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Huntington SF, Cheng WY, Sarpong EM, Leng S, Farooqui MZH, Agu US, Catillon M, Lejeune D, Downes N, Matay L, Duh MS, De Nigris E. Real-world patterns and sequences of targeted therapy use in chronic lymphocytic leukemia and small lymphocytic lymphoma in the United States: a longitudinal study. Leuk Lymphoma 2024; 65:932-942. [PMID: 38696747 DOI: 10.1080/10428194.2024.2331631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/12/2024] [Indexed: 05/04/2024]
Abstract
With increasing focus on novel targeted therapies for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), this longitudinal claims-based study evaluated real-world CLL/SLL treatment sequences, particularly sequential targeted therapy. Among patients with first-line (1 L) treatment in 2014-2017 (N = 2,612; median follow-up = 3 years), the most common 1 L treatment was chemoimmunotherapy (CIT; 44.6%), followed by CD20 (25.2%) and Bruton's tyrosine kinase inhibitors (BTKi; 21.7%). Among those with 1 L in 2018-2021 (N = 4,534; median follow-up = 1 year), these were BTKi (45.5%), CD20 (20.4%), CIT (17.5%), and B-cell lymphoma 2 inhibitor (8.3%). In 2014-2017, the proportion of patients receiving sequential targeted therapy in the first 2 LOTs was 11.2% (80.2% was BTKi→BTKi); in 2018-2021, this proportion was 34.3% (66.4% was BTKi→BTKi). Over time, there was a substantial increase in targeted therapy use in 1 L and sequential targeted therapy, particularly with BTKi→BTKi. Future studies should assess clinical outcomes to determine optimal sequences for CLL/SLL and reasons for restarting BTKi.
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Characteristics and Clinical Outcomes of Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Receiving Ibrutinib for ≥5 Years in the RESONATE-2 Study. Cancers (Basel) 2023; 15:cancers15020507. [PMID: 36672456 PMCID: PMC9857192 DOI: 10.3390/cancers15020507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/18/2023] Open
Abstract
Primary results from the phase 3 RESONATE-2 study demonstrated superior efficacy and tolerability with ibrutinib versus chlorambucil in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Here, we describe characteristics and outcomes of patients who received ibrutinib treatment for ≥5 years in RESONATE-2. Patients aged ≥65 years with previously untreated CLL/SLL, without del(17p), were randomly assigned 1:1 to once-daily ibrutinib 420 mg until disease progression/unacceptable toxicity (n = 136) or chlorambucil 0.5−0.8 mg/kg for ≤12 cycles (n = 133). Baseline characteristics in ibrutinib-randomized patients (n = 136) were generally similar between patients on ibrutinib treatment for ≥5 years (n = 79) versus those on treatment for <5 years (n = 57). In patients on ibrutinib treatment for ≥5 years, complete response rates improved over time, reaching 42% by 5 years. Estimated 7-year progression-free survival and overall survival rates were 82% and 94%, respectively. Adverse events (AEs) led to dose reductions in 16/79 patients (20%); these AEs were resolved for 13/16 patients (81%). AEs led to dose holds (≥7 days) in 45/79 patients (57%); these AEs were resolved for 43/45 patients (96%). More than half (58%) of ibrutinib-randomized patients benefitted from ibrutinib treatment for ≥5 years regardless of baseline characteristics. Dose modification resolved AEs for most patients, thereby facilitating continued treatment.
