Journal of Oncology Pharmacy Practice最新文献

IntroductionTaxane-induced peripheral neuropathy (TIPN) is a common toxicity among patients with breast cancer (BC). Numerous pairwise comparisons have been performed to evaluate neuropathy associated with different taxane agents (docetaxel, paclitaxel, cabazitaxel, nab-paclitaxel, liposomal paclitaxel, and paclitaxel injection concentrate for nanodispersion [PICN]). This network meta-analysis aimed to study the comparative incidence of TIPN associated with taxane agents in females with BC.MethodsA comprehensive data search was performed in PubMed, Web of Science, and Scopus up to August 2024. The studies that compare neuropathy in taxane agents were systematically reviewed. A network meta-analysis was carried out based on a Bayesian framework to evaluate the incidence of peripheral neuropathy in taxanes compared to paclitaxel, as reference comparator. The Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank taxanes based on their neuropathy.ResultsA total of 27 studies with 12101 patients were included. When compared with paclitaxel, nab-paclitaxel was associated with a significantly higher incidence of peripheral neuropathy (OR: 1.74, CrI: 1.22-2.48). Docetaxel (OR: 0.626, CrI: 0.441-0.881) and cabazitaxel (OR: 0.158, CrI: 0.0664-0.375) demonstrated a significantly lower incidence of peripheral neuropathy compared to paclitaxel. Liposomal paclitaxel and PICN lack significant difference compared to paclitaxel. Our analysis provided the order for peripheral neuropathy (from lowest to highest) as follows: cabazitaxel, docetaxel, liposomal paclitaxel, paclitaxel, PICN, nab-paclitaxel.ConclusionsNab-paclitaxel is associated with a significantly higher incidence of peripheral neuropathy compared to paclitaxel in females with BC. Docetaxel and cabazitaxel are linked with less peripheral neuropathy compared with paclitaxel in this population. No significant differences were observed in liposomal paclitaxel and PICN compared to paclitaxel.

Introduction: Transitioning historically inpatient chemotherapy regimens to outpatient administration can reduce hospital stays, resource use, and healthcare expenditures while improving patient quality of life. However, agents like ifosfamide, commonly used in sarcoma, often necessitate inpatient administration for close monitoring of adverse effects. The Fred Hutchinson Cancer Center (FHCC) sarcoma group has developed criteria for outpatient ifosfamide administration after one successful inpatient administration. Nevertheless, there remains a paucity of literature characterizing the safety profile of outpatient ifosfamide administration.

Methods: This was a single-center, retrospective, observational study that included adults 18 years and older with a diagnosis of sarcoma receiving an ifosfamide-based regimen in the outpatient setting at FHCC between March 2021 and September 2024. The primary outcome was a composite proportion of grade 3 or higher ifosfamide-related neurotoxicity, hemorrhagic cystitis, febrile neutropenia, and uncontrolled nausea or vomiting. Secondary outcomes included days of hospitalization saved with outpatient administration.

Results: A total of 12 patients met the inclusion criteria. The most common outpatient treatment regimen was AIM (42%) followed by IE (25%) and VDC-IE (25%). Out of a total of 53 outpatient cycles, 15 cycles (28.3%) across 4 patients (33.3%) had at least 1 grade 3 or higher adverse effect of interest included in the primary outcome. A total of 257 hospitalization days were saved with outpatient administration, resulting in an estimated cost savings of $987,651.

Conclusion: Overall, among sarcoma patients meeting the FHCC outpatient ifosfamide criteria, administration of ifosfamide in the outpatient setting is safe with considerable cost savings to the institution.

