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Moore DC, Granger K, Hill H, Karabinos A, Davis JA. Elranatamab vs. teclistamab: battle of the BCMA bispecifics in relapsed/refractory multiple myeloma. Expert Rev Hematol 2024:1-4. [PMID: 38717927 DOI: 10.1080/17474086.2024.2353751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - Katelynn Granger
- Hollings Cancer Center, Department of Pharmacy, The Medical University of South Carolina, Charleston, SC, USA
| | - Hailey Hill
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - Allison Karabinos
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - James A Davis
- Hollings Cancer Center, Department of Pharmacy, The Medical University of South Carolina, Charleston, SC, USA
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Nguyen DG, Morris SA, Chen A, Moore DC, Hanson SL, Larck C, Musselwhite LW, Turner JD, Salem ME, Kwange SO, Hamilton A, Steuerwald N, Patel JN. Unveiling Discrepant and Rare Dihydropyrimidine Dehydrogenase (DPYD) Results Using an In-House Genotyping Test: A Case Series. J Natl Compr Canc Netw 2024; 22:e247022. [PMID: 38754463 DOI: 10.6004/jnccn.2024.7022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/21/2024] [Indexed: 05/18/2024]
Abstract
Fluoropyrimidine chemotherapy is a primary component of many solid tumor treatment regimens, particularly those for gastrointestinal malignancies. Approximately one-third of patients receiving fluoropyrimidine-based chemotherapies experience serious adverse effects. This risk is substantially higher in patients carrying DPYD genetic variants, which cause reduced fluoropyrimidine metabolism and inactivation (ie, dihydropyridine dehydrogenase [DPD] deficiency). Despite the known relationship between DPD deficiency and severe toxicity risk, including drug-related fatalities, pretreatment DPYD testing is not standard of care in the United States. We developed an in-house DPYD genotyping test that detects 5 clinically actionable variants associated with DPD deficiency, and genotyped 827 patients receiving fluoropyrimidines, of which 49 (6%) were identified as heterozygous carriers. We highlight 3 unique cases: (1) a patient with a false-negative result from a commercial laboratory that only tested for the c.1905 + 1G>A (*2A) variant, (2) a White patient in whom the c.557A>G variant (typically observed in people of African ancestry) was detected, and (3) a patient with the rare c.1679T>G (*13) variant. Lastly, we evaluated which DPYD variants are detected by commercial laboratories offering DPYD genotyping in the United States and found 6 of 13 (46%) did not test for all 5 variants included on our panel. We estimated that 20.4% to 81.6% of DPYD heterozygous carriers identified on our panel would have had a false-negative result if tested by 1 of these 6 laboratories. The sensitivity and negative predictive value of the diagnostic tests from these laboratories ranged from 18.4% to 79.6% and 95.1% to 98.7%, respectively. These cases underscore the importance of comprehensive DPYD genotyping to accurately identify patients with DPD deficiency who may require lower fluoropyrimidine doses to mitigate severe toxicities and hospitalizations. Clinicians should be aware of test limitations and variability in variant detection by commercial laboratories, and seek assistance by pharmacogenetic experts or available resources for test selection and result interpretation.
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Affiliation(s)
- D Grace Nguyen
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sarah A Morris
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Annabel Chen
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sarah L Hanson
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Chris Larck
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Laura W Musselwhite
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - John D Turner
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Mohamed E Salem
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Simeon O Kwange
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Alicia Hamilton
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Nury Steuerwald
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Molecular Biology and Genomics Core Laboratory, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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Fleck C, Karabinos A, Cook A, Moore DC, Jacobs R. Evaluation of safety outcomes with transitioning obinutuzumab from standard rate to short duration infusion in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2024:1-2. [PMID: 38646879 DOI: 10.1080/10428194.2024.2341999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Caroline Fleck
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Allison Karabinos
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Allene Cook
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Moore DC, Elmes JB, Arnall JR, Strassel SA, Patel JN. PD-1/PD-L1 inhibitor-induced immune thrombocytopenia: A pharmacovigilance study and systematic review. Int Immunopharmacol 2024; 129:111606. [PMID: 38359661 DOI: 10.1016/j.intimp.2024.111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) immune checkpoint inhibitors (ICIs) are used for a variety of cancers and are associated with a risk of developing immune-related adverse events, most commonly dermatitis, colitis, hepatitis, and pneumonitis. Immune-mediated hematologic toxicities have been reported, but are less well-described in the literature. Immune thrombocytopenia (ITP) is a rare autoimmune, hematologic adverse event that has been reported with PD-1/PD-L1 inhibitors. METHODS We performed a retrospective observational analysis of the United States Food and Drug Administration Adverse Event Reporting System (FAERS) data. We searched for cases of ITP reported with exposure to PD-1/PD-L1 inhibitors from initial FDA approval for each agent to September 30, 2022. Disproportionality signal analysis was done by calculating the reporting odds ratio (ROR). Oxaliplatin was used as a positive control for sensitivity analysis as it is an anticancer therapy that has been associated with drug-induced ITP. A systematic review of the PubMed database was also conducted to identify published cases of PD-1/PD-L1 inhibitor-induced ITP. RESULTS There were 329 reports of ITP with ICIs in the FAERS database that were reviewed for a disproportionality signal, including atezolizumab (n = 27), durvalumab (n = 17), nivolumab (n = 160), and pembrolizumab (n = 125). The ROR was significant for atezolizumab (ROR 5.39, 95 % CI 3.69-7.87), avelumab (ROR 10.32, 95 % CI 4.91-21.69), durvalumab (ROR 7.91, 95 % CI 4.91-12.75), nivolumab (ROR 9.76, 95 % CI 8.34-11.43), and pembrolizumab (ROR 12.6, 95 % CI 10.55-15.06). In our systematic review, we summated 57 cases of ICI-induced ITP. Nivolumab and pembrolizumab had the most reported cases of ITP in the literature. Most cases reported (53 %) included ITP-directed therapies beyond corticosteroids for the management of ICI-induced ITP. CONCLUSION There is a significant reporting signal of ITP with several ICI agents. Clinicians should be aware of and monitor for signs of this potentially serious adverse event.
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Affiliation(s)
- Donald C Moore
- Clinical Oncology Pharmacy Manager, Levine Cancer Institute, Atrium Health, Department of Pharmacy, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA.
| | - Joseph B Elmes
- Oncology Clinical Staff Pharmacist, Levine Cancer Institute, Atrium Health, Department of Pharmacy, 100 Medical Park Drive, Concord, NC 28025, USA.
| | - Justin R Arnall
- Pharmacist Clinical Coordinator - Hematology/Hemophilia, Atrium Health, Specialty Pharmacy Service, 4400 Golf Acres Drive, Charlotte, NC 28208, USA.
| | - Scott A Strassel
- Atrium Health, Department of Pharmacy, 4400 Golf Acres Drive, Charlotte, NC 28232, USA.
| | - Jai N Patel
- Clinical Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Department of Cancer Pharmacology and Pharmacogenomics, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA.
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Elmes JB, Moore DC, Pineda-Roman M. Successful Ferric Carboxymaltose Desensitization in a Patient With Prior Reactions to Intravenous Iron Therapies. Am J Ther 2024; 31:e205-e206. [PMID: 37433089 DOI: 10.1097/mjt.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
| | | | - Mauricio Pineda-Roman
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Concord, NC
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Moore DC, Digiantonio N, Oxencis CJ, Taucher KD. Pharmacist perspectives on emerging T cell-engaging bispecific therapies in cancer therapeutics. Am J Health Syst Pharm 2024:zxae050. [PMID: 38394329 DOI: 10.1093/ajhp/zxae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Indexed: 02/25/2024] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To summarize the pharmacology, efficacy, safety, dosing, administration, and pharmacist perspectives related to operationalization of new and emerging bispecific therapies indicated for the treatment of various cancers. SUMMARY In recent years, there have been significant advancements in the expansion of immunotherapeutics in the treatment of various malignancies. Bispecific T cell-engaging therapies represent an emerging therapeutic drug class for the treatment of cancer. These therapies are unique antibody constructs that bind simultaneously to 2 targets, a tumor-specific antigen and CD3 on T cells, to elicit an immune response. Recently, several bispecific therapies have been approved, including epcoritamab, glofitamab, mosunetuzumab, tebentafusp, and teclistamab. Epcoritamab and glofitamab have been approved for diffuse large B cell lymphoma, while mosunetuzumab, tebentafusp, and teclistamab have been approved for follicular lymphoma, uveal melanoma, and multiple myeloma, respectively. As a result of their mechanism of action, the approved bispecific therapies have the potential to cause cytokine release syndrome, and, along with this, they all have unique and specific monitoring parameters and operational considerations that require clinician awareness when administering these therapies. Such operational challenges include within-patient dose escalations at therapy initiation, hospitalization for monitoring, and various pharmacological strategies for prophylaxis of cytokine release syndrome. CONCLUSION Bispecific therapies have continued to evolve the therapeutic landscape of cancer, primarily in hematological malignancies. Health-system pharmacists have the opportunity to play a key role in the operationalization and management of this new and emerging drug class.
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Affiliation(s)
- Donald C Moore
- Atrium Health Levine Cancer Institute, Charlotte, NC, USA
| | | | - Carolyn J Oxencis
- Froedtert and the Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA
| | - Kate D Taucher
- Oncology & Infusion Pharmacy Services, Department of Pharmacy, UCHealth, Aurora, CO, USA
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Tran TB, Downing L, Elmes JB, Arnall JR, Moore DC. Avatrombopag for the Treatment of Immune Thrombocytopenia and Periprocedural Thrombocytopenia Associated With Chronic Liver Disease. J Pharm Pract 2024; 37:184-189. [PMID: 36113085 DOI: 10.1177/08971900221125827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosing and administration, and place in therapy of avatrombopag for the treatment of immune thrombocytopenia and chronic liver disease-associated thrombocytopenia. Summary: Avatrombopag is an orally administered thrombopoietin receptor agonist approved for the treatment of immune thrombocytopenia and is the first oral thrombopoietin receptor agonist approved for the treatment of perioperative thrombocytopenia associated with chronic liver disease in adults. The efficacy and safety of avatrombopag has been demonstrated in a multicenter, randomized, double blind, placebo-controlled phase III study in the setting of immune thrombocytopenia and in 2 identically designed, multicenter, randomized, double blind, placebo-controlled phase III trials in the setting of thrombocytopenia associated with chronic liver disease. The most common adverse events reported in the clinical trials were headache, fatigue, and gastrointestinal toxicities. The incidence of bleeding events was comparable between the avatrombopag and placebo treatment groups in each study. Avatrombopag has not been shown to be associated with hepatoxicity and does not require food restriction like the other oral thrombopoietin receptor agonist for immune thrombocytopenia, eltrombopag. Also, unlike eltrombopag for immune thrombocytopenia, it can be dosed less frequently than once daily. Conclusion: Avatrombopag offers another safe and effective oral option for the treatment of immune thrombocytopenia without food restrictions and an alternative, transfusion-sparing option for thrombocytopenia associated with chronic liver disease patients undergoing surgery.