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Development and Validation of a Simple Method for Simultaneously Measuring the Concentrations of BCR-ABL and Bruton Tyrosine Kinase Inhibitors in Dried Blood Spot (DBS): A Pilot Study to Obtain Candidate Conversion Equations for Predicting Plasma Concentration Based on DBS Concentration. Ther Drug Monit 2022; 44:762-770. [PMID: 36372934 DOI: 10.1097/ftd.0000000000000997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dried blood spots (DBSs) are promising candidates for therapeutic drug monitoring. In this study, a simple method for the simultaneous measurement of tyrosine kinase inhibitors (TKIs), including bosutinib, dasatinib, ibrutinib, imatinib, nilotinib, and ponatinib, using DBS was developed and validated. The prediction of the plasma concentration of TKIs based on the TKI concentrations in the DBS was assessed using the developed measurement method. METHODS DBS was prepared using venous blood on Whatman 903 cards. One whole DBS sample containing the equivalent of 40 μL of blood was used for the analysis. The analytical method was validated according to the relevant guidelines. For clinical validation, 96 clinical samples were analyzed. The regression equation was derived from a weighted Deming regression analysis, and correction factors for calculating the estimated plasma concentrations (EPCs) of the analytes from their concentrations in the DBS and the predictive performance of EPC were evaluated using 2 conversion equations. RESULTS This method was successfully validated. Hematocrit had no significant effect on the method's accuracy or precision. Ibrutinib was stable in the DBS for up to 8 weeks at room temperature, whereas all BCR-ABL TKIs were stable for 12 weeks. All BCR-ABL TKIs exhibited similar predictive performance for EPCs using both calculation methods. Good agreement between EPCs and the measured plasma concentrations of bosutinib, imatinib, and ponatinib was observed with both conversion equations. However, Bland-Altman analysis showed that blood sampling time affected the EPC accuracy for dasatinib and nilotinib. CONCLUSIONS A simple method for the simultaneous determination of BCR-ABL and Bruton TKI concentrations in DBS was developed and validated. Owing to the small clinical sample size, further clinical validation is needed to determine the predictive performance of EPCs for the 6 TKIs.
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Collins J, Stump SE, Heiling H, Muir M, Deal A, Proco D, Nguyen C, Cozad M, Mato A, Coombs CC, Muluneh B. Impact of adherence to ibrutinib on clinical outcomes in real-world patients with chronic lymphocytic leukemia. Leuk Lymphoma 2022; 63:1823-1830. [DOI: 10.1080/10428194.2022.2045597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James Collins
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah E. Stump
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Michele Muir
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Allison Deal
- UNC Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Darrian Proco
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Catharine Nguyen
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Monica Cozad
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Benyam Muluneh
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Cancer Center, Chapel Hill, NC, USA
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Frustaci AM, Deodato M, Zamprogna G, Cairoli R, Montillo M, Tedeschi A. SOHO State of the Art Updates and Next Questions: What is Fitness in the Era of Targeted Agents? CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:356-361. [PMID: 34969641 DOI: 10.1016/j.clml.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
The importance of coexisting conditions in chronic lymphocytic leukemia (CLL) outcome has been increasingly recognized over the past years. The role of comorbidities to predict patients' vulnerability toward immunochemotherapy has been well establish, especially since some of the tools commonly used to evaluate patients' fitness were employed to determine treatment eligibility in randomized trials. Nevertheless, is it still unclear how much fitness weights on treatment outcome with targeted agents and which assessment should be preferred. There are key differences in the toxicity profile between novel agents that are getting much more evident in retrospective, real-life experiences, rather than clinical trials. Therefore, an individual patient's comorbid medical conditions may be a deciding factor in therapy selection. Here, we analyze main evidence in literature on the predicting value of comorbidity assessment on outcome and management of CLL patients receiving novel agents.
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Affiliation(s)
- Anna Maria Frustaci
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy.
| | - Marina Deodato
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy
| | - Giulia Zamprogna
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy
| | - Roberto Cairoli
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy
| | - Marco Montillo
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Cancer Center, Milano, Italy
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Dürr P, Schlichtig K, Krebs S, Schramm A, Schötz L, Fromm MF, Dörje F. [Economic aspects in the care of patients with new oral anticancer drugs: findings from the AMBORA trial]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:84-93. [PMID: 35249863 DOI: 10.1016/j.zefq.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The number of prescriptions and costs of oral anticancer drugs are increasing. Therapy discontinuation due to, for example, side effects, progression, or death, often lead to medication wastage. While evidence exists for the economic value of wasted injectable chemotherapeutics, there is a lack of data for oral anticancer drugs in Germany. METHODS The multicenter AMBORA trial investigated 202 patients, who had been newly started on new oral anticancer drugs, over 12 weeks and analyzed the outpatient prescription data of patients who discontinued treatment. The amount of medicines wasted and their costs were determined using the pharmacy retail price. Defined daily doses and prescription data from the AOK Bayern, a German statutory health care insurance company, were used to extrapolate these costs. RESULTS Within 12 weeks, 24.8 % of the AMBORA patients discontinued oral anticancer treatment (50 of 202). Prescription data of 34 patients were evaluable. In total, 1,693 tablets/capsules with a value of 112,212 euros were wasted. The approximate extrapolation to the prescription volume of the AOK Bayern resulted in an estimated wastage of 3.49 million euros in 12 weeks. DISCUSSION Medication wastage due to discontinuation of new oral anticancer drug therapy leads to a considerable financial burden. Regarding rising prescription numbers and therapy costs in oncology, measures to reduce wastage of oral anticancer drugs should be initiated. CONCLUSION Clinical pharmacological / pharmaceutical care including medication reconciliation and review, side effect management and patient counseling to optimize adherence and medication intake behavior, contributes to a reduction of therapy discontinuations, thereby reducing drug wastage. To further reduce drug wastage small (initiation) packages, which are currently not always available for an economic prescription, play an important role. The practice of partial prescription fills, which is already practiced internationally, should also be further discussed in Germany.
