in cancer treatment.

Study objective: Complex pharmacotherapy in cancer patients increases the likelihood of drug-drug interactions (DDIs). Pharmacists play a critical role in the identification and management of DDIs. The aim of present study was to evaluate the role of pharmacist in identifying antifungal drug interactions in cancer patients and providing relevant recommendations.

Methodology: A retrospective, cross-sectional study was conducted to identify antifungal drug interactions over the period of 5 years (2019-2023) among cancer patients. Electronic medical record of 384 hospitalized patients receiving systemic antifungal therapy were reviewed. Severity of interactions and risk classification were made using UptoDate^® Lexidrug^TM software. Pharmacists' recommendations regarding DDIs were also documented. Descriptive statistics and logistic regression were applied to interpret results.

Results: Antifungals were more frequently prescribed to adult patients (53.9%). Female cancer patients were significantly more likely to encounter DDIs than males (p < 0.003). Type of cancer and fungal infections were significantly associated with incidence of DDIs (p < 0.01; p = 0.000). Pharmacist identified DDIs in 53.9% antifungal prescriptions with 22.2% classified as major interactions. A substantial proportion of these interactions involved voriconazole (40.1%). Majority of pharmacist's recommendations included dose optimization of voriconazole (10.4%), close monitoring of RFTs (8.9%) and withholding amphotericin (5.2%) during chemotherapy. All of the recommendations made by pharmacists were accepted by physicians (100%).

Conclusion: The findings indicate that pharmacists identified DDIs in 53.9% of prescriptions and all of their recommendations were accepted by physicians. This highlights the critical role of pharmacists in detecting potential interactions, ensuring medication safety, and minimizing adverse effects associated with complex pharmacotherapy.

Objectives: To underscore the prevalence and mortality of breast cancer and review advancements in metastatic TNBC management, with a particularly focus on the role of antibody-drug conjugates (ADCs), emphasizing the safety and therapeutic potential of Sacituzumab govitecan (SG) as a groundbreaking ADC.

Data sources: This review gathers scientific data from the past decade, sourced from PUBMED, ClinicalTrials.gov, and Google Scholar to retrieve relevant studies focused on SG in metastatic TNBC treatment.

Data summary: Breast cancer is the most common cancer in women, with TNBC being particularly aggressive and difficult to treat. Recent advancements, such as ADCs, have enhanced treatment options. The third-generation Trop-2-targeting ADC, SG, shows promise for metastatic TNBC. This review summarizes available scientific data on SG's safety, efficacy, and future potential. It also discusses ongoing clinical trials evaluating SG in various combinations, offering hope for improved therapeutic strategies in this high-risk group.

Conclusions: ADCs hold great promise for transforming anti-tumor therapies over the next decade and SG has demonstrated substantial efficacy and a manageable safety profile in treating metastatic TNBC. Ongoing trials show that combining SG with immunotherapies enhances its potential, offering hope for better outcomes in patients with limited options. These findings highlight the need for further research to fully define SG's role in optimizing treatment strategies.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but potentially severe condition that significantly affects the quality of life of patients with cancer. This study evaluated MRONJ in patients with cancer treated with zoledronic acid (ZOA) and denosumab (Dmab).

Methods: The survey investigated patients who were diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery after receiving either ZOA or Dmab at the Saitama Medical Center, Saitama Medical University, between April 1, 2022, and March 31, 2023.

Results: Of 252 patients, 27 were ZOA users and 225 were Dmab users. MRONJ was not observed with ZOA. MRONJ was detected in 11 (4.9%) Dmab users, eight male and three female patients with a mean (± standard deviation) age of 74.6 (± 9.2) years (range 61-98 years). The total dose of Dmab was 2724 ± 1838 mg (range: 480-6360 mg). The time from Dmab administration to MRONJ onset was 28.0 ± 16.0 months (range 4.5-53.2 months). Of the 11 patients with MRONJ, four (36.4%) had visited a dentist within the last 12 months. One participant (9.1%) was informed about and understood MRONJ.

Conclusions: MRONJ was only observed in Dmab users, with an incidence rate of 4.9%. The percentage of patients with MRONJ receiving regular dental check-ups was 36.4%, and only 9.1% of patients were aware of MRONJ, both of which are low rates. To reduce MRONJ in patients with cancer, face-to-face consultations with pharmacists could serve as a valuable opportunity to inform patients about MRONJ and encourage regular dental visits.

Chemotherapy-induced peripheral neuropathy is a debilitating pain condition resulting from cancer treatment and is known to be associated with a decrease in health-related quality of life. This single-center cross-sectional study, conducted at Institute of Nuclear Medicine Oncology and Radiotherapy (INOR), Abbottabad, Pakistan, assessed the prevalence and severity of chemotherapy-induced peripheral neuropathy and its impact on quality of life in cancer patients undergoing chemotherapy. Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-CIPN20 questionnaires. Subscales are scored from 0 to 100, with higher scores indicating greater symptom severity. A total of 154 patients participated, with a mean age of 48.57 years (SD 14.22); 33.8% were male and 66.2% were female. The prevalence of sensory CIPN was 36.4%. The mean scores for the sensory, motor, and autonomic subscales of the QLQ-CIPN20 were 23.2 (SD 19.1), 16.6 (SD 15.8), and 14.8 (SD 17.2), respectively. CIPN symptom severity was negatively correlated with global health status/quality of life and physical, role, emotional, cognitive, and social functioning. There was no significant association with age, sex, body surface area, height, weight, or type of chemotherapeutic agent used. However, symptom severity increased with the number of treatment cycles completed (e.g., sensory, p = 0.003). CIPN was prevalent in this healthcare center and significantly impacted function and quality of life. These findings highlight the importance of developing strategies to mitigate CIPN and the need for routine screening of CIPN.