Journal of Oncology Pharmacy Practice最新文献

ObjectiveWith the increasing incidence of cancer worldwide, injectable anticancer agents are being increasingly prescribed for outpatients in day care oncology units. These drugs are prepared in hospital pharmacy cytotoxic units. This paper explores delay factors and pharmacist-led solutions to reduce patients' waiting time for antitumor treatment infusion in day care cancer hospitals.Data SourcesA literature review was carried out using PubMed and other sources, including conference abstracts and relevant publications. The main search terms included "chemotherapy," "waiting time," "oncology," "outpatient," "pharmacy," "pharmacist," and "satisfaction," combined with AND/OR operators. Available data were analyzed and complemented by our pharmaceutical and clinical expertise.Data SummaryBased on published works, we examined the negative impacts of delays on patients' well-being, the role of hospital pharmacists in decreasing these delays and provided our perspective.DiscussionCancer patients already face multiple emotional and physical challenges. Long waiting time can further heighten patients' anxiety and stress. Delays in the delivery of anticancer infusions can be caused by various factors, including logistical problems, drug supply delays, and administrative issues. To minimize these delays, several initiatives can be implemented, such as efficient treatment planning, early prescription and preparation in advance, robotization to enhance productivity, proactive lean management, and improved communication between care teams.ConclusionsIt is important for hospital pharmacists to define a dispensing time for injectable anticancer treatments and monitor it as a quality indicator. Collaboration between pharmacists and physicians to establish this critical threshold will help optimize care and improve the patient's experience.

ObjectiveNursing professionals are frequently exposed to a variety of chemical agents in healthcare settings, including disinfectants, anesthetic gases, cytotoxic drugs and other hazardous substances, raising concerns about potential genotoxic effects. This systematic review investigates the genotoxicity associated with occupational exposure commonly encountered by nursing staff.MethodsA systematic search conducted in August 2025 across PubMed, SCOPUS, and Web of Science identified 16 relevant studies that evaluated DNA damage using biomarkers, such as the micronucleus assay, comet assay, and chromosomal aberration tests in human or mammalian cells.ResultsAll included studies consistently reported genotoxic effects linked to occupational exposure, including increased frequencies of micronuclei, DNA strand breaks, and chromosomal alterations. Quality assessment indicated that 15 (out of 16) studies were of moderate to strong methodological rigor, supporting the reliability of these results.ConclusionThese findings underscore the need for enhanced monitoring and protective measures for nursing professionals at risk of long-term genetic damage. The micronucleus assay emerges as a suitable assay for biomonitoring these professionals.

ObjectiveTo review the safety and tolerability of intrathecal (IT) chemotherapy used in the treatment of leptomeningeal disease (LMD) from solid and hematologic malignancies, with emphasis on agent-specific toxicity profiles and delivery-associated adverse effects.Data SourcesThis review synthesizes data from prospective and retrospective clinical studies and pharmacokinetic analyses evaluating IT chemotherapeutic agents for LMD. Agents reviewed include methotrexate, cytarabine, pemetrexed, topotecan, etoposide, thiotepa, trastuzumab, and intrathecal immune checkpoint inhibitors. Systemic pharmacokinetic and toxicity data were reviewed to contextualize adverse effects of IT chemotherapy.Data SummaryIntrathecal chemotherapy was generally associated with predominantly low-grade toxicities. Common adverse events included headache, nausea, vomiting, meningismus, fatigue, and radicular or myelopathic symptoms. Methotrexate and cytarabine were the most frequently utilized IT agents and demonstrated higher risks of neurotoxicity, including chemical arachnoiditis, encephalopathy, and leukoencephalopathy, particularly with cumulative dosing and concurrent radiotherapy. Pemetrexed and topotecan demonstrated favorable tolerability across multiple studies, with infrequent grade ≥3 toxicities. Targeted IT therapies, including trastuzumab and immune checkpoint inhibitors, were associated primarily with mild and self-limited adverse events in early studies. Delivery-related toxicities were generally manageable, with Ommaya reservoir administration associated with improved drug distribution and treatment feasibility.ConclusionsIntrathecal chemotherapy for LMD is generally safe and well tolerated, however, methotrexate and cytarabine are associated with higher neurotoxicity risk. Newer intrathecal agents demonstrate favorable safety profiles and may represent tolerable treatment options for select patients.

Objective: This study aimed to investigate changes in hepatotoxicity associated with the concomitant use of tyrosine kinase inhibitors (TKIs) with Acid suppressants (AS), and to explain the underlying mechanisms.

Data sources: The PubMed, Scopus and Web of Science databases were searched up to July 1, 2025. We started the search on May 1, 2025. Relevant data on hepatotoxicity alternations and their associated mechanisms were extracted and analyzed.