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Affiliation(s)
- Pauline Dürr
- Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland; Apotheke des Universitätsklinikums Erlangen, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland
| | - Katja Schlichtig
- Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland
| | - Sabine Krebs
- Apotheke des Universitätsklinikums Erlangen, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland
| | | | | | - Martin F Fromm
- Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland
| | - Frank Dörje
- Apotheke des Universitätsklinikums Erlangen, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland.
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Melis EJ, Zwart-van Rijkom JE, Egberts TC, van den Bemt BJ, Witteveen PO, Gardarsdottir H. The association between patient satisfaction with information and adherence to oral anticancer agents. J Oncol Pharm Pract 2022; 29:637-645. [PMID: 35130094 DOI: 10.1177/10781552221077258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Adherence to anticancer agents is a critical factor in achieving adequate clinical response, and became a major challenge for patients and caregivers since the increased substitution of parenteral cytostatic by oral drugs. One of the factors that influences adherence is how well informed patients are about their therapy. This study assesses the association between patient satisfaction with information about oral anticancer agents and adherence. MATERIALS AND METHODS This study was conducted among patients (≥18 years) who began oral anticancer therapy. Patients satisfaction with information and adherence were assessed using validated questionnaires. Adherence was also assessed using refill data. Logistic regression was applied to assess the association between overall patient satisfaction with information and both self-reported adherence and adherence based on an MPR value of above 80%. RESULTS In total, 124 patients were included in the study. The median (IQR) satisfaction with information was 15.0(4) on a scale of 0-17. Eighty-two percent of participants reported adherence, while the refill data demonstrated that 64.5% of patients had an adherence rate of 80% or higher. Overall satisfaction with information was not significantly associated with self-reported adherence (OR adj 0.98 [95% CI 0.85-1.15]) or refill-based adherence (OR adj 1.11 [95% CI 0.99-1.24]). CONCLUSION The findings indicate no significant relationship between patient satisfaction with information and adherence. The population was highly satisfied with information about the oral anticancer agents, which indicates a high level of satisfaction with usual care. However, the refill data reveals that 35.5% of patients were not adherent.
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Affiliation(s)
- Eward J Melis
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Toine Cg Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Bart Jf van den Bemt
- Department of Pharmacy, 6033Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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8
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An Easily Expandable Multi-Drug LC-MS Assay for the Simultaneous Quantification of 57 Oral Antitumor Drugs in Human Plasma. Cancers (Basel) 2021; 13:cancers13246329. [PMID: 34944950 PMCID: PMC8699473 DOI: 10.3390/cancers13246329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Oral antitumor therapy has significantly improved clinical outcomes in multiple tumor entities. However, following a standard dosing regime, strong interindividual variability in patients’ plasma concentrations can be observed for many oral antitumor drugs. This results in risks of reduced therapeutic effect and increased side effects. Monitoring these variable plasma concentrations is an important tool in evaluating multiple factors influencing drug exposure and, if necessary, adjusting therapeutic doses. Here, we developed a method for the simultaneous measurement of 57 oral antitumor drug plasma concentrations. Detection and quantification were achieved using liquid chromatography coupled to an Orbitrap mass spectrometer, which can be easily expanded to newly approved oral antitumor drugs in the future. Applicability of the method was proven by measuring 71 plasma samples from 39 patients undergoing oral antitumor therapy. In summary, the developed method provides an important tool for exposure measurements of oral antitumor drugs. Abstract Oral anticancer drugs have led to significant improvements in the treatment of multiple tumor entities. However, in patients undergoing oral antitumor therapy, plasma concentrations are highly variable, resulting in risks of reduced therapeutic effects or an increase in side effects. One important tool to reduce this variability is therapeutic drug monitoring. In this work we describe a method to simultaneously quantify the plasma concentrations of 57 oral antitumor agents. Quantification of these drugs was achieved using liquid chromatography coupled to an Orbitrap mass spectrometer. The method was fully validated according to the FDA guidelines and constitutes a simple and robust way for exposure monitoring of a wide variety of oral anticancer drugs. Applicability to clinical routine was demonstrated by the analysis of 71 plasma samples taken from 39 patients. In summary, this new multi-drug method allows simultaneous quantification of 57 oral antitumor drugs, which can be applied to exposure monitoring in clinical studies, taking into account the broad variety of oral antitumor drugs prescribed in clinical routine.