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Affiliation(s)
- Thuy B Tran
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | - Lauren Downing
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | - Joseph B Elmes
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | - Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
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Ziegengeist JL, Elmes JB, Strassels SA, Patel JN, Moore DC. Alpelisib-Induced Diabetic Ketoacidosis: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System and Review of the Literature. Clin Breast Cancer 2024:S1526-8209(24)00004-1. [PMID: 38245400 DOI: 10.1016/j.clbc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Alpelisib is a PI3K inhibitor indicated with fulvestrant for treatment of advanced or metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated breast cancer. In the phase III SOLAR-1 trial, grade 3/4 hyperglycemic events were reported in 36.6% of patients receiving alpelisib-fulvestrant compared to 0.7% receiving placebo-fulvestrant. As case reports of diabetic ketoacidosis (DKA) have been associated with alpelisib use, the goal of this study was to characterize the FAERS reported cases of this severe adverse effect. METHODS A retrospective disproportionality analysis was performed using the FAERS database by calculating the reporting odds ratio (ROR) of DKA events with alpelisib from 2019 to 2022. A PubMed literature review of case reports characterizing alpelisib-induced DKA was performed. RESULTS Pharmacovigilance database analysis revealed significance in reporting among 87 DKA cases with alpelisib (ROR 9.84, 95% confidence interval 7.3-13.2), including hospitalization and death as reported outcomes. Review of 11 published case reports reveals median onset of DKA at 14 days with successful rechallenge possible. CONCLUSION Significant association with reporting exists between DKA and alpelisib exposure. We observed similar median time to onset of hyperglycemia between our analysis compared to that reported in SOLAR-1. Considering early onset of this toxicity, it is imperative that patients be closely monitored when initiating alpelisib. Addition of a preemptive antihyperglycemic or escalation in those previously on antihyperglycemic medications is beneficial in decreasing the severity of hyperglycemia with alpelisib. Further study investigating risk factors is warranted to better elucidate which patients require preemptive therapy.
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Affiliation(s)
- Julia L Ziegengeist
- Department of Pharmacy, Clinical Pharmacist Coordinator, Levine Cancer Institute, Atrium Health, Charlotte, NC.
| | - Joseph B Elmes
- Department of Pharmacy, Oncology Clinical Staff Pharmacist, Levine Cancer Institute, Atrium Health, Concord, NC
| | | | - Jai N Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Clinical Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Donald C Moore
- Department of Pharmacy, Clinical Oncology Pharmacy Manager, Levine Cancer Institute, Atrium Health, Charlotte, NC
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Moore DC, Elmes JB, Arnall JR, Strassels SA, Patel JN. Hepatitis B reactivation in patients with multiple myeloma treated with anti-CD38 monoclonal antibody-based therapies: a pharmacovigilance analysis. Int J Clin Pharm 2023; 45:1492-1495. [PMID: 37289318 DOI: 10.1007/s11096-023-01608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Daratumumab and isatuximab are anti-CD38 monoclonal antibodies indicated for the treatment of multiple myeloma. These agents can increase the risk of infectious complications, including viral infections. Cases of hepatitis B virus (HBV) reactivation have been reported in the literature in patients receiving anti-CD38 monoclonal antibody-based therapies. AIM The objective of this analysis was to determine if the association between anti-CD38 monoclonal antibody exposure and the development of hepatitis B reactivation had a detectable reporting signal in the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). METHOD We conducted a post marketing pharmacovigilance analysis by querying the FAERS for reports of HBV reactivation with daratumumab or isatuximab exposure reported between 2015 and 2022. Disproportionality signal analysis was conducted by calculating reporting odds ratios (RORs). RESULTS Sixteen cases of hepatitis B virus reactivation were reported in the FAERS database among patients receiving daratumumab or isatuximab reported between 2015 and 2022. The ROR for HBV reactivation was statistically significant for both daratumumab (ROR 4.76, 95% CI 2.76-8.22) and isatuximab (ROR 9.31, 95% CI 3.00-28.92). CONCLUSION Overall, our analysis demonstrates a significant reporting signal for HBV reactivation with daratumumab and isatuximab.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Joseph B Elmes
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Concord, NC, 28025, USA
| | - Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28208, USA
| | - Scott A Strassels
- Department of Pharmacy, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28232, USA
| | - Jai N Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
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Moore DC, Elmes JB, Strassels SA, Patel JN. Use of patient-reported outcome measures for oncology drugs receiving accelerated approval. Support Care Cancer 2023; 31:602. [PMID: 37773545 DOI: 10.1007/s00520-023-08068-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
Patient-reported outcomes (PROs) represent an important evaluation of health-related quality of life that has become more commonly incorporated into oncology drug clinical trials. The frequency of PRO inclusion as an endpoint in oncology drug clinical trials leading to the initial accelerated approval of a new therapy is not yet known. We conducted a cross-sectional study evaluating all new drug applications submitted to the FDA over the past 10 years (2013-2022) that led to the initial approval of an oncology drug through the accelerated approval process. The objective was to assess whether the trials leading to such an approval included PROs. Between 2013 and 2022, the FDA approved 59 unique drugs for an oncology indication via the accelerated approval pathway, and 35 (59%) included a PRO assessment in the clinical trial. A median of 1 PRO measurement was used in each trial, with 23 different types of PRO assessment tools were used across the 59 new drug applications. In summary, we found that PRO measurements are inconsistently utilized in trials leading to initial accelerated approval of oncology drugs, and there seems to be a lack of harmonization of different PRO measurement tools used across trials.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Joseph B Elmes
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Concord, NC, 28025, USA
| | - Scott A Strassels
- Department of Pharmacy, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28232, USA
| | - Jai N Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
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Morris SA, Moore DC, Musselwhite LW, Lopes KE, Hamilton A, Steuerwald N, Hanson SL, Larck C, Swift K, Smith M, Kadakia KC, Chai S, Hwang JJ, Patel JN. Addressing barriers to increased adoption of DPYD genotyping at a large multisite cancer center. Am J Health Syst Pharm 2023; 80:1342-1349. [PMID: 37235983 DOI: 10.1093/ajhp/zxad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To describe the implementation of an in-house genotyping program to detect genetic variants linked to impaired dihydropyrimidine dehydrogenase (DPD) metabolism at a large multisite cancer center, including barriers to implementation and mechanisms to overcome barriers to facilitate test adoption. SUMMARY Fluoropyrimidines, including fluorouracil and capecitabine, are commonly used chemotherapy agents in the treatment of solid tumors, such as gastrointestinal cancers. DPD is encoded by the DPYD gene, and individuals classified as DPYD intermediate and poor metabolizers due to certain genetic variations in DPYD can experience reduced fluoropyrimidine clearance and an increased risk of fluoropyrimidine-related adverse events. Although pharmacogenomic guidelines provide evidence-based recommendations for DPYD genotype-guided dosing, testing has not been widely adopted in the United States for numerous reasons, including limited education/awareness of clinical utility, lack of testing recommendations by oncology professional organizations, testing cost, lack of accessibility to a comprehensive in-house test and service, and prolonged test turnaround time. Based on stakeholder feedback regarding barriers to testing, we developed an in-house DPYD test and workflow to facilitate testing in multiple clinic locations at Levine Cancer Institute. Across 2 gastrointestinal oncology clinics from March 2020 through June 2022, 137 patients were genotyped, and 13 (9.5%) of those patients were heterozygous for a variant and identified as DPYD intermediate metabolizers. CONCLUSION Implementation of DPYD genotyping at a multisite cancer center was feasible due to operationalization of workflows to overcome traditional barriers to testing and engagement from all stakeholders, including physicians, pharmacists, nurses, and laboratory personnel. Future directions to scale and sustain testing in all patients receiving a fluoropyrimidine across all Levine Cancer Institute locations include electronic medical record integration (eg, interruptive alerts), establishment of a billing infrastructure, and further refinement of workflows to improve the rate of pretreatment testing.
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Affiliation(s)
- Sarah A Morris
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Laura W Musselwhite
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Karine Eboli Lopes
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Alicia Hamilton
- Molecular Biology and Genomics Core Facility, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nury Steuerwald
- Molecular Biology and Genomics Core Facility, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Sarah L Hanson
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Chris Larck
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Kristen Swift
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Mathew Smith
- Molecular Biology and Genomics Core Facility, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Kunal C Kadakia
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Seungjean Chai
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Jimmy J Hwang
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Kachur E, Patel JN, Morse AL, Moore DC, Arnall JR. Post-Transplant Cyclophosphamide for the Prevention of Graft-vs.-Host Disease in Allogeneic Hematopoietic Cell Transplantation: A Guide to Management for the Advanced Practitioner. J Adv Pract Oncol 2023; 14:520-532. [PMID: 37808076 PMCID: PMC10558021 DOI: 10.6004/jadpro.2023.14.6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Cyclophosphamide remains a critical component to haploidentical transplant conditioning regimens. Post-transplant cyclophosphamide (PTCy) emerged as an effective component of graft-vs.-host disease (GVHD) prophylaxis in the nonmyeloablative haploidentical bone marrow transplant setting. The relative ease of administration compared with ex vivo manipulations and efficacy in reducing GVHD has led to increasing PTCy use in transplant centers around the world. The role of PTCy has expanded to haploidentical transplantation with myeloablative conditioning regimens and peripheral blood progenitor cells as the donor source. Moreover, encouraging results in GVHD management have been shown with the use of PTCy alone or in combination with other immunosuppressives in the human leukocyte antigen-matched donor setting. The toxicity profile of cyclophosphamide varies extensively depending on dose, duration, overall drug exposure, and, potentially, pharmacogenetics. This review highlights the pharmacology, pharmacokinetics, and toxic effects of cyclophosphamide and offers practical guidance for clinical application in the post-transplant setting. We summarize data on the management of high-dose cyclophosphamide toxicities and provide insights into the pharmacogenetic implications on drug efficacy and safety data.