Data summary: Concomitant use of gefitinib, erlotinib, crizotinib and lapatinib with antacids (proton pump inhibitors or H2 receptor antagonists) was associated with increased hepatotoxicity. This effect is attributed to hepatic drug accumulation due to the inhibition of efflux transporters (ABCB1 and ABCG2), which outweighs the reduction in drug absorption caused by elevated gastric pH. Imatinib, showed divergent results: increased hepatotoxicity when combined with PPIs but reduced hepatotoxicity with H2RAs, likely due to additional transporter-related interactions. In the case of nilotinib, reduced drug absorption resulting from increased gastric pH appeared to be the dominant mechanism, leading to decreased hepatotoxicity. For TKIs such as pazopanib and cabozantinib, no significant change in hepatotoxicity was observed with AS coadministration.

Conclusion: The impact of coadministration of TKIs with antacids on hepatotoxicity varies depending on the specific TKI and its pharmacokinetic characteristics. These interactions highlight the need for careful evaluation and monitoring in clinical practice.

IntroductionSacituzumab govitecan is approved for the treatment of triple-negative advanced/metastatic breast cancer and hormone-receptor positive, HER2-negative advanced/metastatic breast cancer. Clinical trials show favorable improvements in progression-free survival (PFS) and overall survival (OS). However, they report a large percentage of patients experiencing hypersensitivity reactions. It has been observed that use of sacituzumab govitecan at [redacted institution] may have a lower rate of hypersensitivity reactions than seen in clinical trials.MethodsThis study aimed to determine the real-world data of PFS and OS of sacituzumab govitecan while evaluating the incidence and severity of hypersensitivity reactions. It was a retrospective, single-center, multi-site study conducted across [redacted], which included adult patients who received at least one dose of sacituzumab govitecan from April 1, 2020 to July 31, 2024 for an FDA-approved breast cancer indication.ResultsA total of 75 patients met the inclusion criteria for assessment. The median PFS was 2.8 months (95% CI, 0.0-14.4) and the median OS was 7.2 months (95% CI, 0.0-19.3). No hypersensitivity reactions were reported, hence reaction severity was not assessed nor associated with treatment discontinuation.Conclusion and RelevanceThis study demonstrated that PFS and OS may be shorter than estimated in clinical trials. However, baseline performance status and previous lines of therapy were not evaluated and thus may have impacted the results. Additionally, no hypersensitivity reactions were observed. From review of this data, the low risk of reactions helps justify future research to assess the necessity of certain premedications and/or elimination of observation times.

IntroductionMultiple myeloma (MM) is a common hematologic cancer treated with bortezomib, a 26S proteasome inhibitor supplied by the Brazilian Unified Health System (SUS). Limited post-reconstitution stability leads to drug waste, though studies suggest longer stability if sterility is maintained. Closed-system transfer devices (CSTDs) may enable safe reuse and reduce waste.This study evaluated, using a cost-focused simulated model based on retrospective consumption data, the impact of incorporating the CTSD on direct hospital costs related to the handling of the last bortezomib vial of each day in a Brazilian public oncology hospital.MethodsRetrospective observational and quantitative study, considering all bortezomib vials used in a brazilian hospital between January 1 and December 31, 2024. Prescribed, used, and discarded volumes were analyzed. An alternative scenario with CSTD use was simulated, allowing reuse of leftovers for up to seven days, based on literature data regarding physicochemical and microbiological stability.ResultsIn 2024, 245 patients received bortezomib. A total of 4296 doses were administered, consuming 2837 vials. The CSTD simulation reduced 114 vials but resulted in a 2.76% increase in total cost (R$ 125,789.92 vs. R$ 122,416.55). An increase in treated patients (256 vs. 245) and completed cycles (1118 vs. 1074) was observed.ConclusionAlthough direct cost reduction was not achieved, CSTD use may eliminate waste, expand patient access, and optimize public healthcare resources.

PurposeRecent publications have explored workload and productivity to improve oncology pharmacy practice. The Hematology/Oncology Pharmacist Association (HOPA) aimed to build upon this research by assessing task valuation.MethodsA web-based survey was fielded from 1/16/25-2/13/25. Eligible respondents were oncology pharmacists reporting experience with tasks related to 3 categories: direct patient care, non-direct patient care, and education/professional development. After validation, the final survey was estimated to take 10 min to complete and included 22 questions assessing valuation of workplace tasks separated into categories.Results676 responses were included. Most respondents completed post-graduate training and were board-certified in oncology. Median years in practice and in current role were 10 years and 4 years, respectively. Direct patient care was the highest ranked task category followed by education/professional development and non-patient care tasks. The most valued tasks by category were communicating with the interdisciplinary team, precepting learners, and creating standardized treatment plans, respectively. Ordinal logistic regression models did not identify any specific variables that significantly impacted results. Tasks associated with lower job satisfaction included facilitating medication access, ensuring compliance, and completing annual competencies.ConclusionWorkforce challenges, including burnout and inadequate metrics, threaten job satisfaction and retention of oncology pharmacists. Identification of tasks valued by oncology pharmacists, coupled with other practice factors such as workload and productivity, provides a more comprehensive picture of the pharmacy workforce landscape. These findings can guide strategic decisions to expand high value services and re-align lower valued tasks, with the ultimate goal of enhancing job satisfaction and improving retention.