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9
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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10
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Woyach J, Tedeschi A, Munir T, Siddiqi T, Hillmen P, Byrd JC, Ghia P, Mulligan SP, Dai S, Amaya-Chanaga CI, Dean JP, O'Brien SM, Barr PM. Using ibrutinib in earlier lines of treatment results in better outcomes for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma. Leuk Lymphoma 2021; 62:3278-3282. [PMID: 34384312 DOI: 10.1080/10428194.2021.1957871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jennifer Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Talha Munir
- Department of Haematology, St. James's University Hospital, Leeds, UK
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Peter Hillmen
- Department of Haematology, The Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, UK
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Sandra Dai
- Department of Biostatistics, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | - James P Dean
- Department of Clinical Science, Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Susan M O'Brien
- Department of Hematology and Oncology, UC Irvine, Chao Family Comprehensive Cancer Center, Irvine, CA, USA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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Mukai Y, Yoshida Y, Yoshida T, Kondo T, Inotsume N, Toda T. Simultaneous Quantification of BCR-ABL and Bruton Tyrosine Kinase Inhibitors in Dried Plasma Spots and Its Application to Clinical Sample Analysis. Ther Drug Monit 2021; 43:386-393. [PMID: 33065614 DOI: 10.1097/ftd.0000000000000825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent reports highlight the importance of therapeutic drug monitoring (TDM) of BCR-ABL and Bruton tyrosine kinase inhibitors (TKIs); thus, large-scale studies are needed to determine the target concentrations of these drugs. TDM using dried plasma spots (DPS) instead of conventional plasma samples is a promising approach. This study aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of BCR-ABL and Bruton TKIs for further TDM studies. METHODS A 20-μL aliquot of plasma was spotted onto a filter paper and dried completely. Analytes were extracted from 2 DPS using 250 μL of solvent. After cleanup by supported liquid extraction, the sample was analyzed by LC-MS/MS. Applicability of the method was examined using samples of patients' DPS transported by regular mail as a proof-of-concept study. The constant bias and proportional error between plasma and DPS concentrations were assessed by Passing-Bablok regression analysis, and systematic errors were evaluated by Bland-Altman analysis. RESULTS The method was successfully validated over the following calibration ranges: 1-200 ng/mL for dasatinib and ponatinib, 2-400 ng/mL for ibrutinib, 5-1000 ng/mL for bosutinib, and 20-4000 ng/mL for imatinib and nilotinib. TKI concentrations were successfully determined for 93 of 96 DPS from clinical samples. No constant bias between plasma and DPS concentrations was observed for bosutinib, dasatinib, nilotinib, and ponatinib, whereas there were proportional errors between the plasma and DPS concentrations of nilotinib and ponatinib. Bland-Altman plots revealed that significant systematic errors existed between both methods for bosutinib, nilotinib, and ponatinib. CONCLUSIONS An LC-MS/MS method for the simultaneous quantification of 6 TKIs in DPS was developed and validated. Further large-scale studies should be conducted to assess the consistency of concentration measurements obtained from plasma and DPS.
