Journal of Oncology Pharmacy Practice最新文献

Introduction5-Fluorouracil (5-FU) is a chemotherapeutic agent used in various malignancies. 5-FU-induced leukoencephalopathy is a rare but reversible neurotoxic effect occurring within days of administration. Symptoms include confusion, agitation, and cognitive disturbances, with severe cases potentially causing coma. Diagnosis is supported by magnetic resonance imaging (MRI) showing characteristic brain changes. Treatment involves discontinuing 5-FU and initiating supportive care. Most patients recover within one week, but relapse may occur with repeated exposure, making early recognition critical.Case reportA 42-year-old male with recurrent Stage IV gastric adenocarcinoma and chronic kidney disease developed progressive 5-FU-related leukoencephalopathy after repeated exposure. MRI findings and symptoms of confusion, disorientation, and memory deficits were consistent with 5-FU leukoencephalopathy. Initial work-up was inconclusive, therefore, treatment was continued. Neurologic symptoms worsened after further cycles, leading to chemotherapy discontinuation and surgical resection. Disease recurrence led to reinitiation of modified 5-FU therapy, triggering acute neurotoxicity confirmed by MRI.Management and outcomeThe patient was managed by discontinuing 5-FU, beginning high-dose intravenous thiamine and methylprednisolone, and providing supportive care. Neurologic symptoms including confusion, facial diplegia, and unsteady gait gradually resolved. By Day 9, he returned to baseline mental status without deficits.DiscussionEarly recognition and intervention in 5-FU-induced leukoencephalopathy is crucial, especially in patients with renal dysfunction or repeated exposures. Dihydropyrimidine dehydrogenase (DPD) deficiency has not been directly implicated in this condition. Metabolic disruption and thiamine depletion contribute to pathogenesis. Prompt 5-FU discontinuation and initiation of supportive care can hasten recovery. Clinical vigilance is imperative in patients with known risk factors.

BackgroundEsophageal cancer remains a leading cause of cancer-related mortality worldwide, with docetaxel, cisplatin, and fluorouracil (DCF) chemotherapy being a standard treatment option for locally advanced disease. However, DCF is associated with a high incidence of febrile neutropenia (FN), a serious complication that can lead to treatment delays, hospitalizations, and increased morbidity. Pegfilgrastim, a long-acting granulocyte colony-stimulating factor (G-CSF), is recommended for FN prevention, but its efficacy in esophageal cancer patients receiving DCF chemotherapy remains unclear.MethodsA systematic literature search of PubMed, Cochrane Library, Scopus, and Web of Science identified eligible studies. Retrospective and prospective studies comparing prophylactic pegfilgrastim with placebo or no G-CSF in patients undergoing DCF therapy were included. Eight reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. The extracted data were then verified by two additional reviewers. A meta-analysis was conducted to calculate pooled effect sizes.ResultsPooled analysis showed that pegfilgrastim significantly reduced FN incidence (OR = 0.283, 95% CI: 0.102-0.782, p = 0.015). FN rates ranged from 3.3% to 30.8% in the pegfilgrastim group versus 26.7% to 60.6% in the control group. Pegfilgrastim was also associated with lower rates of severe neutropenia and shorter hospital stays, with no significant increase in adverse events.ConclusionsIn our study, Pegfilgrastim prophylaxis significantly reduces FN risk, severe neutropenia, and hospital stays in esophageal cancer patients receiving DCF chemotherapy, without increasing major complications. These findings support its routine use in this population, though further prospective randomized trials are needed to optimize dosing strategies and confirm long-term benefits.

BackgroundAfter hospital discharge, recipients of allogeneic hematopoietic stem cell transplantation (HSCT) must adhere to immunosuppressants to reduce the risk of complications such as graft-versus-host disease (GvHD). The use of therapeutic drug monitoring (TDM), a measure of medication adherence (MA), in the transplantation field has received limited research attention.ObjectivesWe used TDM to measure MA to the oral calcineurin inhibitors (CNIs) cyclosporine A (CSA) and tacrolimus (FK), from the patient's first follow-up visit after discharging up to 100 days after HSCT. The secondary aim was to identify risk factors for medication non-adherence (MNA) and the relationship between MNA and HSCT-related complications.Materials and MethodsA retrospective observational study was conducted at an academic hospital in northeast Italy. We included 269 adults undergoing allogeneic HSCT and a total of 1493 CNI serum assays.ResultsUsing an MA threshold of ≥ 80%, 37.2% of patients were adherent (57.9% to CSA and 17.9% to FK). There were no differences at the analyzed time points; however, MNA with TDM below the target range increased over time. There were no risk factors for MNA, nor differences in GvHD or hospital readmissions between adherent and non-adherent patients.ConclusionTDM can be used to assess MA to CNIs up to 100 days after HSCT, but due to the limitations of this measure, it would be useful to corroborate the results with other MA measurement systems. Prospective studies are required to identify risk factors, outcomes of MNA, and to validate which MA threshold could establish clinical relevance.