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Affiliation(s)
- Ekaterina Kachur
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Jai N Patel
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Allison L Morse
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Donald C Moore
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Justin R Arnall
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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Moore DC, Arnall JR. Sutimlimab: A Complement C1s Inhibitor for the Management of Cold Agglutinin Disease-Associated Hemolysis. Ann Pharmacother 2023; 57:970-977. [PMID: 36476151 DOI: 10.1177/10600280221138802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To review the pharmacology, pharmacokinetics, efficacy, safety, dosing and administration, and place in therapy of sutimlimab for the management of cold agglutinin disease (CAD)-associated hemolysis. DATA SOURCES A literature search of PubMed (1966-October 2022) was conducted using the keywords sutimlimab, BIVV009, and cold agglutinin. Data were also obtained from prescribing information, meeting abstracts, and clinicaltrials.gov. STUDY SELECTION AND DATA EXTRACTION All published prospective clinical trials, prescribing information, and meeting abstracts on sutimlimab for the treatment of CAD were reviewed. DATA SYNTHESIS Sutimlimab is a first-in-class complement C1s inhibitor indicated for the treatment of CAD-associated hemolysis. This approval was based on the phase III CARDINAL trial, which evaluated sutimlimab in patients with CAD-associated hemolysis. The primary endpoint of achieving a hemoglobin of ≥12 g/dL or increase of ≥2 above baseline was achieved by 54% of patients with sutimlimab in the 26-week trial. The phase III CADENZA trial was a placebo-controlled trial in which sutimlimab has demonstrated a significant improvement in the composite endpoint of hemoglobin increase of ≥1.5 g/dL, avoidance of transfusion, and avoidance of additional CAD therapies (73% sutimlimab vs 15% placebo). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS Sutimlimab rapidly halts hemolysis, improves hemoglobin, and improves quality-of-life in patients with CAD. Safety issues with sutimlimab include infusion-related reactions and risk of serious infections with encapsulated bacteria. CONCLUSIONS Sutimlimab provides an additional therapeutic option in the treatment of CAD-associated hemolysis that can lead to rapid improvement in hemoglobin and anemia-related symptoms.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
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Raheem F, Alsuhebany N, Hickey Zacholski E, Paulic N, Sandler A, Uk N, Moore DC. Ocular toxicities associated with antibody drug conjugates and immunotherapy in oncology: clinical presentation, pathogenesis, and management strategies. Expert Opin Drug Saf 2023; 22:921-928. [PMID: 37612255 DOI: 10.1080/14740338.2023.2251380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The development of molecularly targeted anticancer therapies and immunotherapy continues to revolutionize the treatment of cancer. FDA accelerated approvals of novel targeted therapies allowed for introduction of these agents into the clinic at a rapid rate. On-and off-target ocular toxicities are prevalent treatment-related adverse events of newer therapies including antibody drug conjugates (ADCs) and immunotherapy. Ocular toxicities associated with ADCs and immunotherapy have heterogeneous presentations and pathogenesis requiring unique and often complex monitoring, and management. AREAS COVERED In this article, we provide an updated review of treatment-emergent ocular toxicity associated with new and novel oncologic therapies and summarize guidelines and best practice strategies for prevention, monitoring and management. A literature search was performed through PubMed, ClinicalTrials.gov, and FDA website (1 January 2017 to 10 May 2023) to identify relevant information. EXPERT OPINION The implementation of a strategy for monitoring, prevention, and management of treatment-related ocular toxicities involves a multi-disciplinary, often cross-center approach. Communication with infusion nursing leadership, clinic staff, and eye care providers is crucial to the successful implementation of eye care plans to prevent and manage ocular toxicity.
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Affiliation(s)
- Farah Raheem
- Clinical Pharmacy Specialist, Hematology/Oncology, Assistant Professor of Pharmacy, Mayo Clinic College of Medicine and Science, Mayo Clinic Arizona, Phoenix, USA
| | - Nada Alsuhebany
- College of Pharmacy, oncology clinical pharmacist, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Erin Hickey Zacholski
- Clinical Pharmacy Specialist, Gynecologic Oncology, VCU Health, Massey Cancer Center, Virginia Commonwealth University (VCU) School of Pharmacy, Richmond, VA, USA
| | - Nikola Paulic
- Clinical Pharmacy Specialist, Oncology, Hospitals Geauga Medical Center, Willoughby, OH, USA
| | - Anna Sandler
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Nathan Uk
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Donald C Moore
- Clinical Oncology Pharmacy Manager, Atrium Health Levine Cancer Institute, Charlotte, NC, USA
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Moore DC, Guinigundo AS. The Role of Biomarkers in Guiding Clinical Decision-Making in Oncology. J Adv Pract Oncol 2023; 14:15-37. [PMID: 37206905 PMCID: PMC10190804 DOI: 10.6004/jadpro.2023.14.3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Recent advances in molecular diagnostics have led to the characterization of an increasing number of actionable genomic alterations and immune-based signatures, which have facilitated the development of many highly effective cancer therapies. In addition to their prognostic value, some of these biomarkers have been shown to have predictive value and have had a significant impact on clinical decision-making. The presence of these therapeutic targets can thus aid health-care professionals to select the optimal therapies and avoid use of ineffective, potentially toxic ones. Earlier agents were generally approved for only one or a limited number of malignancies and/or stages, but more recent approvals encompass multiple tumor types that bear a common molecular alteration regardless of tumor type (i.e., tumor-agnostic indications). The expanding use of tumor-agnostic biomarkers has the potential to greatly broaden the use of these therapies to a wider patient population. Yet the rapidly increasing number of tumor-specific and tumor-agnostic biomarkers, and the continually changing treatment guidelines regarding the use of targeted agents and associated testing requirements, present challenges for advanced practitioners to remain current on these topics and their ability to apply these advances to clinical care. Here, we review predictive oncology biomarkers currently in use and their role in clinical decision-making, including those specified in product prescribing information and clinical practice guidelines. Current clinical guidelines regarding recommended targeted therapies for selected malignancies, and when molecular testing should be performed, are discussed.
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Affiliation(s)
- Donald C. Moore
- From Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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Moore DC, Guinigundo AS. Biomarker-Driven Oncology Clinical Trials: Novel Designs in the Era of Precision Medicine. J Adv Pract Oncol 2023; 14:9-13. [PMID: 37206904 PMCID: PMC10190802 DOI: 10.6004/jadpro.2023.14.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Oncology drug development historically has followed a path of sequential phase I, II, and III clinical trials using traditional trial designs, with the goal of achieving regulatory approval. These studies are often conducted with inclusion criteria that limit enrollment to a single tumor type or tumor site of origin, excluding other patients who might also respond. Increased use of precision medicine targeting biomarkers or specific oncogenic mutations has led to novel clinical trial designs that can evaluate these therapies in a less limited fashion. Master protocols such as basket trials, umbrella trials, and platform trials can, for example, evaluate histology-specific therapies targeting a common oncogenic mutation across multiple tumor types or screen for the presence of multiple different biomarkers rather than a single one. In other cases, they can lead to more rapid evaluation of a drug and evaluate targeted therapies in tumor types for which they are not yet currently indicated. As the use of complex biomarker-based master protocols increases, advanced practitioners must understand these novel trial designs, their advantages and disadvantages, and how their use may advance drug development and maximize the clinical benefits of molecular precision therapy.
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Affiliation(s)
- Donald C. Moore
- From Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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Moore DC. 2021-2022 Drug Updates: Investigational Therapeutics in the Pipeline. J Adv Pract Oncol 2023; 14:237-240. [PMID: 37197720 PMCID: PMC10184839 DOI: 10.6004/jadpro.2023.14.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
During JADPRO Live 2022, Donald C. Moore, PharmD, BCPS, BCOP, DPLA, FCCP, discussed investigational therapeutic agents in the drug development pipeline. Dr. Moore highlighted agents that represent either a new drug class, a novel mechanism of action, a rethinking of how to approach treating a disease, or those that have recently received FDA Breakthrough Designation status that advanced practitioners should be aware of.
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Affiliation(s)
- Donald C Moore
- From Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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Moore DC, Guinigundo AS. The Advanced Practitioner's Role in the Rapidly Evolving Landscape of Precision Medicine. J Adv Pract Oncol 2023; 14:39-48. [PMID: 37206903 PMCID: PMC10190805 DOI: 10.6004/jadpro.2023.14.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic malignancies. For many of these agents, predictive biomarker testing is necessary to determine the presence of such alterations in order to select patients who are most likely to respond, and to avoid the use of ineffective and potentially harmful alternative therapy. Recent technological advances such as next-generation sequencing have facilitated the identification of targetable biomarkers in patients with cancer and thus help inform treatment decisions. Moreover, new molecular-guided therapies and associated predictive biomarkers continue to be discovered. For some cancer therapeutics, regulatory approval requires the use of a companion diagnostic to ensure proper patient selection. Advanced practitioners therefore need to be aware of current biomarker testing guidelines regarding who should be tested, how and when to test, and how these results can guide treatment decisions using molecular-based therapies. They should also recognize and address potential barriers and disparities in biomarker testing to ensure equitable care for all patients, and assist in educating patients and colleagues alike on the importance of testing and integration into clinical practice to enhance outcomes.