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Affiliation(s)
- Yuji Mukai
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Hokkaido. Dr. Yuji Mukai is now with the Department of Pharmacy, University of Tsukuba Hospital, Ibaraki
| | - Yuka Yoshida
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Hokkaido. Dr. Yuji Mukai is now with the Department of Pharmacy, University of Tsukuba Hospital, Ibaraki
| | | | - Takeshi Kondo
- Department of Hematology, Blood Disorders Center, Aiiku Hospital, Hokkaido; and
| | - Nobuo Inotsume
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Hokkaido. Dr. Yuji Mukai is now with the Department of Pharmacy, University of Tsukuba Hospital, Ibaraki
- Nihon Pharmaceutical University, Saitama, Japan
| | - Takaki Toda
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Hokkaido. Dr. Yuji Mukai is now with the Department of Pharmacy, University of Tsukuba Hospital, Ibaraki
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12
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Solano M, Daguindau E, Faure C, Loriod P, Pain C, Maes AC, Marguet P, Kroemer M, Rumpler A, Fontan J, Deconinck E, Limat S, Clairet AL. Oral therapy adherence and satisfaction in patients with multiple myeloma. Ann Hematol 2021; 100:1803-1813. [PMID: 33938996 DOI: 10.1007/s00277-021-04543-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients; however, they must self-manage their medication and adherence plays an important role in patient care. It has been shown that patient satisfaction with their medication has a strong positive correlation with adherence in chronic diseases. The aim of this study was to estimate adherence rate of oral antimyeloma therapies and to identify risk factors for medication non-adherence. This observational, prospective, and multicentre survey based on a self-report questionnaire enrolled MM patients with at least 3 months of oral therapy. The 6-item Girerd scale and the medication possession ratio (MPR) were used for measuring medication adherence and the SATMED-Q® questionnaire was used for measuring satisfaction. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. A total of 101 patients participated in the survey, yielding a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the Girerd questionnaire. According to the MPR, adherence was evaluated at 96% (i.e. MPR ≥ 0.80). Both methods combined, adherence was estimated at 50.5%. One risk factor for medication non-adherence was identified: Eastern Cooperative Oncology Group Performance Status > 2 (p = 0.007). One predictive factor for high medication adherence was identified: high satisfaction with treatment (p = 0.01). Identifying patients at higher risk for non-adherence allows clinical pharmacists to personalise therapeutic information and education and to improve the quality of healthcare overall.
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Affiliation(s)
- Marine Solano
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.
| | - Etienne Daguindau
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Cyril Faure
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pierre Loriod
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Coline Pain
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Anne-Cécile Maes
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pauline Marguet
- Pharmacy Department, Centre Hospitalier Général Louis Pasteur, Hospital of Dole, Dole, France
| | - Marie Kroemer
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne Rumpler
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Jean Fontan
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Eric Deconinck
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Samuel Limat
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne-Laure Clairet
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
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13
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Hillmen P, Xie J, Yong ASM, Waweru C, Sorof TA, Goyal RK, Davis KL. Real-world treatment patterns, adverse events and clinical outcomes in patients with chronic lymphocytic leukaemia treated with ibrutinib in the UK. EJHAEM 2021; 2:219-227. [PMID: 35845284 PMCID: PMC9175847 DOI: 10.1002/jha2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in adults in the UK. Ibrutinib, an oral Bruton tyrosine kinase inhibitor (BTKi) for CLL approved by the UK's National Institute for Health and Care Excellence in January 2017, represented a major shift in CLL management. Real-world data on ibrutinib use in routine clinical practice will inform patients' and physicians' decision-making. We conducted a retrospective medical chart review of UK patients with CLL who initiated ibrutinib between January 2017 and July 2018. Data for 259 patients were contributed by 34 haematology-oncology specialists, with a median follow-up duration of 16.7 months. Median age at ibrutinib initiation was 71 years. Ibrutinib first-line monotherapy was prescribed in 20.1% of patients. Ibrutinib was permanently discontinued in 15.4% of patients, mostly owing to progressive disease. Adverse events (AEs) were reported in 151 patients (58.3%). The most common were bruising (19.3% of patients), cytopenias (17.0%) and diarrhoea (11.6%). Ibrutinib dose reduction was observed in 14.3% of patients and was temporarily discontinued in 10.4% of patients, with the main reason for both being toxicity. These results expand the real-world evidence on ibrutinib therapy and demonstrate a high burden of AEs, highlighting the need for more tolerable BTKis.
