Journal of Oncology Pharmacy Practice最新文献

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.

IntroductionOpioid medications are crucial for managing pain among patients with cancer. Yet, inappropriate prescribing and medication issues can compromise patient safety and quality of care. Clinical pharmacists play a significant role in optimizing opioid therapy and addressing issues related to opioid medication use.ObjectivesThis study aimed to examine clinical pharmacist interventions and identify opioid medication-related issues in patients with cancer.MethodWe conducted a retrospective observational study at Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, conducting a chart review from 1^st July 2021 to 31^st December 2021.ResultsOut of 10,534 opioid medication orders, we documented a total of 974 interventions based on our inclusion criteria. Tramadol and morphine accounted for most of these interventions, comprising 49.27% (n = 475) and 40.04% (n = 386), respectively. Regarding clinical significance, 41.70% (n = 406) were deemed significant, while 37.36% (n = 365) were somewhat significant. The majority of interventions, i.e., 54.05% (n = 521), primarily aimed at optimizing patient outcomes, followed by a secondary aim of improvements in communication, i.e., 25.52% (n = 246).ConclusionThis study establishes the evaluation of clinical pharmacist interventions on opioid medication use in patients with cancer, an issue particularly in oncology settings in Pakistan. The findings emphasize the crucial role of clinical pharmacists in addressing issues related to opioid issue medications, thus improving patient safety and optimizing opioid use for patient well-being.

Aim/BackgroundThe aim of this study was to determine long-term physicochemical and biological stability of nivolumab and pembrolizumab diluted in saline infusion bags and partially used medication vials. This may enable the prolonged clinical use of these expensive monoclonal antibodies (mAbs) to minimize the economic loss.MethodsSterile nivolumab and pembrolizumab concentrates in partially used medication vials and compounded nivolumab and pembrolizumab infusion solutions were stored for two and four weeks, respectively, at 2-8°C in the dark. Subsequently, concentrates and compounded solutions were stored for an additional two weeks under ambient temperature and light conditions. A panel of validated and complementary methods, consisting of enzyme-linked immunosorbent assay, size exclusion chromatography, and dynamic light scattering, were used to assess the biological and physiochemical stability of these mAbs.ResultsAll samples showed that purity and concentration had remained within the criteria of <5% as stated in the European Pharmacopoeia. Diluted in infusion bags, nivolumab and pembrolizumab remained biologically and physiochemically stable for up to four weeks when stored at 2-8°C in the dark with an additional two weeks of ambient temperature and light. Stability in partially used medication vials was demonstrated for at least two weeks when stored at 2-8°C in the dark with an additional two weeks of ambient temperature and light.ConclusionThe findings of this study justify the storage and clinical re-use of sterile nivolumab and pembrolizumab in partially used medication vials and compounded IV infusion bags for up to six weeks. This minimizes the risk of economic loss due to waste. Moreover, these findings support the batch-wise compounding of fixed-dose and dose-banded nivolumab and pembrolizumab infusion bags.

The greatest challenge in healthcare today lies in managing limited resources to deliver high-quality care to the patients who need it the most. Payers heavily rely on budget impact models to assess the net costs or potential savings associated with adding a new intervention and to inform their formulary decision. Drugs developed for rare conditions are often prohibitively expensive due to the complex manufacturing processes and investments required to undertake clinical trials. These interventions often play a critical role in organ preservation and can be lifesaving when no alternative therapies are available. The significant cost of these treatments has to be weighed against the potential cost consequences of not using the treatment including downstream complications of an avoidable event. Over the past few decades, oncologic treatments have seen significant advancements. Despite these innovations, radiation therapy and chemotherapy remain the backbone of treatment for many types of cancers. These therapies often damage healthy cells alongside cancer cells, leading to a range of side effects that can affect multiple organ systems. While some side effects, such as those from radiation therapy, may be resolved within weeks or months after treatment ends, others may persist or emerge months to years later. Worse yet is the impact of these side effects on patients' ability to continue with their cancer treatment regimen. Here we discuss a case of glucarpidase in managing high dose methotrexate toxicity and consideration of full impact, not only on the budget but also the patient.

Introduction: Darolutamide is a second-generation nonsteroidal androgen receptor antagonist approved for treatment of castrate-resistant, nonmetastatic prostate cancer and metastatic hormone-sensitive prostate cancer. Case report: A mid-70s man with castration-resistant prostate cancer was initiated on darolutamide. Due to impaired renal function and a history of poor tolerance to previous chemotherapy, the patient was started at 300 mg per day with a plan to titrate to the recommended renal-adjusted dose. He was admitted to the hospital for complaints of lower extremity weakness during week 11 of treatment. Physical examination and imaging did not indicate any significant pathology from cancer or other medical conditions causing his symptoms. The pharmacist identified and reported a significant drug interaction between darolutamide and rosuvastatin. Management & Outcome: The suggested change was rosuvastatin discontinuation. Limiting the rosuvastatin dose to 5 mg is recommended during concomitant use with darolutamide. Since the patient had been receiving rosuvastatin 40 mg daily, he was potentially receiving five times the maximum dose. Considering the patient's complaints of myalgia and a marked elevation in creatine phosphokinase, his condition confirmed the diagnosis of rosuvastatin-darolutamide-induced rhabdomyolysis. Clinical symptoms improved and creatinine phosphokinase (CPK) elevation subsided following rosuvastatin cessation. Discussion: Darolutamide inhibition of breast cancer resistance protein (BCRP), organic anion-transporting polypeptides (OATP), and other protein transporters impacts clearance of substrate drugs to varying extents. Clinical relevance of inhibition depends on the extent to which affected proteins and transporters contribute to the clearance of the substrate. Rosuvastatin's significant reliance on BCRP for active efflux leads to an elevated risk of statin-associated muscle symptoms when co-administered with darolutamide.

