Journal of Oncology Pharmacy Practice最新文献

IntroductionDaratumumab, a monoclonal antibody that specifically targets the myeloma cells' CD38 antigen, is promisingly used in both monotherapy and combination therapy for relapsed patients with multiple myeloma. However, this approach had a significant challenge due to the high rate of infusion-related reaction in the first dosage (up to 38%) despite strict instructions on infusion rate and dilution volume. This study describes a patient who overcame severe infusion reaction after the first dosage by desensitization.Case reportA 60-year-old man with multiple myeloma was relapsed with multiple bone damage and elevated immunoglobulin D lambda after VTD (bortezomid, thalidomide, dexamethasone) regimen completion. After 60 min of initial Daratumumab dose with sufficient pre-medication, the patient manifested suspected grade 3 infustion reaction and was transported to the intensive care unit.Management and outcomeDaratumumab was immediately terminated; adrenaline, methylprednisolone, and diphenhydramine were started. Another regimen was performed. However, due to substantial progression of symptoms, a re-introduction of daratumumab was considered. Daratumumab prick and intradermal skin test was performed with negative result. Desensitization were sucessfull with the number of bags and steps gradually lowered with no adverse events observed. After three cycles, the patient achieved VGPR (Very Good Partial Response) without any symptomatic spinal cord compression.ConclusionDesensitization is a promising solution to overcome daratumumab's severe infusion reaction, opening the new approach for clinicians. To ensure success, it is important to have a multidisciplinary team with experienced allergist, hematologist, Intensive Care Init (ICU) team and oncology pharmacist to create a safe environment for desensitization.

PurposeOncology Pharmacists providing care for cancer patients need access to medication history, act to prevent drug- / herb-drug interaction (HDI), educate patients on detection and management of adverse effects (AE) through proper use of supportive care. However, language barriers are common in case with less spoken languages, making communication challenging. We aimed to design and validate a set of illustrations addressing these key topics.MethodsThe design of the pictures was led by three pharmacists, focusing on three topics: general information (medication history), problems detection (AE of anticancer treatments, HDI) and the proper use of supportive care (e.g., mouthwash). Illustrations were created using Canva^® (Canva Pty Ltd, Perth, Australia). Each card underwent a two-step validation process: an on-site evaluation (Wooclap^® (Bruxelles, Belgium) for agreement/disagreement with recommendations), followed by a broader validation involving a multidisciplinary panel including oncologists, general practitioners, nurses, pharmacists, and patients- using a 9-point Likert scale on a Google^® Form (Google, Mountain View, CA, USA).ResultsA total of 53 cards were initially evaluated by 19 pharmacists who fully approved 18 of them and provided recommendations for the others. Subsequently, a panel of 27 respondents rated the 53 cards. After the first round, the mean score was 7.37 ± 1.2, with all but five cards receiving a score >6 and being validated. The clarity of four cards (weight variation, HDI, dry skin, neuropathy) was improved while one (St John's wort) was ultimately removed. The four revised cards were then resubmitted and received approval.ConclusionsA final set of 52 validated cards will help enhance pharmaceutical care for cancer patients facing language barriers.

Background and AimChronic myeloid leukemia (CML) incidence has recently increased in younger individuals. With time, given the nature of the disease and available therapies, as well as the existing paucity and inconsistency of advice, worries about fertility have surfaced. With all these clear unknowns, we designed this study to raise awareness among both physicians and CML patients about whether male and female patients of childbearing age were using contraception at the time of diagnosis, and if so, which methods they were using. In this context, this study aimed to evaluate the contraception methods in patients with CML.Materials and MethodsEighteen centres from Turkey participated in the study. Male and female patients of childbearing age diagnosed with chronic and accelerated phase CML between the years 2000 and 2024 were evaluated retrospectively.ResultsOf the two hundred and thirty-two patients included, one hundred and twenty-five (53.9%) of these patients were female and 107 (46.1%) were male. At diagnosis, all female patients were in the childbearing age, and male patients were sexually active. The median age at diagnosis of the patients was 38 (range, 18-77) years. Eighty-six (68.8%) female patients were using any contraception method, while this was 53.2% (n = 57) among male patients.ConclusionIn conclusion, since CML patients are diagnosed at an earlier age and the desire of these patients to have children, adequate information and evaluation should be provided regarding fertility and contraception issues, especially in female patients, from the moment of diagnosis.