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Affiliation(s)
- Donald C. Moore
- From Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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19
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Parish PC, Moore DC, Wayman M, Arnall J. Evaluation of Pharmacist Impact on Patients Initiating Eculizumab for Atypical Hemolytic Uremic Syndrome in the Inpatient Setting. Ann Pharmacother 2023; 57:506-507. [PMID: 35906797 DOI: 10.1177/10600280221113830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Moore DC, Guinigundo AS. Revolutionizing Cancer Treatment: Harnessing the Power of Biomarkers to Improve Patient Outcomes. J Adv Pract Oncol 2023; 14:4-8. [PMID: 37206906 PMCID: PMC10190803 DOI: 10.6004/jadpro.2023.14.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
There has been an increasing number of approvals for targeted therapies and immunotherapies in oncology in the past decade. This has changed the treatment paradigm for many solid tumors and hematologic malignancies, and therefore the outcomes of patients with cancer. Advanced practitioners should be up to date with advances in cancer biomarker testing and its implications for the use of targeted therapy and immunotherapy to integrate this information into clinical decision-making.
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Affiliation(s)
- Donald C. Moore
- From Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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21
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Meek B, Desai N, Moore DC, Tran T, Knovich MA, Arnall J. Real-world experience and considerations on concomitant caplacizumab and anticoagulation in thrombotic thrombocytopenic purpura. Ann Hematol 2023; 102:457-459. [PMID: 36441262 DOI: 10.1007/s00277-022-05049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Benson Meek
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Building J Suite B1, Charlotte, NC, USA
| | - Nuti Desai
- WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Donald C Moore
- Levine Cancer Institute, 1021 Morehead Medical Dr., Charlotte, NC, 28204, USA
| | - Thuy Tran
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Building J Suite B1, Charlotte, NC, USA
| | - Mary Ann Knovich
- Levine Cancer Institute, 1021 Morehead Medical Dr., Charlotte, NC, 28204, USA
| | - Justin Arnall
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Building J Suite B1, Charlotte, NC, USA.
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Moore DC, Eagers KA, Janes A, Pineda-Roman M. Tafasitamab and lenalidomide for relapsed/refractory diffuse large B-cell lymphoma in a patient on chronic intermittent hemodialysis. J Oncol Pharm Pract 2023; 29:239-241. [PMID: 35585701 DOI: 10.1177/10781552221102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Tafasitamab is an anti-CD19 monoclonal antibody indicated for the treatment of relapsed/refractory diffuse large B-cell lymphoma to be given in combination with lenalidomide. Experiences with tafasitamab in the setting of hemodialysis are limited and the efficacy and safety of this agent in this setting are unknown. CASE REPORT We describe a patient with relapsed/refractory diffuse large B-cell lymphoma with hemodialysis-dependent end-stage renal disease who successfully received tafasitamab/lenalidomide. MANAGEMENT AND OUTCOME Tafasitamab and reduced dose lenalidomide were initiated for relapsed diffuse large B-cell lymphoma. Tafasitamab was administered on non-dialysis days. Follow-up imaging for disease response assessment demonstrated a complete response. Therapy was well tolerated; the only major toxicity experienced was grade 4 neutropenia that resolved with dose adjustment to lenalidomide. Over a year from initiating therapy, the patient remains in a complete response. DISCUSSION/CONCLUSION The combination of tafasitamab and dose-reduced lenalidomide produced a complete response in the treatment of relapsed/refractory diffuse large B-cell lymphoma in the setting of chronic intermittent hemodialysis.
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Affiliation(s)
- Donald C Moore
- Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | | | - Amanda Janes
- Levine Cancer Institute, Atrium Health, Concord, NC, USA
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Arnall JR, Moore DC, Michael M, Wolcott M, Cowgill N. Measuring the Impact of a Pharmacist-Driven Blood Factor Education Program: A Prospective, Single-Center Observational Study. Hosp Pharm 2022; 58:282-288. [DOI: 10.1177/00185787221137901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Patients with bleeding disorders are best served by multidisciplinary teams. Pharmacists can play a critical role in the optimal management of patients with bleeding disorders through blood factor stewardship strategies and programs. An educational program was developed and implemented wherein a hematology pharmacist provided brief recorded lectures to an entire department of pharmacists in a multi-site health-system with the goal to improve the knowledge base and confidence among this population of general practitioners. Methods: The primary objective of this study was to evaluate the educational outcomes of a blood factor education program for pharmacists. The impact of the educational program was determined by measuring the difference in mean test scores between the pre- and post-program surveys. Results: The final analysis included 214 participants. The primary endpoint of mean competency test score was significantly improved in the post-test compared to pre-test (78.33% vs 52.83%; P < .0001). Any degree of test score improvement was observed in 99% ( n = 212) of participants. Pharmacist confidence was significantly improved in all 20 domains of bleeding disorders and blood factor product verification and management. Conclusion: This program identified that most pharmacists in a large multi-site health-system were not familiar with bleeding disorders to a satisfactory degree, commonly because of the relative rare encounters with bleeding disorder-related orders, and that despite systems-based support there was an opportunity to improve practice through education. Such educational programming could be beneficial for the development of pharmacist-provided care and is a measure that could be implemented as part of blood factor stewardship initiatives.
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Affiliation(s)
- Justin R Arnall
- Specialty Pharmacy Servivce, Atrium Health, Charlotte, NC, USA
| | - Donald C Moore
- Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | - Meghan Michael
- Specialty Pharmacy Servivce, Atrium Health, Charlotte, NC, USA
| | - Michael Wolcott
- High Point University Fred Wilson School of Pharmacy, High Point, NC, USA
| | - Nicole Cowgill
- Specialty Pharmacy Servivce, Atrium Health, Charlotte, NC, USA
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Lavery L, DiSogra K, Lea J, Trufan SJ, Symanowski JT, Roberts A, Moore DC, Heeke A, Pal S. Risk factors associated with palbociclib-induced neutropenia in patients with metastatic breast cancer. Support Care Cancer 2022; 30:9803-9809. [PMID: 36260177 DOI: 10.1007/s00520-022-07400-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/07/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neutropenia is the most common adverse event with palbociclib, an oral cyclin-dependent kinase 4/6 inhibitor, with grade 3/4 neutropenia occurring in up to 67% of patients in phase III trials evaluating this agent in metastatic breast cancer. This retrospective chart review assessed characteristics of patients on palbociclib to evaluate for risk factors in the development of grade 3/4 neutropenia. PATIENTS AND METHODS Patients with metastatic breast cancer who received palbociclib were included. Patient demographics collected included age, gender, race, body mass index, breast cancer treatment history, palbociclib starting dose, baseline absolute neutrophil count, baseline platelet count, concomitant hormonal therapy, concomitant use of denosumab, and use of concomitant strong CYP3A4 inhibitors/inducers. Events of interest occurring within 30 days of initiation of palbociclib were also noted including antibiotic and corticosteroid use, mucosal conditions, open wounds, or surgery. The incidence and potential risk factors for grade 3/4 neutropenia in the first 6 months of treatment were analyzed. RESULTS A total of 257 patients were included in the analysis with 206 patients (80.2%) and 139 patients (54.1%) experiencing all-grade neutropenia and grade 3/4 neutropenia, respectively. Multivariate analysis found baseline myelosuppression and recent antibiotic use to be independent predictors of grade 3/4 neutropenia. Normal weight patients had an increased risk for grade 3/4 neutropenia compared to obese patients by multivariate analysis. CONCLUSION The results of this study showed baseline myelosuppression and recent antibiotic use within 30 days of palbociclib initiation were predictive of a higher incidence of grade 3/4 neutropenia. Obese patients were less likely to develop grade 3/4 neutropenia compared to normal weight patients.
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Affiliation(s)
- Lesli Lavery
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 10660 Park Rd, Charlotte, NC, 28210, USA.
| | - Kristyn DiSogra
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28208, USA
| | - Julia Lea
- Department of Pharmacy, Levine Cancer Institute, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Sally J Trufan
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - James T Symanowski
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Ashley Roberts
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28208, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, 100 Medical Park Drive, Concord, NC, 28025, USA
| | - Arielle Heeke
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Sridhar Pal
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 10660 Park Rd, Charlotte, NC, 28210, USA
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Moore DC, Elmes JB, Arnall JR, Strassels SA, Patel JN. Immune checkpoint inhibitor-induced acquired haemophilia: A pharmacovigilance analysis of the FDA adverse event reporting system. Haemophilia 2022; 28:e145-e148. [PMID: 35895993 DOI: 10.1111/hae.14632] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Donald C Moore
- Atrium Health, Department of Pharmacy, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Joseph B Elmes
- Atrium Health, Department of Pharmacy, Levine Cancer Institute, Concord, North Carolina, USA
| | - Justin R Arnall
- Atrium Health, Specialty Pharmacy Service, Charlotte, North Carolina, USA
| | - Scott A Strassels
- Department of Pharmacy, Atrium Health, Charlotte, North Carolina, USA
| | - Jai N Patel
- Atrium Health, Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Charlotte, North Carolina, USA
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Moore DC, Elmes JB, Arnall JR, Strassels SA, Patel JN. Acquired thrombotic thrombocytopenic purpura associated with immune checkpoint inhibitors: A real-world study of the FDA adverse event reporting system. Int Immunopharmacol 2022; 110:109015. [PMID: 35803131 DOI: 10.1016/j.intimp.2022.109015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) are used for a variety of cancers and are associated with a risk of developing immune-related adverse events, most commonly colitis, dermatitis, hepatitis, and thyroiditis. Rare autoimmune hematologic toxicities have been reported but are less well-described in the literature. Acquired thrombotic thrombocytopenic purpura (TTP) is a life-threatening autoimmune condition that has been reported with ICIs but has been limited to case reports. METHODS We performed a retrospective observational analysis of the United States Food and Drug Administration Adverse Event Reporting System (FAERS) data. We searched for cases of TTP reported with exposure to ICIs from initial FDA approval for each agent to December 31, 2021. Disproportionality signal analysis was done by calculating the reporting odds ratio (ROR). RESULTS There were 35 reports of TTP with ICIs in the FAERS database, including atezolizumab (n = 7), durvalumab (n = 2), nivolumab (n = 18), and pembrolizumab (n = 8). The ROR was significant for atezolizumab (ROR 6.22, 95% CI 2.96-13.09), nivolumab (ROR 3.16, 95% CI 1.99-5.03), and pembrolizumab (ROR 2.56, 95% CI 1.28-5.12). CONCLUSIONS There is a significant reporting signal of TTP with several ICI agents. Clinicians should be aware of and monitor for signs of this potentially serious adverse event.