IntroductionAcute lymphoblastic leukemia (ALL) is the most common childhood cancer, and high-dose methotrexate (HDMTX) is a key chemotherapeutic agent. HDMTX can cause nephrotoxicity. This study aimed to identify prognostic indicators of HDMTX-related severe nephrotoxicity in children with ALL.MethodsA retrospective review of children with ALL treated at Chiang Mai University Hospital (2016-2020) was conducted. Demographic, clinical, and treatment-related factors associated with HDMTX-related severe nephrotoxicity were analyzed using multivariable multilevel logistic regression, reported as adjusted odds ratio (aOR).ResultsA total of 61 children with ALL underwent 243 HDMTX infusion cycles. HDMTX-related severe nephrotoxicity occurred in 37.7% (23/61) of patients and 12.3% (30/243) of infusion cycles. No significant differences in baseline characteristics were observed. Concurrent amikacin use was an independent risk factor (aOR = 17.693 [1.613-194.032] P = 0.019), while higher baseline urine pH was protective (aOR = 0.190 [0.082-0.440] P < 0.001). A baseline urine pH < 7.0 was identified as the optimal cutoff for predicting HDMTX-related severe nephrotoxicity (area under the ROC curve = 0.72 [0.63-0.81]). All nephrotoxic events resolved completely.ConclusionsConcurrent amikacin use and low baseline urine pH are significant predictors of HDMTX-related severe nephrotoxicity in children with ALL. Identification of these factors is crucial for preventing nephrotoxicity.

Chemotherapy-induced oral mucositis (OM) is a common and distressing complication of cancer treatment, significantly impacting patients' quality of life. Chamomile (Matricaria recutita L.), known for its anti-inflammatory and wound-healing properties, may offer a natural and accessible preventive option. This study aimed to evaluate the efficacy of a chamomile infusion mouthwash in preventing OM among chemotherapy-naïve patients. A prospective cohort study included 72 patients initiating chemotherapy. Participants were allocated to two groups: one using a chamomile mouthwash (standardized infusion, three times daily) and a control group with no mouthwash. OM severity was assessed on day 21 using the WHO oral mucositis grading scale. Multivariate analysis identified independent protective factors. The incidence of OM was significantly lower in the chamomile group (5.4%) compared to controls (26.5%, p = 0.016). No severe cases (grade ≥3) occurred in the chamomile group. Multivariate analysis confirmed chamomile mouthwash as an independent protective factor (aOR = 0.184; 95% CI: 0.036-0.941; p = 0.042). Chamomile mouthwash is a simple, well-tolerated, and cost-effective intervention for preventing OM in patients receiving chemotherapy. These findings support its potential role in supportive cancer care. Further randomized controlled trials are warranted to validate these results and optimize administration protocols.

IntroductionPatients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients.MethodsThis prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact^® and Micromedex^® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them.ResultsA total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633).ConclusionDDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.

IntroductionThe goal of pharmacogenetic testing is to identify genetic variants with significant implications on drug safety and efficacy. Several professional organizations and institutions have demonstrated the value of pharmacist involvement in the implementation of pharmacogenomic services. Therefore, we aimed to establish a pharmacist-guided model for interpretation of pharmacogenetic results for all oncology patients seen at the Dartmouth Cancer Center (DCC) in Lebanon, NH.MethodsA pilot of a pharmacist-guided pharmacogenomics dosing service was implemented at the DCC. Pharmacy services included review of results from a next generation sequencing panel for DPYD, TPMT, NUDT15, and UGT1A1 variants. The pharmacist wrote a note in the electronic health record (EHR) detailing actionable drug-gene interactions and drug-dosing guidance, which was then routed to the treating oncologist. Outcomes collected included highlighting actionable mutations and defining pharmacist interventions. In addition, time spent formulating and documenting patient-specific drug-dosing recommendations was collected.ResultsFrom February 2024 through May 2024, a total of 71 patients with pharmacogenetic results, provided by the clinical molecular laboratory at Dartmouth Health, were reviewed by the pharmacist. The majority of patients tested were diagnosed with a malignancy of gastrointestinal origin. Twenty-one patients were found to have actionable variants in at least one of the four genes evaluated, and five of the 21 identified patients had active treatment plans for which dose changes were then implemented.ConclusionsImplementation of a pharmacist-guided pharmacogenomics based dosing service aided in optimizing drug therapy and has positioned Dartmouth Health for further expansion of pharmacogenomics and personalized patient care.