IntroductionWe compared the efficacy of first-generation granisetron and second-generation palonosetron in triplet anti-emetic prophylaxis in patients with non-small cell lung cancer (NSCLC) receiving cisplatin-based high emetogenic chemotherapy (HEC).MethodsThis prospective, multicenter, non-randomized, observational study was conducted between June 2018 and December 2021. Patients diagnosed with NSCLC who received triplet anti-emetic prophylactic treatment with aprepitant and dexamethasone plus granisetron or palonosetron before the first cycle of chemotherapy were included in the study. At the end of the first week after chemotherapy, the emesis scale was applied to the patients during the outpatient control. The primary endpoint was complete response (CR) and total control (TC).ResultsOne hundred twenty-one patients were included in the study. Sixty-one patients were in the granisetron group and 60 patients were in the palonosetron group. CR was higher with granisetron in the acute phase (70.5% vs. 58.3%, p = 0.16; respectively) and higher with palonosetron in the delayed phase (61.7% vs. 55.7%, p = 0.5; respectively), although not statistically significant. The TC rates were also not significantly different between the groups (54.1% vs.57.6%, p = 0.69).ConclusionsThere was no significant difference between granisetron and palonosetron in both acute and delayed control of emesis in NSCLC patients receiving cisplatin-based HEC.

Objective: The aim of this overview was to summarize evidence of the efficacy and safety of thalidomide in the treatment of oncology-related diseases approved in Brazil, and to assess the quality of the available data. Methods: A literature search was performed in the Cochrane Library, PubMed, Embase, Lilacs, and SciELO databases. Studies must contain evidence of efficacy and/or safety of thalidomide use for multiple myeloma - MM, graft-versus-host disease - GVHD, and myelodysplastic syndrome - MDS. The extracted information were: authors, year, literature search, studies design, target population, studies sample, comparisons and thalidomide dose, funding, outcomes, results / pooled effect, heterogeneity, conclusion. Results: This overview showed the available data about efficacy and safety of thalidomide used in the treatment of oncology-related approved indications in Brazil. It also classified the methodological quality of studies according to Amstar 2 tool. Despite of the poor quality of the articles found, they supported the efficacy of thalidomide in MM treatment. The main adverse events reported were peripheral neuropathy, infections, hematological, thromboembolic, and gastrointestinal events. Evidence supported that the more drugs combined, the greater the efficacy, but there is also a greater risk of toxicity. For the indications of GVHD and MDS no systematic reviews and/or meta-analyses that met the inclusion criteria were found. Conclusions: The overview confirmed thalidomide's efficacy on MM. It is important to monitor and manage the occurrence of thalidomide-related adverse events. Strict control over its use must always be reinforced to maintain its safe use.

