Journal of Oncology Pharmacy Practice最新文献

ObjectiveThe evolution of chemotherapy regimens and biologic therapies has improved survival rates for cancer patients, requiring the management of increasingly complex treatment protocols. In this context, strategies such as drug holidays (DH), intermittent therapy, and maintenance approaches have been explored to reduce therapeutic burden and mitigate long-term toxicity. However, the use of DH in oncology remains poorly defined, with no standardized protocols or clear guidelines. This review aims to evaluate the application of DH in solid tumor treatments, focusing on its definition and correlation with clinical outcomes, particularly in reducing toxicity and delaying resistance.Data sourceSystematic search of the PubMed database was conducted, with the final search executed on June 30, 2024, to identify relevant studies on DH in cancer therapy.Data SummaryA systematic search of PubMed identified 27 relevant studies. DH was most frequently explored in colorectal cancer, with positive outcomes reported in prostate cancer, basal cell carcinoma, and thyroid cancer. However, negative outcomes were observed in renal cancer and melanoma. Definitions of DH varied widely between studies, complicating comparisons. While DH may reduce toxicity in specific cancers, such as prostate and thyroid cancers, its clinical efficacy and long-term benefits remain unclear.ConclusionNo study has shown robust evidence supporting DH as a universally beneficial strategy. Further well-designed studies are needed to clarify its role in cancer treatment.

BackgroundImmunocompromised patients undergoing cancer therapy are at increased risk for severe infections such as rabies. Coordinating rabies post-exposure prophylaxis (PEP) with ongoing treatment requires careful planning.Case PresentationA 73-year-old female with metastatic breast cancer, scheduled to begin second-line chemotherapy, sustained a WHO Category 3 cat scratch injury. A clinical pharmacist collaborated with oncology and infectious disease teams to promptly initiate rabies PEP. Rabies vaccine and monoclonal antibody were administered per national guidelines. The chemotherapy start date was deferred by five days based on pharmacist-infectious disease team consultation to ensure optimal vaccine response. The clinical pharmacist played a central role in timing decisions, vaccine administration, and patient education.ConclusionThis case report underscores the complexities of managing infectious disease risks in immunocompromised oncology patients. The timely coordination of rabies post-exposure prophylaxis in a patient undergoing cancer treatment is a clinically relevant issue, especially given the potential for attenuated vaccine responses and treatment delays. The case provides a practical example of how clinical pharmacist-driven (interdisciplinary collaboration) interventions can enhance patient safety without compromising oncologic outcomes.

IntroductionBone-modifying agents (BMAs) effectively prevent skeletal-related events (SREs) in bone metastases (BMs). While early BMA use is recommended upon BM diagnosis, its benefits and optimal timing remain unclear. This study investigated whether early BMA initiation after BM diagnosis delays SRE onset by analyzing pooled data from placebo-controlled trials.MethodsRandomized controlled trials in which a BMA or placebo was administered after BM diagnosis were extracted. For each trial's BMA and placebo arms, the waiting period from BM diagnosis to BMA initiation and the effective period from BMA initiation to SRE onset were investigated. The hazard ratio (HR) for the SRE-free period relative to the placebo period was calculated. A waiting period of ≤6 months was defined as the early initiation group, whereas that of >6 months was the delayed initiation group. The HRs were meta-analyzed.ResultsData from 17 studies were analyzed. Early initiation of BMAs showed a trend toward a longer duration of efficacy compared with delayed initiation (+5.5 versus [vs.] + 3.2 months, p = 0.056). However, the pooled HR demonstrated efficacy at both initiation timepoints (0.62 [0.56-0.69] vs. 0.73 [0.60-0.83]).ConclusionsAlthough early initiation of a BMA after BM diagnosis is recommended, its efficacy-specifically whether it prolongs the time to SRE onset-remains unclear.

BackgroundSecond-generation antiandrogens have significantly improved outcomes in patients with prostate cancer; however, their complex pharmacokinetic profiles can result in significant drug-drug interactions (DDIs) in patients with comorbid conditions which require chronic anticoagulation.ObjectiveThis review aims to describe the DDIs between antiandrogens and commonly used anticoagulants, with a focus on understanding the clinical implications of pharmacokinetics and drug metabolism.MethodsA comprehensive literature review of pharmacokinetic data, clinical trials, and prescribing information was performed. Drug metabolism of antiandrogens and anticoagulants was examined, including the effects of CYP450 enzyme and/or P-glycoprotein (P-gp) inhibition and induction on anticoagulant efficacy and safety.ResultsEnzalutamide and apalutamide are strong inducers of CYP3A4, which may reduce exposure to warfarin, apixaban, and rivaroxaban. Apalutamide induces P-gp, and therefore has DDIs with all direct oral anticoagulants (DOACs). Darolutamide and abiraterone exhibit minimal CYP450 induction and inhibition, and do not interact with warfarin or DOACs.ConclusionDrug-drug interactions between antiandrogens and anticoagulants are common and can affect therapeutic efficacy and safety. Clinical decision-making surrounding drug selection requires an interprofessional approach grounded in pharmacokinetic knowledge to ensure safe and effective care in patients with prostate cancer.