Lactose intolerance is quite common among people world-wide. Despite this, lactose is often used as a pharmaceutical excipient due to its pharmacologically inactive nature. We reviewed the literature to determine how much lactose can typically be tolerated by patients reporting a history of lactose intolerance and measured the amount of excipient in commonly used solid oral oncology dosage forms. We determined that most patients should be able to tolerate a significantly higher amount of lactose than that found in maximum daily doses of oncology tablets and capsules, based on our literature review and the measured amount of excipient in commonly used solid oral oncology dosage forms. If patients report gastrointestinal symptoms, adverse drug reactions and medical conditions should be considered as more likely causes than lactose intolerance. We created a flow chart for pharmacists to follow when dispensing oral medications to lactose intolerant patients. This chart may assist in patient management if the lactose content of a medication is questioned or if a patient reports gastrointestinal symptoms.

IntroductionThe increasing incidence of cancer entails a rising burden of cytotoxic drugs preparation. To improve the preparation process of cytotoxic drugs, specially designed half-filled bags with overfill capacity were manufactured and used in clinical routine. The aim of this study was to investigate the impact of using such bags on the duration of preparation, human resources, costs and environmental sustainability.Methods and MaterialsA retrospective study comparing two methods, volume substitution and excess volume addition, for cytotoxic drug preparations was conducted over two periods of 6 months, within a University Hospital chemotherapy production unit. Volume substitution method (period 1; 5527 preparations) corresponded to the use of filled-bags. Excess volume addition method (period 2; 5108 preparations) corresponded to the use of half-filled bags. Preparation time included drug reconstitution and gravimetric controls. Data were extracted from the BD Cato^TM database.ResultsMedian duration of preparation using the excess volume addition method (2.4 min; IQR: 1.9-3.2) was significantly shorter than the volume substitution method (3.2 min; IQR: 2.6-4.1; p < 0.0001). It allowed saving 67 h during period 2, corresponding to 9.8% of a full-time equivalent technician. However, mean cost per preparation was significantly increased by 58% when using the excess volume addition method (p < 0.0001), due to higher costs of the newly designed bags. Broken down over the course of a year, the excess volume addition method would decrease the weight of cytotoxic waste for the entire hospital by 2.21%.ConclusionUsing the excess volume addition method with half-filled bags decreases time preparation, consumables and waste related to cytotoxic drug preparation.

ObjectiveOncology treatment regimens require increasing information technology (IT) integration in health systems to enhance delivery and safety, however, this creates a burden on medical teams and clinical pharmacists to manage. This primer introduces the University of Michigan Health Academic Medical Center's (UMH-AMC) response to this need with the Chemotherapy Orders Team (COT).SummaryThe COT includes five clinical oncology pharmacy generalists with a split full-time equivalent (FTE) appointment in COT-based activities and staffing in infusion. They manage the clinical content of oncology and non-oncology treatment and therapy plans at UMH-AMC, including over 1330 commercial plans and over 260 investigational plans. The COT ensure compliance with national and regulatory guidelines for order sets. This involves leaning on order group standardization to improve the efficiency of treatments across multiple disease states. The COT has been instrumental in managing the compounding standards for all infusion agents, including support to the electronic health record (EHR) team.ConclusionThe COT is an innovative team of clinical pharmacist infusion generalists, providing non-traditional clinical and operations support. They work alongside medical teams, pharmacy operations, and health informatics to provide robust management of EHR pathways for oncology and non-oncology related therapies. Importantly, they act as a translational liaison between the clinical teams and the EHR. Their efforts to modernize and improve the treatment and therapy plan experience at UMH-AMC has been an ongoing exercise, with many improvements in order set standardization and communication.