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Affiliation(s)
- Donald C Moore
- Levine Cancer Institute, Atrium Health Department of Pharmacy, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA.
| | - Joseph B Elmes
- Levine Cancer Institute, Atrium Health Department of Pharmacy, 100 Medical Park Drive, Concord, NC 28025, USA
| | - Justin R Arnall
- Atrium Health Specialty Pharmacy Service, 4400 Golf Acres Drive, Charlotte, NC 28208, USA
| | - Scott A Strassels
- Atrium Health Department of Pharmacy, 4400 Golf Acres Drive, Charlotte, NC 28232, USA
| | - Jai N Patel
- Clinical Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health Department of Cancer Pharmacology and Pharmacogenomics, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA
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Moore DC, Elmes JB, Strassels SA, Patel JN. Brentuximab vedotin-induced pancreatitis in lymphoma: a pharmacovigilance study. Leuk Lymphoma 2022; 63:1768-1769. [DOI: 10.1080/10428194.2022.2045601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Donald C. Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | - Joseph B. Elmes
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | | | - Jai N. Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Moore DC, Peery MR, Tobon KA, Raheem F, Hwang GS, Alhennawi L, Hughes ME. New and emerging therapies for the treatment of relapsed/refractory diffuse large B-cell lymphoma. J Oncol Pharm Pract 2022; 28:1848-1858. [PMID: 35469489 DOI: 10.1177/10781552221096165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin lymphoma. Approximately 40% of patients with DLBCL will experience disease relapse or will be refractory to first line chemoimmunotherapy, necessitating second-line salvage therapy. This has historically consisted of platinum-based chemotherapy regimens followed by autologous hematopoietic stem cell transplantation with curative intent for transplant-eligible patients or palliative chemotherapy for transplant-ineligible patients. In recent years there have been several new therapeutic agents approved for the treatment of relapsed/refractory DLBCL, thereby expanding the therapeutic landscape. These agents include polatuzumab vedotin, tafasitamab, loncastuximab tesirine, selinexor, and anti-CD19 chimeric antigen receptor T-cell therapies such as axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. This review summarizes the pharmacology, efficacy, safety, dosing, and administration of new agents recently approved for the treatment of relapsed/refractory DLBCL.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Atrium Health, 536516Levine Cancer Institute, Concord, NC, United States
| | - Matthew R Peery
- Department of Pharmacy, 6887Virginia Commonwealth University Health, Richmond, VA, United States
| | - Katherine A Tobon
- Malignant Hematology Program, 25301Moffitt Cancer Center, Tampa, FL, United States
| | | | - Grace S Hwang
- 24083Baylor St Luke's Medical Center, Houston, TX, United States
| | - Lin Alhennawi
- 15502University of Cincinnati College of Pharmacy, Cincinnati, OH, United States
| | - Mitchell E Hughes
- Lymphoma Program, Hematology/Oncology Division, Perelman Center for Advanced Medicine, 21798University of Pennsylvania, Philadelphia, PA, United States
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Moore DC. 2020–2021 Drug Updates: Investigational Therapeutics in the Pipeline. J Adv Pract Oncol 2022; 13:286-291. [PMID: 35663186 PMCID: PMC9126357 DOI: 10.6004/jadpro.2022.13.3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During JADPRO Live Virtual 2021, Donald C. Moore, PharmD, BCPS, BCOP, DPLA, discussed investigational therapeutic agents in the drug development pipeline. Dr. Moore highlighted agents that represent either a new drug class, a novel mechanism of action, a rethinking of how to approach treating a disease, or those that have recently received FDA Breakthrough Designation status that advanced practitioners should be aware of.
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Affiliation(s)
- Donald C Moore
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The pharmacology, efficacy, safety, and dosing/administration of new and emerging therapies for the treatment of multiple myeloma are summarized. SUMMARY There have been significant advancements in the treatment of multiple myeloma in recent years, with an expansion of available drug therapies. Newer therapies for multiple myeloma include the anti-CD38 monoclonal antibodies daratumumab and isatuximab, the exportin 1 inhibitor selinexor, the anti-B-cell maturation antigen (BCMA) antibody-drug conjugate belantamab mafodotin, and the chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel. These agents have unique toxicity profiles, specific monitoring parameters, and operational considerations that clinicians treating multiple myeloma should be aware of. There is likely to be continued rapid expansion of new agents for patients with multiple myeloma, as there are many novel investigational agents in the drug development pipeline, such as bispecific antibodies and additional CAR T-cell therapies. CONCLUSION Several therapeutic agents have been recently approved by the Food and Drug Administration for the treatment of multiple myeloma. There are many novel agents in the pipeline, including bispecific antibodies and CAR T-cell therapies that have the potential to continue to change the treatment landscape of multiple myeloma.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | | | - Brandon R Shank
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Moore DC, Elmes JB, Gebru T, Lavery LA, Pellegrino A, Plesca D. Implementation, utilization, and evaluation of a pharmacist-driven romiplostim dosing service for patients with immune thrombocytopenia at a multisite cancer centre. J Oncol Pharm Pract 2022; 28:613-617. [DOI: 10.1177/10781552211073763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Romiplostim is a thrombopoietin receptor agonist approved for the treatment of patients with chronic immune thrombocytopenia who have had an insufficient response to corticosteroids, immune globulin, or splenectomy. Dose adjustments of romiplostim are based on platelet counts and follow a dosing schema that requires frequent monitoring. As a quality improvement initiative to increase clinical efficiency and promote clinical pharmacy services at our institution, we developed a collaborative practice agreement and implemented a novel pharmacist-driven romiplostim dosing protocol. Methods A retrospective chart review was conducted to evaluate the acceptance, utilization, and impact of the pharmacist-driven romiplostim dosing service. The primary outcome of our analysis was the adoption rate by providers of the romiplostim pharmacist dosing service. Secondary endpoints were focused on patients newly initiating romiplostim on the dosing service and included platelet responses and number of dose adjustments by a pharmacist Results A total of 54 patients received romiplostim in our analysis: 25 patients who had already been receiving romiplostim and 29 patients who newly initiated romiplostim during the study period. Of the 29 patients newly initiating romiplostim, 27 (93%) had their dosing managed by a pharmacist Twenty-one patients (84%) and 18 patients (75%) achieved an initial and durable response with romiplostim, respectively. Pharmacists made a median of 3 dose adjustments to romiplostim per patient. Conclusion The implementation of a pharmacist-driven romiplostim dosing service led to a significant adoption and utilization by physicians at our health system.
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Affiliation(s)
- Donald C. Moore
- Department of Pharmacy, Levine Cancer Institute, 100 Medical Park Drive, Concord NC 28025
| | - Joseph B. Elmes
- Department of Pharmacy, Levine Cancer Institute, 100 Medical Park Drive, Concord NC 28025
| | - Tsion Gebru
- Department of Pharmacy, Levine Cancer Institute, 4525 Cameron Valley Pkwy, Charlotte, NC 28211
| | - Lesli A. Lavery
- Department of Pharmacy, Levine Cancer Institute, 10660 Park Rd, Charlotte, NC 28210
| | - Annie Pellegrino
- Department of Pharmacy, Levine Cancer Institute, 1656 Riverchase Blvd, Rock Hill, SC 29732
| | - Dragos Plesca
- Department of Pharmacy, Levine Cancer Institute, 1021 Morehead Medical Dr, Charlotte, NC 28204
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Arnall JR, Maples KT, Harvey RD, Moore DC. Daratumumab for the Treatment of Multiple Myeloma: A Review of Clinical Applicability and Operational Considerations. Ann Pharmacother 2021; 56:927-940. [PMID: 34963325 DOI: 10.1177/10600280211058754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review the available data for the efficacy and safety of daratumumab in the treatment of multiple myeloma (MM), both in the newly diagnosed and relapsed/refractory settings, as well as provide additional guidance to clinicians on operational, safety, and supportive care considerations. DATA SOURCES A literature search of PubMed (1966 to October 2021) was conducted using the keywords daratumumab, Darzalex, and myeloma. Data were also obtained from prescribing information and unpublished abstracts from meetings. STUDY SELECTION AND DATA EXTRACTION All relevant published articles, prescribing information, and unpublished meeting abstracts on daratumumab for the treatment of MM were reviewed. DATA SYNTHESIS Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of MM. The addition of daratumumab to proteasome inhibitor and immunomodulatory drug-based regimens has led to a consistent improvement in progression-free survival and response rates in relapsed/refractory MM as per the POLLUX, CASTOR, APOLLO, and CANDOR trials. The ALCYONE and MAIA phase III trials have demonstrated an overall survival benefit when adding daratumumab to frontline regimens for transplant-ineligible patients with newly diagnosed MM. In transplant-eligible patients, daratumumab-based quadruplet regimens have improved depth of response in the CASSIOPIEA and GRIFFIN trials. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Operational and safety considerations that clinicians need to account for do exist, including different administration and infusion strategies, infusion-related reactions, increased risk for infectious complications, and interference with blood transfusion management. CONCLUSIONS Daratumumab has led to a shift in the treatment paradigm of both newly diagnosed and relapsed/refractory MM, leading to improvements in outcomes such as response rates, depth of response, and progression-free survival.