IntroductionBreast cancer is the most prevalent neoplasm among women and one of the leading causes of death in developed countries. There are screening programs aimed at reducing the morbidity and mortality associated with breast cancer Breast Self-Examination (BSE) is a primary method which involves examining their breasts and armpits to detect changes, facilitating an early detection of this disease.MethodsA quasi-experimental study was conducted to assess the effect of health education on BSE among adult women through pharmaceutical intervention.ResultsHealth education significantly reduced perceived barriers (p < 0.001), with the most notable improvement in self-efficacy dimension (4.94 ± 3.17 to 8.11 ± 2.64, p < 0.001) after the intervention. Women performing BSE increased significantly from 59.7% to 95.5% (p < 0.001). Quality of life improved by more than 6 points on a 100-point scale (p = 0.001). Women under 40 were more confident in performing BSE correctly (OR = 2.284, 95%CI = 1.364 - 3.823, p < 0.001), better understood the procedure (OR = 2.741, 95%CI = 1.544 - 4.866, p < 0.001), knew better the proper body positions (OR = 1.787, 95%CI = 1.236 - 2.584, p < 0.001) and were more aware of the dates for BSE (OR = 1.399, 95%CI = 1.132 - 1.729, p < 0.001).ConclusionThe lack of knowledge among women about this practice underscores the need to implement and promote more health programs that encourage learning and education about one's own body.

Introduction: Immune checkpoint inhibitors (ICIs), such as pembrolizumab, are integral to cancer therapy but can cause severe immune-related adverse events (irAEs), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These rare, life-threatening reactions typically occur early in treatment, with delayed onset being less commonly reported.

Case report: We present a 67-year-old female with triple-negative breast cancer who developed a diffuse, painful rash five months after discontinuing pembrolizumab. Physical exam revealed ∼15% body surface area involvement without mucosal lesions. Biopsy confirmed SJS/TEN overlap. The patient had previously experienced pembrolizumab-induced Grade 2 pneumonitis.

Management & outcome: Initial treatment with high-dose corticosteroids yielded minimal improvement. Intravenous immunoglobulin (IVIG) was added, resulting in clinical stabilization. The patient was discharged after 11 days with a steroid taper and showed gradual symptom improvement at one-month follow-up.

Discussion: This case highlights an exceptionally delayed onset of pembrolizumab-induced SJS/TEN overlap, extending known timelines for irAE manifestation. Prior pneumonitis may have predisposed the patient to subsequent cutaneous toxicity. Despite a SCORTEN score predicting high mortality, aggressive immunosuppressive therapy led to a favorable outcome. This underscores the importance of prolonged vigilance and multidisciplinary management in patients with prior irAEs.

ObjectiveHematopoietic stem cell transplant (HSCT) is the only curative option for genetic, immunological, and hematological disorders such as leukemia, lymphoma, and bone marrow failure syndromes. Graft-versus-host disease (GVHD) remains the most frequent post-transplant complication and is commonly managed with cyclosporine. However, recipients of HSCT are at high risk of life-threatening infections despite prophylaxis, and azole antifungals can alter cyclosporine concentrations, predisposing patients to toxicities. This study is the first from Pakistan to evaluate the effect of azole antifungals on cyclosporine levels and associated toxicities.Material and methodsA retrospective analysis was performed on 150 HLA-matched HSCT recipients at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT) who received cyclosporine with either fluconazole or voriconazole between October 2018 and December 2022. Cyclosporine levels and toxicities were assessed on day +14. Primary outcomes included cyclosporine-related adverse effects (hypertension, nephrotoxicity, hepatotoxicity, neurotoxicity, electrolyte imbalance), while the secondary objective was to correlate toxicities with cyclosporine drug concentrations in the presence of triazole antifungals.ResultsThe study included 97 males (64.4%) and 53 females (35.3%), with a median age of 11 years (range: 6-20). Beta-thalassemia major was the most common indication (n = 71, 47%). According to NCI-CTCAE criteria, the most frequent Grade 2 toxicity was hypokalemia (20%), and hepatotoxicity (16%) was the most common Grade 3 event. No Grade 4 toxicities were observed. Supratherapeutic cyclosporine levels occurred with both fluconazole and voriconazole.ConclusionWhile dose adjustment is standard with voriconazole, our findings suggest the need for similar consideration with fluconazole. Larger studies are required to confirm this observation.