IntroductionLaryngopharyngeal dysesthesia is considered an acute peripheral neuropathy secondary to oxaliplatin neurotoxicity.Case reportWe report a case of laryngopharyngeal dysesthesia that developed in a patient with colon adenocarcinoma after receiving her third cycle of oxaliplatin.Management & outcomeShe was treated with antihistamines, steroids, oxygen, and adrenaline and referred to the allergy department for investigation of a hypersensitivity reaction to the drug. Skin tests and tryptase extracted after the acute episode ruled out this possibility. However, the patient presented a slight elevation of interleukin 6, commonly observed in cytokine release reactions. The patient continued her oxaliplatin treatment with cautious administration and under the supervision of the allergist.DiscussionLaryngopharyngeal dysesthesia is part of oxaliplatin neurotoxicity and does not require discontinuation of the drug. However, in patients with severe laryngopharyngeal dysesthesia symptoms, it would be advisable to perform a differential diagnosis with hypersensitivity reactions and cytokine release reactions, whose management differs from neurotoxic reactions.

We present a case of a 41-year-old female diagnosed with Granulosa Cell Tumor (GCT) EC IVB who developed a hypersensitivity reaction (HSR) to carboplatin during the sixth cycle of treatment and subsequently underwent successful intraperitoneal desensitization with cisplatin during hyperthermic intraperitoneal chemotherapy (HIPEC). The patient experienced a severe HSR 30 min after carboplatin infusion, presenting with generalized rash, pruritus, nausea, chest pain, and dyspnea. The infusion was halted, and she was treated with intramuscular epinephrine (0.50 mg), intravenous chloropyramine (20 mg), and 250 mL saline, resolving symptoms. Platinum skin tests were subsequently performed and yielded negative results for carboplatin, cisplatin, and oxaliplatin. Following multidisciplinary consensus, cytoreductive surgery with HIPEC and intraperitoneal desensitization to cisplatin was planned. The patient had a peritoneal carcinomatosis index (PCI) of 17. Cytoreductive surgery included omentectomy, appendectomy, resection of mesenteric implants, diaphragmatic and parietal peritonectomy, in bloc hysterectomy, bilateral salpingo-oophorectomy, and pelvic peritonectomy, achieving a completeness of cytoreduction (CC-0). HIPEC was performed with cisplatin (100 mg/m²) at 42°C for 140 min. A desensitization protocol with intraperitoneal cisplatin (180 mg in 8 incremental steps over 140 min) was successfully completed without adverse reactions. Platinum-based chemotherapeutics are frequently associated with HSR, with increasing incidence upon repeated exposure. Intraperitoneal administration, as in HIPEC, may reduce systemic hypersensitivity risks. While prior cases have demonstrated safe HIPEC administration of cisplatin in patients with oxaliplatin-induced HSR, no documented cases exist of intraperitoneal drug desensitization in this context. Our case suggests that intraperitoneal desensitization with cisplatin may be a viable alternative for patients with systemic HSR to platinum agents. Further research is required to establish safety protocols, cross-reactivity risks, and efficacy outcomes for this approach.

ObjectiveThis review discusses current strategies, new advancements and clinical trials for the treatment of bone metastases.MethodWe performed a narrative review using literatures obtained from PubMed and Google Scholar using the terms such as "Prostate cancer", "bone metastases", "treatment". The search included articles between 2000 and 2024. For clinical trial information, we searched www.clincialtrial.gov and included trials of Prostate cancer and bone metastases.SummaryWe go through the mechanisms of action, clinical effectiveness, and limitations of current and emerging therapies, including bisphosphonates, Receptor activator of nuclear factor kappa-Β ligand (RANKL) inhibitors, novel agents and Prostate-Specific Membrane Antigen (PSMA) targeted approaches. By examining recent research and ongoing clinical trials, we seek to inform the development of optimized treatment strategies and guide future research directions. The review discuss about novel agents such as Radium-223 and Lutetium-177. Lutetium-177 is emerging as a promising treatment for metastatic prostate cancer with bone involvement. These treatment options offer significant survival benefits in patients with bone-dominant metastatic prostate cancer. The review also explores combination treatments, where integrating bone-targeted therapies with systemic prostate cancer treatments holding potential for enhanced efficacy. Ongoing clinical trials investigating novel treatment options and advanced drug delivery techniques are highlighted.ConclusionThe advancements signify a promising direction in the treatment of bone metastases in prostate cancer, highlighting the need for continuous innovation to enhance patient care and outcomes.