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Affiliation(s)
| | - Jing Xie
- AstraZenecaGaithersburgMarylandUSA
| | | | | | - Thuy Anh Sorof
- Acerta Pharma (a member of the AstraZeneca group)South San FranciscoCaliforniaUSA
| | - Ravi K. Goyal
- RTI Health SolutionsResearch Triangle ParkNorth CarolinaUSA
| | - Keith L. Davis
- RTI Health SolutionsResearch Triangle ParkNorth CarolinaUSA
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14
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Dürr P, Schlichtig K, Kelz C, Deutsch B, Maas R, Eckart MJ, Wilke J, Wagner H, Wolff K, Preuß C, Brückl V, Meidenbauer N, Staerk C, Mayr A, Fietkau R, Goebell PJ, Kunath F, Beckmann MW, Mackensen A, Neurath MF, Pavel M, Dörje F, Fromm MF. The Randomized AMBORA Trial: Impact of Pharmacological/Pharmaceutical Care on Medication Safety and Patient-Reported Outcomes During Treatment With New Oral Anticancer Agents. J Clin Oncol 2021; 39:1983-1994. [PMID: 33822650 DOI: 10.1200/jco.20.03088] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oral anticancer drugs (eg, kinase inhibitors) play an important role in cancer therapy. However, considerable challenges regarding medication safety of oral anticancer drugs have been reported. Randomized, controlled, multicenter studies on the impact of intensified clinical pharmacological/pharmaceutical care on patient safety and patient treatment perception are lacking. METHODS Patients were eligible for the randomized, multicenter AMBORA study, if they were newly started on any of the oral anticancer drugs approved in 2001 or later without restriction to certain tumor entities. Patients were randomly assigned to receive either standard of care (control group) or an additional, intensified clinical pharmacological/pharmaceutical care, which included medication management and structured patient counseling, over a period of 12 weeks (intervention group). Primary end points were the number of antitumor drug-related problems (ie, side effects and unresolved medication errors) and patient treatment satisfaction with the oral anticancer therapy after 12 weeks measured with the Treatment Satisfaction Questionnaire for Medication, category convenience. RESULTS Two hundred two patients were included. Antitumor drug-related problems were significantly lower in the intervention compared with the control group (3.85 v 5.81 [mean], P < .001). Patient treatment satisfaction was higher in the intervention group (Treatment Satisfaction Questionnaire for Medication, convenience; 91.6 v 74.4 [mean], P < .001). The hazard ratio for the combined end point of severe side effects (Common Terminology Criteria for Adverse Events ≥ 3), treatment discontinuation, unscheduled hospital admission, and death was 0.48 (95% CI, 0.32 to 0.71, P < .001) in favor of the intervention group. CONCLUSION Treatment with oral anticancer drugs is associated with a broad range of medication errors and side effects. An intensified clinical pharmacological/pharmaceutical care has considerable, positive effects on the number of medication errors, patient treatment perception, and severe side effects.
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Affiliation(s)
- Pauline Dürr
- Pharmacy Department, Erlangen University Hospital, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Katja Schlichtig
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin Kelz
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Birgit Deutsch
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Renke Maas
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Jochen Wilke
- Practice for Hematology and Oncology, Fürth, Germany
| | - Harald Wagner
- Practice for Hematology and Oncology, Fürth, Germany
| | - Kerstin Wolff
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 1, University Hospital Erlangen, Erlangen, Germany
| | - Caroline Preuß
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Valeska Brückl
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 5, Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Norbert Meidenbauer
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 5, Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Staerk
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Andreas Mayr
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rainer Fietkau
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Peter J Goebell
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Frank Kunath
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias W Beckmann
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Mackensen
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 5, Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 1, University Hospital Erlangen, Erlangen, Germany
| | - Marianne Pavel
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 1, University Hospital Erlangen, Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, Erlangen University Hospital, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Martin F Fromm
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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15
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Mato AR, Sharman JP, Biondo JML, Wu M, Mun Y, Kim SY, Humphrey K, Boyer M, Zhu Q, Seymour JF. The impact of early discontinuation/dose modification of venetoclax on outcomes in patients with relapsed/refractory chronic lymphocytic leukemia: post-hoc analyses from the phase III MURANO study. Haematologica 2020; 107:134-142. [PMID: 33327712 PMCID: PMC8719076 DOI: 10.3324/haematol.2020.266486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 11/09/2022] Open
Abstract
Fixed-duration venetoclax plus rituximab (VenR) has a manageable safety profile and improves survival in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL). We present data from the phase III MURANO study on the impact of venetoclax modification or premature discontinuation on outcomes in patients with R/R CLL.