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Affiliation(s)
- Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | - Kathryn T Maples
- Department of Pharmaceutical Services, Winship Cancer Institute, Emory University Hospitals, Atlanta, GA, USA
| | - R Donald Harvey
- Winship Cancer Institute, School of Medicine, Emory University, Atlanta, GA, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
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Moore DC, Soni AC, Hu B, Smith ET, Levine J, Moyo TK, Jacobs R, Ghosh N, Park SI. Rituximab, lenalidomide, and ibrutinib in relapsed/refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Br J Haematol 2021; 196:e30-e33. [PMID: 34642938 DOI: 10.1111/bjh.17886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Donald C Moore
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Amy C Soni
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Elton T Smith
- Carolinas Pathology Group, Atrium Health, Charlotte, NC, USA
| | - Jonathan Levine
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Tamara K Moyo
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Steven I Park
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Ciolek AM, Arnall J, Moore DC, Palkimas S, Der-Nigoghossian J, Dane K. Eptacog Beta for Bleeding Treatment and Prevention in Congenital Hemophilia A and B With Inhibitors: A Review of Clinical Data and Implications for Clinical Practice. Ann Pharmacother 2021; 56:831-838. [PMID: 34595941 DOI: 10.1177/10600280211049394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review the pharmacology, dosing and administration, safety, clinical efficacy, and role of eptacog beta in the treatment of congenital hemophilia with inhibitors. DATA SOURCES A literature search of PubMed (1966 to August 2021) was conducted using the keywords eptacog beta, recombinant FVII, and hemophilia. STUDY SELECTION AND DATA EXTRACTION All relevant published articles and prescribing information on eptacog beta for the treatment of congenital hemophilia with inhibitors were reviewed. DATA SYNTHESIS Eptacog beta is a novel recombinant activated factor VII (rVIIa) product that demonstrated efficacy in controlling bleeding and associated pain in patients with hemophilia A or B with inhibitors. Eptacog beta has limited Food and Drug Administration-approved and off-label indications compared with other bypassing agents (BPAs; activated prothrombin complex concentrates [aPCC; eptacog alfa]). Eptacog beta costs less than eptacog alfa, but still more than aPCCs. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review provides insight into the role of eptacog beta for treatment of congenital hemophilia with inhibitors and reviews important health system formulary considerations for available BPAs. CONCLUSIONS Eptacog beta is more cost-effective than eptacog alfa and, as such, may become the preferred rVIIa formulary product. However, eptacog alfa availability remains necessary for the treatment of disorders where eptacog beta has limited data. aPCC should remain the first-line BPA for the treatment of bleeding in patients with inhibitors with no contraindications to use because of its equivocal efficacy and safety and in light of the magnitude of cost savings associated with this strategy.
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Affiliation(s)
- Alana M Ciolek
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Donald C Moore
- Levine Cancer Institute, Atrium Health, Concord, NC, USA
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Crawford J, Moore DC, Morrison VA, Dale D. Use of prophylactic pegfilgrastim for chemotherapy-induced neutropenia in the US: A review of adherence to present guidelines for usage. Cancer Treat Res Commun 2021; 29:100466. [PMID: 34655862 DOI: 10.1016/j.ctarc.2021.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Evidence-based US guidelines provide recommendations for the use of granulocyte colony-stimulating factor (G-CSF) as supportive therapy in patients with cancer receiving chemotherapy. Pegfilgrastim is recommended for FN prophylaxis in patients with non-myeloid malignancies receiving a high-risk chemotherapy regimen, or an intermediate-risk regimen if one or more risk factors are present. The guidelines highlight the patient characteristics and chemotherapy regimens for solid tumors and hematologic malignancies that may influence a patient's overall risk of FN and may benefit from pegfilgrastim support. This review aimed to evaluate how pegfilgrastim use in patients with cancer receiving myelosuppressive chemotherapy in routine clinical practice aligns with evidence-based US guidelines. Examination of the literature revealed widespread deviation in relation to under- and over-prescribing, and timing of administration in US clinical practice. Pegfilgrastim is often over-prescribed in patients receiving palliative chemotherapy and those at low risk of FN. Potential under-prescribing of pegfilgrastim was also observed. In this literature search, data that appear to support same-day administration of pegfilgrastim were from uncontrolled studies that were limited in size. Analyses of healthcare claims data clearly favored next-day use, with statistically significant increases in FN incidence among patients receiving same-day pegfilgrastim versus those treated 1-4 days post-chemotherapy. Earlier-than-recommended administration typically occurs at the physician's discretion where next-day administration might present barriers to the patient receiving supportive therapy.There is a need to ensure appropriate prescribing to optimize patient outcomes, as deviation from the guideline recommendations was associated with increased incidence of FN and hospitalization.
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Affiliation(s)
| | - Donald C Moore
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vicki A Morrison
- University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, USA
| | - David Dale
- University of Washington, Seattle, WA, USA
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Moore DC. Bruton tyrosine kinase inhibitors for Waldenström macroglobulinemia: A review. J Oncol Pharm Pract 2021; 27:1993-1999. [PMID: 34558376 DOI: 10.1177/10781552211038309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this review is to evaluate the available evidence for the Bruton tyrosine kinase inhibitors in the treatment of Waldenström macroglobulinemia. DATA SOURCES A search of the PubMed database was conducted using the following search terms: ibrutinib, PCI-32765, acalabrutinib, ACP-196, zanubrutinib, BGB-3111, and Waldenström macroglobulinemia. Prospective clinical trials evaluating the efficacy and safety of ibrutinib, acalabrutinib, and zanubrutinib in patients with Waldenström macroglobulinemia were evaluated. Abstracts from the American Society of Hematology and American Society of Clinical Oncology annual meetings were reviewed as well as the prescribing information for each drug. DATA SUMMARY The first-generation Bruton tyrosine kinase inhibitor ibrutinib received Food and Drug Administration approval for Waldenström macroglobulinemia in 2015; this was the first drug approved for this rare condition. Ibrutinib has been evaluated as monotherapy and in combination with rituximab for the treatment of Waldenström macroglobulinemia. Since then, second-generation Bruton tyrosine kinase inhibitors, acalabrutinib and zanubrutinib, have been evaluated in prospective clinical trials for the treatment of Waldenström macroglobulinemia. All three agents have demonstrated high overall response rates and durable responses. CONCLUSION Bruton tyrosine kinase inhibitors have demonstrated significant clinical activity in the treatment of Waldenström macroglobulinemia, both in treatment naïve as well as the relapsed/refractory patient populations.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, USA
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Hollifield AL, Arnall JR, Moore DC. Caplacizumab: an anti-von Willebrand factor antibody for the treatment of thrombotic thrombocytopenic purpura. Am J Health Syst Pharm 2021; 77:1201-1207. [PMID: 32588878 DOI: 10.1093/ajhp/zxaa151] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, efficacy, safety, dosing and administration, and place in therapy of caplacizumab, a novel antibody fragment that inhibits von Willebrand factor, for the treatment of acquired thrombotic thrombocytopenic purpura (TTP) are summarized. SUMMARY Caplacizumab is a humanized anti-von Willebrand factor monoclonal antibody fragment that inhibits the interaction between ultralarge von Willebrand factor multimers and platelets. Caplacizumab is indicated for use in combination with standard-of-care modalities such as plasma exchange and immunosuppressive therapy for the treatment of adults with acquired TTP. By inhibiting von Willebrand factor, caplacizumab offers a new approach to the management of TTP by preventing the development of potentially life-threatening microvascular thrombosis that can occur in the disease process. In a randomized, placebo-controlled phase 3 trial, patients with acquired TTP treated with caplacizumab had more rapid platelet level normalization than placebo users; caplacizumab use also resulted in lower rates of disease recurrence and TTP-related death. The most common adverse events associated with caplacizumab use are bleeding-related events. In a phase 3 trial, serious bleeding-related adverse events were reported in 8 patients (11%) in the caplacizumab group and 1 patient (1%) in the placebo group. Caplacizumab is administered as an 11-mg intravenous loading dose 15 minutes prior to plasma exchange, followed by administration of 11 mg subcutaneously daily after plasma exchange. Once-daily caplacizumab administration can be continued for 30 days after the last plasma exchange. The medication and supplies for administration are provided as a single-use kit; patients should be trained on proper reconstitution and self-administration technique prior to the use of caplacizumab in the ambulatory setting. CONCLUSION Caplacizumab is a first-in-class von Willebrand factor inhibitor approved for the treatment of adults with acquired TTP.
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Affiliation(s)
| | | | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC
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Abstract
The B-cell receptor signaling pathway plays an integral role in the proliferation and survival of malignant B cells. Targeting the B-cell receptor pathway via the inhibition of Bruton tyrosine kinase (BTK) has evolved the treatment of a variety of B-cell malignancies, including chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenström macroglobulinemia. Currently, there are three BTK inhibitors approved by the U.S. Food and Drug Administration: ibrutinib, acalabrutinib, and zanubrutinib. This article reviews the pharmacology, clinical efficacy, safety, dosing, drug-drug interactions, and implications for advanced practitioners of BTK inhibitors in the treatment of B-cell malignancies.
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Affiliation(s)
- Donald C Moore
- Atrium Health, Levine Cancer Institute, Department of Pharmacy, Concord, North Carolina
| | - Daniel Thompson
- Atrium Health Cabarrus, Department of Pharmacy, Concord, North Carolina
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Wooten KM, Arnall JR, Bowser KM, J Pennell L, Wade-Davis JN, Olin JL, Taylor M, Moore DC. Publication rates of hematology/oncology abstracts presented at major pharmacy association meetings. J Oncol Pharm Pract 2021; 28:10781552211004700. [PMID: 33779372 DOI: 10.1177/10781552211004700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Professional conferences are where research findings are initially presented. Studies suggest many research ideas presented at conferences are never published. Previous studies have demonstrated that the full publication rate of abstracts presented at pharmacy meetings is approximately 20%. The objective of this study was to determine the full publication rate of hematology/oncology abstracts presented at major pharmacy organization annual meetings. METHODS A systematic search of PubMed and Google Scholar was performed. Publication status was evaluated for hematology/oncology abstracts presented at annual meetings for the following organizations: American College of Clinical Pharmacy Annual Meeting, American Society of Health-System Pharmacists Midyear Clinical Meeting, Hematology/Oncology Pharmacy Association Annual Meeting, and International Society of Oncology Pharmacy Practitioners Annual Meeting. Data collected included the meeting of abstract presentation, number of authors, abstract study type, country of origin, journal of publication, and type of publication. Abstracts presented as trainee research were excluded. RESULTS Of 451 oncology abstracts evaluated, the most common topic categories included pharmacotherapy (n = 244; 54.1%), clinical pharmacy practice (n = 84; 18.6%), and operational/compounding (n = 69; 15.3%). The overall publication rate was 17.5% (n = 79). Abstracts were published as full manuscripts over a spread of 48 different journals. Factors associated with full publication included abstracts with more than 5 authors (OR 3.86, 95% CI 2.32-6.43; p < 0.0001) and abstracts presented at oncology-focused pharmacy meetings (OR 2.92, 95% CI 1.49-5.72; p = 0.0018). CONCLUSION This study showed an overall publication rate of 17.5% for abstracts presented at pharmacy meetings, consistent with prior studies.