IntroductionNational guidelines for breast cancer support substitution with nab-paclitaxel for paclitaxel or docetaxel due to medical necessity.¹ This study aimed to assess for correlation between weekly nab-paclitaxel dose and relative dose intensity (RDI) amongst early breast cancer patients.MethodsThis single-center, retrospective cohort study included adult patients with early breast cancer who switched from weekly paclitaxel to nab-paclitaxel after hypersensitivity reaction. The primary outcome of RDI was assessed in patients receiving nab-paclitaxel 80 mg/m² (NB80) or 100 mg/m² (NB100) intravenously (IV) weekly. Secondary outcomes included adverse effects, incidence of nab-paclitaxel alterations, and growth factor (GCSF) administration for secondary prophylaxis.ResultsAmongst 26 patients, the median age was 43 years (range 33 to 71), with the majority (54%) having stage II or later disease. Median RDI with NB80 was 91% (range 69 to 100%) versus 86% (55 to 100%) with NB100. Fifty percent of all patients underwent dose reductions. Dose delays occurred in a higher proportion of patients on 50% with NB80 vs 33% with NB100. Early nab-paclitaxel discontinuations occurred more on NB100 (33% vs 10%). Incidence of chemotherapy-induced peripheral neuropathy (CIPN) was 80% vs 83% with NB80 and NB100, respectively, while grade 2 CIPN was more common on NB100 (50% vs 35%). A lower rate of neutropenia resulted from NB80 (60 vs 67% with NB100).ConclusionNab-paclitaxel dosed at 80 mg/m² IV weekly, after switching due to paclitaxel hypersensitivity, may promote improved RDI and safety compared to nab-paclitaxel 100 mg/m² weekly amongst early breast cancer patients.

IntroductionOral mucositis is a common and painful side effect of chemotherapy and radiotherapy in cancer patients, significantly impairing their quality of life and adherence to treatment. Although dexamethasone is recognized for its anti-inflammatory properties, no commercial mouthwash formulation exists at a concentration of 0.1 mg/mL. This study aimed to formulate and evaluate the physicochemical and microbiological stability of hospital-prepared dexamethasone-based mouthwashes.MethodsNine different formulations were developed by varying the humectants, cosolvents and surfactants. Stability was assessed over 28 days by monitoring pH, viscosity, density, zeta potential and dexamethasone concentration using HPLC. Microbiological quality was also evaluated. Statistical analyses were conducted using Student's t-test and ANOVA.ResultsFormula F9, composed of sorbitol as humectant and propylene glycol as cosolvent, demonstrated optimal physicochemical stability, with non-significant variation in viscosity and acceptable pH levels. The dexamethasone content remained within 98.48% after 52 days. Microbiological analyses showed no contamination at Day 28.ConclusionThe F9 formulation appears to be a stable and safe candidate for clinical use as a dexamethasone-based mouthwash. The recommended dosage for adults and children over five years of age is 10 mL (swish and spit) four times daily, while for children under five years, the recommended dosage is 5 mL (swish and spit) twice daily. Further clinical studies are warranted to confirm its therapeutic benefits in the management of oral mucositis.

BackgroundBispecific monoclonal antibodies (BsAbs) are utilized in patients with relapsed or refractory multiple myeloma (MM) and light chain amyloidosis (AL amyloidosis) but are associated with high rates of neutropenia and infection. Granulocyte colony stimulating factors (G-CSF) offer a potential means to mitigate infection risk and maintain BsAb treatment, however their use alongside BsAbs is not well defined.MethodsThis single-center, retrospective chart review included adult patients with MM or AL amyloidosis who received teclistamab, talquetamab, or elranatamab at Dana-Farber Cancer Institute from 2022 to 2025. The primary outcome was to assess the rate of infections in patients with or without concomitant G-CSF therapy. The secondary outcomes were to compare the infection characteristics and relative dose intensities of BsAbs in patients with or without concomitant G-CSF therapy and to describe the efficacy of G-CSF therapy.ResultsInfection rates were comparable in patients that received G-CSF (60% with G-CSF vs. 41% without; p=0.055). Relative BsAb dose intensity was similar in patients that received G-CSF (95.2% with G-CSF vs. 100% without; p=0.23). G-CSF was effective in resolving grade 3 (89%) and grade 4 (75%) neutropenia, with a median time to resolution of 7 days, and same day administration with BsAb occurred in 69% of patients.ConclusionsG-CSF administration resulted in comparable infection rates and treatment intensity relative to those not receiving G-CSF. G-CSF was effective in resolving neutropenia, often permitting same-day BsAb administration. These findings support the feasibility and utility of G-CSF during BsAb therapy to minimize infection-related complications and treatment deviations.