Time-dependent Cox proportional hazards regression models, stratified by 17p deletion and risk status, evaluated the impact of venetoclax discontinuation/modification on investigator-assessed progression-free survival (PFS) and overall survival (OS). Analyses were performed retrospectively (without type-1 error control) in intention-to-treat patients from the VenR arm of MURANO. Overall, 140/194 (72%) patients in the VenR arm completed 2 years of therapy; 54/194 (28%) patients prematurely discontinued treatment. Inferior PFS was observed in patients prematurely discontinuing venetoclax for any reason (disease progression excluded; p
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Affiliation(s)
| | - Jeff P Sharman
- Willamette Valley Cancer Institute and Research Center, Eugene, OR, USA/US Oncology Research, US Oncology Network, Texas
| | | | - Mei Wu
- Genentech, Inc., South San Francisco, CA
| | - Yong Mun
- Genentech, Inc., South San Francisco, CA
| | | | | | | | - Qian Zhu
- Genentech, Inc., South San Francisco, CA
| | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC
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16
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Schlichtig K, Dürr P, Dörje F, Fromm MF. New Oral Anti-Cancer Drugs and Medication Safety. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:775-782. [PMID: 31920193 DOI: 10.3238/arztebl.2019.0775] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 04/30/2019] [Accepted: 08/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many oral anti-cancer drugs have come onto the market in the past 20 years. For example, kinase inhibitors, such as the BCR-ABL and BRAF inhibitors, have markedly improved the treatment of chronic myeloid leukemia and melanoma. In this review, we discuss the special challenges posed by poor adherence, drug-drug interactions with other substances, and side effects, among other problems, and the ways in which these challenges can be met. METHODS A selective search was carried out in PubMed for original and review articles on the safety of new oral anti-cancer drugs. Guidelines and current Summaries of Product Characteristics (SmPC) were also considered in the analysis. RESULTS Review articles have pointed out numerous safety concerns with oral anti-cancer drugs. One of these is adherence, on which highly variable figures are available (with mean non-adherence rates ranging from 0 to 54%). The absorption of approximately half of these drugs is influenced by the patient's diet, and that of approximately 20% by gastric pH (Caution: proton-pump inhibitors may influence bioavailability). 70% of the active substances are metabolized primarily by CYP3A4, which means that their pharmacokinetics can be altered by grapefruit juice and CYP3A4 modulators. The prevention, detection, and treatment of side effects (which can be gastrointestinal, cutaneous, cardiovascular, or other) is a highly important matter. CONCLUSION The increasing use of oral anti-cancer drugs confronts patients and treatment teams with special challenges. To optimize treatment outcomes, a multidisciplinary approach should be taken, involving physicians, pharmacists, and nurses. To improve medication safety, medication and side-effect management should be performed, and adherence should be regularly checked and systematically encouraged.
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Affiliation(s)
- Katja Schlichtig
- Chair of Clinical Pharmacology and Clinical Toxicology, Institute for Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen; Pharmacy, University Hospital Erlangen; Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (EMN), Erlangen
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17
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Hardy-Abeloos C, Pinotti R, Gabrilove J. Ibrutinib dose modifications in the management of CLL. J Hematol Oncol 2020; 13:66. [PMID: 32503582 PMCID: PMC7275592 DOI: 10.1186/s13045-020-00870-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/01/2020] [Indexed: 12/05/2022] Open
Abstract
Background Ibrutinib is a Bruton tyrosine kinase inhibitor approved for the treatment of chronic lymphocytic leukemia (CLL) in 2014. Ibrutinib is often used to treat patients who are younger than the patients originally included in theclinical trials have additional unfavorable prognostic factors and suffer from additional comorbidities excluded from the original phase III trials. Our objective was to examine current clinical practices and their impact in this expanded population of CLL patients who often require adjustments in the standard prescribed dose and schedule of therapy. Materials and methods An extensive review of the medical literature was conducted to establish the consensus on ibrutinib dose modifications in patients with CLL. Twenty-nine studies were reviewed including fourteen clinical trials and fifteen “real-world practice” studies. Results The average discontinuation rate was similar between clinical trials and “real-world practice” studies though the reasons for discontinuation differed. CLL progression was a more common reason for discontinuation in clinical trial studies while toxicity was a more common reason for discontinuation in “real-world practice” studies. Some studies have suggested worse outcomes in patients requiring dose reductions in ibrutinib while others have shown no change in treatment efficacy in patients requiring dose reductions due to concomitant CYP medications or increased immunosuppression post-transplant. Conclusion The impact of ibrutinib dose modifications on clinical outcome remains unclear. Patients on concomitant CYP3A inhibitors should be prescribed a lower dose than the standard 420 mg daily, in order to maintain comparable pharmacologic properties. Further research is required to establish definitive clinical practice guidelines.