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Affiliation(s)
| | - Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | | | | | | | | | | | - Donald C Moore
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC, USA
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Lee A, Larck C, Moore DC. Impact of obesity on safety outcomes and treatment modifications with ado-trastuzumab emtansine in breast cancer patients. J Oncol Pharm Pract 2020; 28:49-54. [PMID: 33356991 DOI: 10.1177/1078155220982648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate indicated for the treatment of HER2-positive breast cancer. The 2012 American Society of Clinical Oncology guidelines on chemotherapy dosing in obesity recommend using full weight-based cytotoxic chemotherapy doses to treat obese patients with cancer. These guidelines were published prior to the advent of anticancer antibody-drug conjugates. There is a need to investigate the safety of T-DM1 in obese patients. METHODS This retrospective chart review included adult patients with breast cancer receiving T-DM1. The primary endpoint was a composite of the incidence of T-DM1 treatment modifications secondary to an adverse event. Secondary outcomes included the incidence of dose reductions, dose delays, treatment discontinuations, and adverse events. RESULTS A total of 119 patients with HER2-positive breast cancer who received T-DM1 therapy were included in this study: 44 obese patients and 75 non-obese patients. The composite outcome of treatment modifications due to toxicity was significantly higher in obese patients compared to non-obese patients (45% vs 25%, p = 0.024). Treatment delays were significantly higher in obese patients (36% vs 16%, p = 0.011). All-grade adverse events with a higher incidence in obese patients included left ventricular ejection fraction decrease (11% vs 5%), bilirubin increase (32% vs 12%), thrombocytopenia (61% vs 55%), and peripheral neuropathy (34% vs 27%). CONCLUSIONS This study suggests obese patients receiving T-DM1 may require more treatment modifications secondary to adverse events compared to non-obese patients. Larger studies are needed to determine if obese patients are at higher risk for specific T-DM1-induced adverse events.
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Affiliation(s)
- Anna Lee
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Chris Larck
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Donald C Moore
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC, USA
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Moore DC, Gebru T, Plesca D. Evaluation of a pharmacist-driven rapid infusion rituximab conversion protocol at a multisite cancer center. J Oncol Pharm Pract 2020; 27:1914-1918. [PMID: 33297847 DOI: 10.1177/1078155220977898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Infusion-related reactions (IRR) are a common adverse event associated with rituximab, an anti-CD20 monoclonal antibody indicated for the treatment of B-cell lymphomas. IRR risk is highest with the first infusion, which is given by a slow titration over an average of 3.5 hours. Subsequent administrations can be given over an accelerated, rapid 90-minute infusion if patients meet specific criteria. To improve rapid infusion rituximab utilization, we developed and implemented a pharmacist-driven protocol which allows pharmacists to change the administration instructions to rapid infusion. METHODS A retrospective chart review was conducted to evaluate patients age ≥18 years with B-cell lymphomas who were eligible to receive rapid infusion rituximab following protocol implementation. The primary outcome was the prevalence of the use of rapid infusion rituximab for eligible patients. Secondary outcomes included the frequency of pharmacist-initiated conversions to rapid infusion rituximab and incidence of IRR with rapid infusions. RESULTS A total of 180 patients were included in this study; 89 patients in the pre-protocol group and 91 patients in the post-protocol group. Fifteen patients and 66 patients in the pre-protocol and post-protocol groups, respectively, received rapid infusion rituximab (17% vs. 73%, p < 0.00001). The pharmacist-driven protocol was used to convert 49 patients (54%) to rapid infusion. No IRR occurred in patients receiving rapid infusion rituximab. CONCLUSION The implementation of a pharmacist-driven protocol led to a significant improvement in the use of rapid infusion rituximab and optimized chair time utilization at our institution.
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DiSogra KY, Tran T, Arnall JR, Janes A, Moore DC, Park SI. Ibrutinib treatment via alternative administration in a patient with chronic lymphocytic leukemia and dysphagia. J Oncol Pharm Pract 2020; 27:1265-1269. [PMID: 33106104 DOI: 10.1177/1078155220967440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ibrutinib is a small molecule inhibitor of Bruton's tyrosine kinase indicated for the treatment of a variety of B-cell malignancies including chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom's macroglobulinemia. These indolent hematologic malignancies are considered diseases of the elderly, a population that may have dysphagia leading to difficulty swallowing tablets and capsules. Ibrutinib is currently not available in a liquid oral dosage form. We report the utilization and clinical outcomes associated with alternative administration of ibrutinib capsules in a patient with chronic lymphocytic leukemia and significant dysphagia. CASE REPORT An 86-year old female requiring chronic lymphocytic leukemia-directed therapy due to a rising absolute lymphocyte count and worsening, transfusion-dependent anemia with a past medical history of dementia and dysphagia, was initiated on ibrutinib. MANAGEMENT & OUTCOME Due to the patient's significant inability to swallow, ibrutinib capsules were administered via an alternative method by opening them and sprinkling onto soft food or applesauce. With ibrutinib therapy, the patient has had a significant clinical response in her chronic lymphocytic leukemia as evidenced by her decreased absolute lymphocyte count and achieving transfusion independence with improvements in hemoglobin. DISCUSSION Ibrutinib administration via this alternative method resulted in an initial clinical response in the treatment of our patient's chronic lymphocytic leukemia as evidenced by a decreasing absolute lymphocyte count and improved anemia that achieved transfusion independence. The patient has maintained this response to therapy after approximately 1 year at the time of manuscript preparation.
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Affiliation(s)
| | - Thuy Tran
- Atrium Health, Specialty Pharmacy Service, Charlotte, NC, USA
| | - Justin R Arnall
- Atrium Health, Specialty Pharmacy Service, Charlotte, NC, USA
| | - Amanda Janes
- Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Donald C Moore
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Steven I Park
- Atrium Health, Levine Cancer Institute, Concord, NC, USA
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Abstract
Objective Prior research has evaluated the effects of acute exercise on episodic memory function. These studies have, on occasion, demonstrated that acute exercise may enhance both short- and long-term memory. It is uncertain as to whether the acute exercise improvements in long-term memory are a result of acute exercise attenuating declines in long-term memory, or rather, are driven by the enhancement effects of acute exercise on short-term memory. The present empirical study evaluates whether the decline from short- to long-term is influenced by acute exercise. This relationship is plausible as exercise has been shown to activate neurophysiological pathways (e.g., RAC1) that are involved in the mechanisms of forgetting. Methods To evaluate the effects of acute exercise on forgetting, we used data from 12 of our laboratory's prior experiments (N = 538). Across these 12 experiments, acute exercise ranged from 10 to 15 mins in duration (moderate-to-vigorous intensity). Episodic memory was assessed from word-list or paragraph-based assessments. Short-term memory was assessed immediately after encoding, with long-term memory assessed approximately 20-min later. Forgetting was calculated as the difference in short- and long-term memory performance. Results Acute exercise (vs. seated control) was not associated with an attenuated forgetting effect (d = 0.10; 95% CI: -0.04, 0.25, P = 0.17). We observed no evidence of a significant moderation effect (Q = 6.16, df = 17, P = 0.17, I2 = 0.00) for any of the evaluated parameters, including study design, exercise intensity and delay period. Conclusion Across our 12 experimental studies, acute exercise was not associated with an attenuated forgetting effect. We discuss these implications for future research that evaluates the effects of acute exercise on long-term memory function.
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Affiliation(s)
- D C Moore
- Department of Health, Exercise Science and Recreation Management, Exercise & Memory Laboratory, The University of Mississippi, University, MS 38677, USA
| | - S Ryu
- Department of Health, Exercise Science and Recreation Management, Exercise & Memory Laboratory, The University of Mississippi, University, MS 38677, USA
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Moore DC, Arnall JR, Thompson DL, Martin AL, Robinson J, Ndiaye A, Paul B, Atrash S, Bhutani M, Voorhees PM, Usmani SZ. Evaluation of Montelukast for the Prevention of Infusion-related Reactions With Daratumumab. Clin Lymphoma Myeloma Leuk 2020; 20:e777-e781. [PMID: 32660902 DOI: 10.1016/j.clml.2020.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of multiple myeloma. Infusion-related reactions (IRRs) are among the most common adverse events associated with daratumumab. IRRs are most common with the first infusion of daratumumab. Recommended premedications to be given prior to the daratumumab dose include acetaminophen, diphenhydramine, and a corticosteroid. There is emerging data to suggest that the addition of montelukast to this premedication regimen can lower the incidence of daratumumab-related IRRs. PATIENTS AND METHODS This was a single-center, retrospective chart review conducted at a large, multistate health system with several different hematology/oncology practice sites. Eligible patients included those with a primary diagnosis of a plasma cell disorder who received at least 1 dose of daratumumab. The primary outcome was the incidence of IRRs with the first daratumumab infusion. RESULTS A total of 141 patients receiving daratumumab-based therapy were included in this study. All patients received acetaminophen, diphenhydramine, and a corticosteroid as premedications prior to the first infusion of daratumumab. Overall, 46 (33%) patients experienced an IRR with the first infusion of daratumumab. The incidence of IRR was lower in patients that received montelukast as a premedication compared with those that did not (montelukast, n = 25 [27%]; no montelukast, n = 21 [45%]; P = .0371). Patients in each arm experienced similar rates of overall, composite pulmonary, gastrointestinal, and systemic IRR manifestations. CONCLUSION The use of montelukast prior to the first daratumumab infusion led to a reduction in the incidence of IRRs in our experience.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC.