IntroductionOccupational exposure to antineoplastic drugs remains a significant concern for healthcare workers. Surface contamination is a key indicator of exposure risks and reflects the effectiveness of practices. This study aimed to describe contamination with 11 antineoplastic drugs on 12 surfaces in Canadian healthcare centres participating in the 2025 monitoring program and to examine practices implemented by these centres, including the potential influence of hazardous drug committees.MethodsEach centre sampled six standardized sites in oncology pharmacies and six in outpatient clinics. Ultra-performance liquid chromatography-tandem mass spectrometry quantified cyclophosphamide, docetaxel, doxorubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate, paclitaxel and vinorelbine. Inductively coupled plasma mass spectrometry quantified platinum-based drugs. The Kolmogorov-Smirnov test assessed differences in contamination, and chi-square tests compared practice implementation.ResultsA total of 127 centres participated. Overall, 35% (504/1 453) of surfaces were contaminated, most frequently cyclophosphamide (22%, 90^th percentile 0.0052 ng/cm²) and gemcitabine (14%, 0.0017 ng/cm²). The most contaminated sites were the front grille inside the biological safety cabinet (70%) and the armrest of the treatment chair (67%). More than half of centres (67/122, 55%) reported having a hazardous drugs committee. Cyclophosphamide surface contamination differed by committee presence and meeting frequency (p = 0.034). Centres with a committee were more likely to implement certain handling practices, including cleaning vials before storage (p = 0.004).ConclusionsSurface contamination remains frequent but at low concentrations, with evidence of improvement over time. Multidisciplinary committees, continuous monitoring and broader staff engagement are essential to strengthen safety culture and reduce occupational exposure.

IntroductionLet's Communicate Cancer is an educational programme designed to support pharmacy staff in recognising and signposting patients with possible cancer symptoms. This study explored pharmacists' views on its educational impact, suitability, acceptability, and areas for improvement.MethodsAn anonymised cross-sectional digital survey was used to collect pre/post-programme data and was distributed to participants between September and November 2024. Participants were community pharmacists undertaking postgraduate study at the University of Bradford. Quantitative data were analysed using descriptive statistics and differences identified using paired t-tests; free-text responses underwent thematic analysis.ResultsFifty-one pharmacists completed the study. Most were female (56.4%, n = 29) and had practised for 2-3 years (60.8%, n = 31). Baseline confidence in recognising cancer symptoms was low, although correct identification rates were high for lung (88.2%, n = 45) and bowel cancer symptoms (84.3%, n = 43). Post-programme, confidence in recognising symptoms increased (27.4% v 98%), discussing them with patients (27.6% v 96.1%), and signposting to further investigation (41.1% v 96.1%) (p ≤ 0.05 for all questions). Satisfaction with content (96%, n = 49) and design (84.2%, n = 43) was high. Suggested improvements included development of physical near-patient resources to aid conversations.ConclusionLet's Communicate Cancer effectively improved pharmacists' knowledge and confidence in recognising and signposting patients with symptoms of possible cancer. This programme is well positioned to support the emerging role of pharmacists as a resource to identify symptomatic patients for investigation. An ongoing collaboration between the British Oncology Pharmacy Association and the International Society for Oncology Pharmacy Practitioners has been established to support international adoption.

PurposeCancer pain is one of the most distressing symptoms, severely impairing patients' quality of life (QoL). This study aimed to assess cancer pain using multidimensional questionnaires and to evaluate the impact of pharmacist-led interventions on pain management and QoL.MethodsA prospective interventional study was conducted among eligible cancer patients. Pain and QoL were assessed using validated multidimensional questionnaires. Pharmacist interventions included counselling, an educational video, and a patient information leaflet. Patients were reassessed post-intervention, and pre- and post-intervention data were analyzed for statistical significance.ResultsA total of 147 cancer patients were enrolled, with nearly equal gender distribution. Breast, buccal mucosa, and lung cancers were most prevalent. Surgery was the predominant treatment, followed by radiation and chemotherapy. Pharmacist-led interventions significantly improved QoL across physical, emotional, social, sleep, and behavioral domains (all p < 0.01), with overall QoL scores rising from 4.8 ± 1.25 to 10.5 ± 2.13 (p < 0.001). The economic domain showed comparatively slight improvement, reflecting persistent financial strain. Use of non-pharmacological strategies such as meditation, physiotherapy, and psychosocial support increased significantly post-intervention.ConclusionA comprehensive assessment with a multidimensional pain questionnaire revealed the broad impact of cancer pain on patients' lives. Pharmacist-led interventions, combining education, counselling, and supportive care, significantly improved pain control and quality of life across physical, emotional, social, and sleep domains. The persistent economic burden indicates the importance of integrated financial support, but our findings highlight the vital role of clinical pharmacists in delivering holistic, patient-centered cancer pain management.