ObjectiveIntensive chemotherapy combinations with venetoclax are being used more frequently for acute myeloid leukemia (AML). In May 2022, a critical shortage of fludarabine prompted cladribine substitution at several institutions in the United States. FLAG-Ida-Ven and CLIA-Ven are similar IC regimens using different purine analogues, potentially with different efficacy and toxicity. To describe the patient population, outcomes, and toxicities of patients receiving FLAG-Ida-Ven and CLIA-Ven.Data SourcesA retrospective analysis of patients over 18 years with AML who received FLAG-Ida-Ven or CLIA-Ven for relapsed/refractory AML (R/R AML) at the City of Hope between December 2020 and January 2023.Data SummaryThere were 31 patients who received FLAG-Ida-Ven; 8 patients received CLIA-Ven. Patients were identified using ICD-10 code for AML and documented administration of medications. Most patients included were male with de novo AML with ELN adverse risk AML. Median age was 53 years (20-78) for FLAG-Ida-Ven and 47.5 years (23-69) for CLIA-Ven. Prior exposure to venetoclax based therapy was common (61.3% vs 50%). The ORR (overall response rate) in FLAG-Ida-Ven and CLIA-Ven was 46.7% and 75%, of which 86% vs 83% were MRD negative, respectively. There were 42% (n = 13) and 50% (n = 4) of patients who were able to proceed to allogeneic stem cell transplant in the FLAG-Ida-Ven and CLIA-Ven with median time to transplant being 89 vs 132 days respectively.Regarding safety, CLIA-Ven had a higher incidence of grade 3 or 4 non-hematologic adverse events, 6% vs 50% respectively. Survival from therapy initiation at 6 months was 48.4% vs 75%.ConclusionConsistent with the literature, it appears that the activity between FLAG-Ida-Ven and CLIA-Ven are comparable, however FLAG-Ida-Ven may have a more tolerable safety profile.

To review pharmacology, pharmacokinetics, therapeutic use, product safety/description and perspectives on use of lutetium Lu 177 vipivotide tetraxetan in patients with metastatic castration-resistant prostate cancer (mCRPC). Data sources: A literature search was conducted using PubMed/Dynamed (October 2013-May 2025), limited to English language, humans, clinical trials, case reports, and guidelines. Data summary: Lutetium Lu 177 vipivotide tetraxetan is comprised of the beta-emitting radioisotope lutetium Lu-177 linked to a peptide, vipivotide tetraxetan, which binds to cells expressing prostate-specific membrane antigen (PSMA), resulting in cell death from the radiation. Kidney excretion may result in increased renal toxicity in patients with reduced renal function. Based on 2 phase III clinical trials, lutetium Lu 177 vipivotide tetraxetan 7.4 GBq administered intravenously every 6 weeks for up to 6 doses is effective in patients with mCRPC and PSMA-positive metastases after progressing on an androgen receptor pathway inhibitor and docetaxel therapy or an androgen receptor pathway inhibitor alone, by significantly improving radiographic progression-free survival. It is generally well tolerated, with asthenia/fatigue, dry mouth, mild nausea and low-grade anemia most commonly occurring. Severe adverse drug reactions are uncommon. It should only be administered by trained personnel in a designated clinical setting with existing radiation safety protocols. Patients must limit close contact, use precautions with using the bathroom and other daily activities in days following treatment. Patient education is necessary to ensure safe daily practices. Several ongoing trials are evaluating lutetium Lu 177 vipivotide tetraxetan in combination with other anticancer agents for treatment of mCRPC, using different dosing strategies, or in other settings (metastatic castration-sensitive prostate cancer and early-stage prostate cancer). Conclusion: Lutetium Lu 177 vipivotide tetraxetan is an effective and well tolerated treatment for patients with mCRPC, PSMA-positive metastases after progressing on an androgen receptor pathway inhibitor ± docetaxel. Ongoing studies evaluating its use in earlier disease stages and with different dosing strategies, will better define the role of this therapy in the treatment of prostate cancer.