IntroductionWith the introduction of Paxlovid™ (a combination of nirmatrelvir and ritonavir) in Canada, a clinical gap was identified for patients with cancer. These patients often take multiple medications with complex mechanisms that can interact with Paxlovid™ (due to ritonavir's potent and irreversible inhibition of CYP3A4 by ritonavir). When this pharmacist-led drug interaction assessment service was started in February 2022, drug interaction databases did not include Paxlovid™. Also, complete medication records for patients receiving treatment within cancer clinics were not readily accessible to healthcare professionals in the community. To address this gap, BC Cancer established a real-time pharmacist-led drug interaction service to support prescribers across British Columbia (BC), Canada.MethodsBetween February 2022 and June 2023, a total of 575 consultation requests were received from across British Columbia. These requests came from a diverse group of healthcare providers, including oncologists, family physicians, nurse practitioners, nurses, and pharmacists, as well as from patients. Data was collected and analyzed from these consults and chart reviews to identify trends and characterize the utilization of this unique service.ResultsAnalysis showed that the program supported hundreds of patients with cancer across British Columbia, regardless of their geographical location, age, sex, comorbidities, or primary cancer diagnosis. The findings also demonstrate that this pharmacist-led drug interaction service was equitably accessible to patients across the province.ConclusionsThis oncology pharmacist-led initiative supported the prescribing clinicians in the safe and effective use of Paxlovid™ in patients with cancer, minimizing disruption to their cancer therapy. This paper describes the programs' development, implementation, and provides insights into the key challenges and successes encountered during its province-wide rollout.

Introduction: Many drugs used in oncology are dispensed by hospital pharmacies, either for outpatients or for administration by injection in hospital. However, the rest of these patients' medication is obtained from a community pharmacy, which rarely has data on hospital treatments. The aim of this study was to identify the needs of community pharmacists to ensure optimal continuity of pharmaceutical care for patients treated with hospital-use anticancer drugs.

Methods: Community pharmacists were invited to participate in semi-structured interviews via videoconference. Participants were recruited voluntarily by phone. Interviews based on an interview guide were recorded, transcribed verbatim, and conducted until theoretical data saturation. The data were analyzed in double-blind using thematic analysis and organized with NVivo® 15 software.

Results: The data have been classified into four themes: identification of the oncology patient by the community pharmacist, roles of the community pharmacist in the care of the oncology patient, barriers encountered by the community pharmacist in the care of the oncology patient, and needs of the community pharmacist in the care of the oncology patient. The main barrier encountered was the lack of communication at transition points. Community pharmacists report needing training in oncology treatment and they would like to exchange treatment data between hospitals and community pharmacies via the oncology liaison booklet or via the e-health platform.

Conclusion: A rapid communication system integrated into the informatics systems of hospitals and community pharmacies needs to be developed so that hospital care providers and community pharmacists can communicate easily with each other.

ObjectiveTo study the cumulative proportion of favorable response to Histone Deacetylase Inhibitor (HDACi) among head and neck cancer (HNC) patients.Data SourcesA systematic search (till 17^th-May-2025) was carried out in PubMed, Scopus, and Web of Science databases using "Head and Neck cancer" and "HDAC inhibitors" as key concept where all the single-arm clinical trials which have clear data on response to HDACi therapy-based RECIST criteria among HNC patients were included in this study. The meta-analysis was performed using R software.Data SummaryThe search resulted in a total of 178 articles, of which 7 studies were found to be relevant based on the inclusion criteria. Out of a total of 101 advanced HNC patients treated with HDACi in single-arm clinical trials, 74 patients showed favorable antitumor response. The pooled cumulative proportion of favorable response with the random effect model was found to be 0.65. Out of these 7 studies, the average proportion of antitumor response was calculated to be 0.758 among HNC patients who received HDACi concurrently with chemotherapy, chemoradiotherapy, and targeted therapy, whereas the average proportion of antitumor response rate to HDACi was 0.485 among priorly treated HNC patients. Vorinostat was the most used HDACi, where the proportion of favorable response was 0.49 compared to the non-vorinostat HDACi (0.77), like valproic acid, panobinostat, and romidepsin.ConclusionThe overall antitumor response to HDACi was found to be 0.65 (65%), which supports the use of HDACi among advanced HNC patients, particularly along with the concurrent chemo/chemoradiotherapy or targeted therapy.