IntroductionImmune checkpoint inhibitors have improved outcomes for solid tumors but are associated with immune-related adverse events (irAEs). Literature suggests that patients with an absolute lymphocyte count (ALC) ≥ 2000 cells/mm3 prior to treatment with PD-1 inhibitors have an increased risk for irAEs, but the relationship between ALC and irAEs has not been examined with PD-L1 inhibitors. This study evaluates the correlation between ALC and PD-L1 inhibitor related irAEs.MethodsThis retrospective cohort study at an academic health system used electronic health record data from adult patients with solid tumors receiving their first dose of a PD-L1 inhibitor between January 1, 2022, to December 31, 2023. Patients were excluded if they did not have a baseline ALC within 30 days of initial treatment, had a prior irAE(s), had a hematologic malignancy, received any other immunotherapy prior to or during the study period, or were treated with corticosteroids within 1 month prior to treatment.ResultsAmong 210 patients, 186 had a baseline ALC < 2000 cells/mm3 and 24 had a baseline ALC ≥ 2000 cells/mm3. 20 grade 2 + irAE events occurred, 19 in patients with an ALC < 2000 cells/mm3 and only 1 in patients with a baseline ALC ≥ 2000 cells/mm3. There was no correlation between a baseline ALC ≥ 2000 cells/mm3 and incidence of grade 2 + irAE (OR 0.503; 95% CI: 0.064, 3.98; P = 0.515).ConclusionIn this cohort study of patients treated with PD-L1 immune checkpoint inhibitors, baseline ALC ≥ 2000 cells/mm3 did not predict PD-L1 inhibitor related irAEs.

ObjectiveTo summarize the current status, mechanisms, challenges, and future directions of immunotherapy in advanced rectal cancer.Data SourcesPublished clinical trials, translational studies, and mechanistic reports on immunotherapeutic strategies for colorectal and rectal cancer.Data SummaryImmune checkpoint inhibitors (ICIs), particularly PD-1/PD-L1 and CTLA-4 blockade, show promise in MSI-H rectal cancer, while combination therapies are under investigation for microsatellite stable (MSS) tumors. Tumor vaccines and T-cell-based approaches, such as CAR-T and TCR-engineered therapies, are emerging strategies. Major barriers include immune evasion, microenvironment heterogeneity, and resistance mechanisms in MSS disease.ConclusionsImmunotherapy is transforming the treatment landscape of advanced rectal cancer, yet challenges persist. Continued mechanistic exploration and rational combination strategies are essential to improve response rates and expand benefit to MSS patients.

IntroductionThe benefit of clinical trials for lung cancer treatment extends beyond scientific advancement, offering significant cost savings for healthcare systems. This study aims to quantify the economic benefits obtained from the enrollment of lung cancer patients in clinical trials by analyzing the cost savings achieved through reduced medication expenses and medical tests.MethodsA retrospective and longitudinal analysis was performed to evaluate the economic benefits obtained from sponsor-provided medications and medical tests by analyzing data from lung cancer clinical trials conducted at a tertiary hospital in Spain from 2017-2021. Patient demographics, lung cancer histology, mutation status, cancer stage, treatment regimens, and the types and costs of imaging tests were collected from electronic medical records and the pkEnsayos^® software. Cost savings were estimated based on the expenses that would have been incurred under standard-of-care treatment.ResultsA total of 117 patients were enrolled in 35 trials, generating an economic benefit of €2,207,726 over five years. Most of these benefits (94.6%) were associated with NSCLC trials. Trial-medications accounted for €2,079,278 in savings, with phase III studies contributing 76.1% of this amount. A total of 642 imaging tests resulted in an economic benefit of €128,448. The difference in economic benefit between medications and imaging tests was statistically significant.ConclusionThis study showed that lung cancer clinical trials were associated with substantial economic benefits reducing medication expenses and sponsor-financing imaging medical tests. By participating in such trials, healthcare institutions can potentially alleviate the economic burden associated with lung cancer treatment and improve patient access to innovative therapies.

BackgroundAnticancer drugs excreted in urine can disperse during urination, contaminating toilets and causing secondary exposure. Activated carbon sheets adsorb urinary drugs and limit surface diffusion, but whether adsorbed drugs subsequently vaporize is unknown. We evaluated vaporization of cyclophosphamide (CPA) applied to activated carbon sheets.MethodsCPA (10 mg/2 mL) was placed on 100-cm² activated carbon sheets or control sheets without activated carbon and incubated for 24 h in a 4-L chamber at 37 °C. Vaporization was assessed by Ames test (reverse-mutated Salmonella colony counts). CPA in chamber gas and wipe samples from the inner surfaces of the chamber was quantified by HPLC-MS/MS. Sheets were tested immediately after CPA application, after drying, and after rewetting (immediately and at 3 and 7 days after contamination).ResultsCompared with no-CPA exposure, colony counts increased significantly after exposure to CPA-dropped control sheets (p < 0.001), whereas no increase occurred with CPA-coated activated carbon sheets. Gas analysis detected no CPA above the quantification limit when applied to activated carbon sheets; a small amount (49 ng) appeared in one control sample. Wipe samples contained far less CPA on activated carbon than on control sheets (79-93% reduction), and these differences persisted through day 7.ConclusionsAcross bioassay and instrumental analyses, activated carbon sheets retained adsorbed CPA without measurable vaporization for at least 7 days. Activated carbon sheets may offer a practical measure to reduce urine-derived antineoplastic contamination and inhalational exposure from vaporization in toilet environments.