| | | | | | - Allison L Martin
- Department of Pharmacy, Levine Cancer Institute, Charlotte, NC; Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Jordan Robinson
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Ami Ndiaye
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Barry Paul
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Shebli Atrash
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Manisha Bhutani
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
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Moore DC, Arnall JR, Janes A, Pineda-Roman M. Dialysis Independence Following Combination Daratumumab, Thalidomide, Bortezomib, Cyclophosphamide, and Dexamethasone in Multiple Myeloma With Severe Renal Failure. Clin Lymphoma Myeloma Leuk 2020; 20:e395-e398. [PMID: 32359768 DOI: 10.1016/j.clml.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
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Al Kharusi S, Anton G, Badhrees I, Barbeau PS, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao GF, Cen WR, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Darroch L, Daugherty SJ, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski MJ, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen EV, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell MJ, Johnson A, Karelin A, Kaufman LJ, Koffas T, Kostensalo J, Krücken R, Kuchenkov A, Kumar KS, Lan Y, Larson A, Lenardo BG, Leonard DS, Li GS, Li S, Li Z, Licciardi C, Lin YH, MacLellan R, McElroy T, Michel T, Mong B, Moore DC, Murray K, Nakarmi P, Njoya O, Nusair O, Odian A, Ostrovskiy I, Piepke A, Pocar A, Retière F, Robinson AL, Rowson PC, Ruddell D, Runge J, Schmidt S, Sinclair D, Skarpaas K, Soma AK, Stekhanov V, Suhonen J, Tarka M, Thibado S, Todd J, Tolba T, Totev TI, Tsang R, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen LJ, Wichoski U, Wrede G, Wu SX, Xia Q, Yahne DR, Yang L, Yen YR, Zeldovich OY, Ziegler T. Measurement of the Spectral Shape of the β-Decay of ^{137}Xe to the Ground State of ^{137}Cs in EXO-200 and Comparison with Theory. Phys Rev Lett 2020; 124:232502. [PMID: 32603173 DOI: 10.1103/physrevlett.124.232502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden nonunique β-decay transition ^{137}Xe(7/2^{-})→^{137}Cs(7/2^{+}). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultralow background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal to background ratio of more than 99 to 1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden nonunique β-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.
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Affiliation(s)
- S Al Kharusi
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - G Anton
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - I Badhrees
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - P S Barbeau
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - D Beck
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - V Belov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Bhatta
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Breidenbach
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Brunner
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G F Cao
- Institute of High Energy Physics, Beijing 100049, China
| | - W R Cen
- Institute of High Energy Physics, Beijing 100049, China
| | - C Chambers
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - B Cleveland
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - M Coon
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - A Craycraft
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - L Darroch
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - S J Daugherty
- Physics Department and CEEM, Indiana University, Bloomington, Indiana 47405, USA
| | - J Davis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Delaquis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | | | - R DeVoe
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - J Dilling
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Dolgolenko
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Echevers
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - W Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - D Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - J Farine
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - S Feyzbakhsh
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - P Fierlinger
- Technische Universität München, Physikdepartment and Excellence Cluster Universe, Garching 80805, Germany
| | - D Fudenberg
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - P Gautam
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R Gornea
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Gratta
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - C Hall
- Physics Department, University of Maryland, College Park, Maryland 20742, USA
| | - E V Hansen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Hoessl
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - P Hufschmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - M Hughes
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Iverson
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - A Jamil
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Jessiman
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M J Jewell
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - A Johnson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A Karelin
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - L J Kaufman
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Koffas
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - J Kostensalo
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Kuchenkov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - K S Kumar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Y Lan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Larson
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - B G Lenardo
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - D S Leonard
- IBS Center for Underground Physics, Daejeon 34126, Korea
| | - G S Li
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - S Li
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Z Li
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Licciardi
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - Y H Lin
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R MacLellan
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - T McElroy
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - T Michel
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - B Mong
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D C Moore
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - K Murray
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - P Nakarmi
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - O Njoya
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - O Nusair
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Odian
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Piepke
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - F Retière
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A L Robinson
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - P C Rowson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D Ruddell
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - J Runge
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - S Schmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - D Sinclair
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - K Skarpaas
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A K Soma
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - V Stekhanov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - J Suhonen
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - M Tarka
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - S Thibado
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - J Todd
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Tolba
- Institute of High Energy Physics, Beijing 100049, China
| | - T I Totev
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - R Tsang
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - B Veenstra
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - V Veeraraghavan
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - P Vogel
- Kellogg Lab, Caltech, Pasadena, California 91125, USA
| | - J-L Vuilleumier
- LHEP, Albert Einstein Center, University of Bern, Bern CH-3012, Switzerland
| | - M Wagenpfeil
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - J Watkins
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M Weber
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - L J Wen
- Institute of High Energy Physics, Beijing 100049, China
| | - U Wichoski
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Wrede
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - S X Wu
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - Q Xia
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - D R Yahne
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - O Ya Zeldovich
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Ziegler
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
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Cobert AM, Helms C, Larck C, Moore DC. Risk of hepatotoxicity with trastuzumab emtansine in breast cancer patients: a systematic review and meta-analysis. Ther Adv Drug Saf 2020; 11:2042098620915058. [PMID: 32341779 PMCID: PMC7175051 DOI: 10.1177/2042098620915058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/26/2020] [Indexed: 01/28/2023] Open
Abstract
Background Trastuzumab emtansine (T-DM1) is an anti-HER2 antibody-drug conjugate indicated for the treatment of HER2-positive breast cancer. One of the most severe adverse events reported with T-DM1 is hepatotoxicity. The objective of our meta-analysis is to investigate the risk of hepatic adverse events in patients with breast cancer receiving T-DM1 compared with controls. Methods We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing T-DM1 with a control treatment in patients with HER2-positive breast cancer. Phase II/III RCTs with available event number or event rate of hepatic toxicity with an assessable sample size were included. Relative risk (RR) and corresponding 95% confidence intervals (CI) for all grade and high-grade (grade 3/4) aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevations were calculated. Results Seven RCTs were deemed eligible and were included in the meta-analysis. The RR for all-grade AST and ALT elevations were 3.24 (95% CI 2.16-4.86; p < 0.00001) and 2.90 (95% CI 1.98-4.23; p < 0.00001), respectively. The RR for high-grade AST and ALT elevations were 2.73 (95% CI 1.07-6.93; p = 0.03) and 2.17 (95% CI 1.34-3.50; p = 0.002), respectively. Conclusions Our meta-analysis demonstrates that T-DM1-based therapy is associated with an increased risk of AST and ALT elevations.
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Affiliation(s)
- Amani M Cobert
- High Point University Fred Wilson School of Pharmacy, High Point, NC, USA
| | - Catherine Helms
- Clinical Staff Pharmacist, Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Chris Larck
- Pharmacist Clinical Coordinator - Hematology/Oncology, Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Donald C Moore
- Pharmacist Clinical Coordinator, Hematology/Oncology, Atrium Health, Levine Cancer Institute, 100 Medical Park Drive, Concord, NC 28025, USA
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Abstract
Acute myeloid leukemia (AML) is an aggressive myeloid disorder that is associated with a generally poor prognosis. Effective treatment options have been limited for older patients with AML who are not able to undergo intensive remission induction chemotherapy due to advanced age or comorbidities. New and novel agents are needed to improve treatment outcomes for this patient population. Glasdegib is a novel Hedgehog signaling pathway inhibitor approved by the U.S. Food & Drug Administration for the treatment of patients with newly diagnosed AML who are 75 years of age or older or who have comorbidities that preclude intensive induction chemotherapy. Glasdegib is approved in combination with low-dose cytarabine (LDAC). This approval is based on the results of a multicenter, open-label, randomized trial of glasdegib plus LDAC vs. LDAC monotherapy in which the addition of glasdegib resulted in an improvement in median overall survival.
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Affiliation(s)
| | - Donald C Moore
- Levine Cancer Institute, Atrium Health, Concord, North Carolina
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Moore DC, Ringley JT, Nix D, Muslimani A. Impact of Body Mass Index on the Incidence of Bortezomib-induced Peripheral Neuropathy in Patients With Newly Diagnosed Multiple Myeloma. Clinical Lymphoma Myeloma and Leukemia 2020; 20:168-173. [DOI: 10.1016/j.clml.2019.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/08/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
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Abstract
Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, dosing, and administration of mogamulizumab for the treatment of T-cell lymphomas. Data Sources: A literature search of PubMed (1966 to September 2019) was conducted using the keywords mogamulizumab, KW-0761, and lymphoma. Data were also obtained from package inserts and meeting abstracts. Study Selection and Data Extraction: All relevant published articles, package inserts, and unpublished meeting abstracts on mogamulizumab for the treatment of T-cell lymphomas were reviewed. Data Synthesis: Mogamulizumab is an anti-CC chemokine receptor 4 (CCR4) monoclonal antibody that has demonstrated activity in various T-cell lymphomas. It was approved by the US Food and Drug Administration (FDA) for the treatment of adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) who have been treated with at least 1 prior line of therapy. Mogamulizumab demonstrated significant improvement in progression-free survival compared with vorinostat in patients with relapsed or refractory MF or SS. Serious adverse events associated with mogamulizumab include infusion-related reactions, cutaneous drug eruption, and autoimmune complications. Mogamulizumab administration in the preallogeneic hematopoietic stem cell transplant setting can increase the risk for severe posttransplant graft-versus-host disease. Relevance to Patient Care and Clinical Practice: Mogamulizumab is a first-in-class CCR4 inhibitor, providing a new option in the treatment of relapsed or refractory cutaneous T-cell lymphomas. Although not currently FDA approved for this indication, mogamulizumab may have some utility for the treatment of relapsed adult T-cell leukemia/lymphoma. Conclusion: The recent approval of mogamulizumab represents an important addition to the armamentarium of pharmacotherapies for T-cell lymphomas.
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Affiliation(s)
| | | | | | - Chris Larck
- Atrium Health, Levine Cancer Institute, Concord, NC, USA
| | - Steven I. Park
- Atrium Health, Levine Cancer Institute, Concord, NC, USA
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