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Affiliation(s)
- Camille Hardy-Abeloos
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Pinotti
- Library Education and Research Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janice Gabrilove
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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18
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Pharmacists' Role in Managing Patients with Chronic Lymphocytic Leukemia. PHARMACY 2020; 8:pharmacy8020052. [PMID: 32230834 PMCID: PMC7355755 DOI: 10.3390/pharmacy8020052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a hematologic malignancy that has seen significant advances in care over the last 5 years with the approval of oral agents such as ibrutinib and venetoclax for the treatment of this disease. As such, there has been a substantial shift away from the traditional chemotherapy infusions which have allowed patients greater autonomy with oral cancer therapies. This paradigm shift poses new challenges for the medical team, including drug-drug interactions, adherence counseling, and financial toxicity. Pharmacists are uniquely trained and equipped to help to manage the changing landscape of CLL care. From identifying common medications which may impair ibrutinib clearance to ensuring patients are on the appropriate anti-infective prophylaxis while receiving obinutuzumab, pharmacists can play a vital role in ensuring the highest quality of patient care. Furthermore, additional credentialing of clinical pharmacists in select states allows for independent visits with the pharmacists, allowing for greater involvement, particularly for initiation of venetoclax and management of ibrutinib-induced toxicities. Pharmacists are essential to both expanding and enhancing the care of patients with CLL and should be leveraged to improve patient outcomes whenever possible.
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19
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Sircar A, Chowdhury SM, Hart A, Bell WC, Singh S, Sehgal L, Epperla N. Impact and Intricacies of Bone Marrow Microenvironment in B-cell Lymphomas: From Biology to Therapy. Int J Mol Sci 2020; 21:E904. [PMID: 32019190 PMCID: PMC7043222 DOI: 10.3390/ijms21030904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
Lymphoma, a group of widely prevalent hematological malignancies of lymphocyte origin, has become the focus of significant clinical research due to their high propensity for refractory/relapsed (R/R) disease, leading to poor prognostic outcomes. The complex molecular circuitry in lymphomas, especially in the aggressive phenotypes, has made it difficult to find a therapeutic option that can salvage R/R disease. Furthermore, the association of lymphomas with the Bone Marrow (BM) microenvironment has been found to portend worse outcomes in terms of heightened chances of relapse and acquired resistance to chemotherapy. This review assesses the current therapy options in three distinct types of lymphomas: diffuse large B-cell lymphoma, follicular lymphoma and mantle cell lymphoma. It also explores the role of the BM tumor microenvironment as a secure 'niche' for lymphoma cells to grow, proliferate and survive. It further evaluates potential mechanisms through which the tumor cells can establish molecular connections with the BM cells to provide pro-tumor benefits, and discusses putative therapeutic strategies for disrupting the BM-lymphoma cell communication.
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Affiliation(s)
| | | | | | | | | | - Lalit Sehgal
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.S.); (S.M.C.); (A.H.); (W.C.B.); (S.S.)
| | - Narendranath Epperla
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.S.); (S.M.C.); (A.H.); (W.C.B.); (S.S.)
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20
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Novel high-performance liquid chromatography–tandem mass spectrometry method for simultaneous quantification of BCR-ABL and Bruton’s tyrosine kinase inhibitors and their three active metabolites in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1137:121928. [DOI: 10.1016/j.jchromb.2019.121928] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/26/2022]
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