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Haque E, Muhsen IN, Esmail A, Umoru G, Mylavarapu C, Ajewole VB, Abdelrahim M. Case report: Efficacy and safety of regorafenib plus fluorouracil combination therapy in the treatment of refractory metastatic colorectal cancer. Front Oncol 2022; 12:992455. [PMID: 36620581 PMCID: PMC9822717 DOI: 10.3389/fonc.2022.992455] [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: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background More than half of patients with colorectal cancer (CRC) present with metastatic disease or develop recurrent disease on first-line and second-line options. Treatment beyond the second line remains an area of unmet need for patients with progressive or recurrent disease. Methods We retrospectively reviewed data of adult (>18 years old) patients with mCRC who received regorafenib + 5FU combination therapy at Houston Methodist Hospital with outcomes of interest including response rate, discontinuation due to side effects, and overall survival. Results Seven patients received regorafenib + 5FU combination therapy for mCRC after receiving at least two other lines of therapy (including at least one fluorouracil-based therapy). Four patients (57%) achieved disease control in 7-12 weeks after therapy initiation while three patients developed recurrent disease. In patients who achieved disease control, no new adverse events were reported among patients with this combination. Conclusion Regorafenib and Fluorouracil combination could be considered an option beyond the second line for patients with treatment-refractory metastatic colorectal cancer. Further studies, including a prospective trial, are needed to investigate the efficacy and safety of regorafenib plus 5FU therapy compared to other limited available therapies.
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Affiliation(s)
- Emaan Haque
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ibrahim N. Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Abdullah Esmail
- Section of Gastrointestinal Oncology, Houston Methodist Neal Cancer Center, Houston, TX, United States,*Correspondence: Maen Abdelrahim, ; Abdullah Esmail,
| | - Godsfavour Umoru
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, United States,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, United States
| | - Charisma Mylavarapu
- Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Veronica B. Ajewole
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, United States,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, United States
| | - Maen Abdelrahim
- Section of Gastrointestinal Oncology, Houston Methodist Neal Cancer Center, Houston, TX, United States,Cockrell Center for Advanced Therapeutic Phase I program, Houston Methodist Research Institute, Houston, TX, United States,Department of Medicine, Weill Cornell Medical College, New York, NY, United States,*Correspondence: Maen Abdelrahim, ; Abdullah Esmail,
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2
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Ajewole VB, Akindele O, Abajue U, Ndulue O, Marshall JJ, Mossi YT. Cancer Disparities and Black American Representation in Clinical Trials Leading to the Approval of Oral Chemotherapy Drugs in the United States Between 2009 and 2019. JCO Oncol Pract 2021; 17:e623-e628. [PMID: 33974825 PMCID: PMC8120664 DOI: 10.1200/op.20.01108] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Over the past 10 years, oral chemotherapy made up about half (45.6%) of all US Food and Drug Administration (FDA)-approved oncolytic and hematologic medications. Given the disparity in incidence and mortality rate because of certain cancers among Black Americans (BAs) in the United States, a review of BA's representation in the clinical trials that lead to the development and FDA approval of oral chemotherapy drugs becomes imperative. The objective of this study was to evaluate the reporting of race and inclusion of BA in clinical trials that led to the approval of oral chemotherapy medications by the FDA from 2009 to 2019 in the United States. Additionally, we evaluated the inclusion of BAs in clinical trials of three cancer types with the highest disparity rates among BAs (lung, breast, and prostate). METHODS A retrospective review of all FDA-approved oral chemotherapy drug from 2009-2019 was obtained using the FDA's Hematology/Oncology Approvals & Safety Notifications website. Reports of racial and demographics inclusion were obtained from the clinical trials registry. RESULTS Primary outcome: 142 clinical trials led to FDA approval of 81 oral chemotherapy agents between 2009 and 2019, among which 74 (52%) reported on at least one race and were included in our analysis. 35,933 participants were enrolled in these 74 clinical trials, among which 25,684 (71.47%), 6,061 (16.87%), 889 (2.47%), and 826 (2.30%) were White, Asian, Black, and Hispanic, respectively. BAs were also under-represented in the clinical trials of three cancer types with the highest disparity rates among this population. CONCLUSION BAs were under-represented in clinical trials leading to FDA approval of oral chemotherapy drugs. There should be more BAs in cancer clinical trials to increase the generalizability of the results, improve outcomes, and eventually close the health disparity gap among this patient population.
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Affiliation(s)
- Veronica B Ajewole
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX.,Department of Pharmacy, Houston Methodist Hospital, Houston, TX.,Houston Methodist Academic Institute/Weill Cornell Medical College, Houston, TX
| | - Oyinkansola Akindele
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX
| | - Uzoamaka Abajue
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX
| | - Okwuoma Ndulue
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX
| | - Jazzmin J Marshall
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX
| | - Yhenew T Mossi
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX
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3
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Dongarwar D, Ajewole VB, Harris K, Oduguwa E, Ofili TU, Onyenaka C, Arnold S, Broussard J, Ishioye J, Marshal J, Mayoya J, Le D, Fadel M, Olaleye OA, Salihu HM. A Framework for Protecting Pregnant Women in the Era of COVID-19 Pandemic. Int J MCH AIDS 2021; 10:109-112. [PMID: 33868776 PMCID: PMC8039866 DOI: 10.21106/ijma.419] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for the coronavirus disease 2019 (COVID-19) pandemic, highlighted and compounded problems while posing new challenges for the pregnant population. Although individual organizations have provided disparate information, guidance, and updates on managing the pregnant population during the current COVID-19 pandemic, it is important to develop a collective model that highlights all the best practices needed to protect the pregnant population during the pandemic. To establish a standard for ensuring safety during the pandemic, we present a framework that describes best practices for the management of the pregnant population during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Veronica B Ajewole
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Kiydra Harris
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Harris Health System, Houston, TX, USA
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Theresa U Ofili
- Irma Lerma Rangel College of Pharmacy, Texas A&M University, College Station, TX
| | - Collins Onyenaka
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Sade Arnold
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Jorhn Broussard
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Joan Ishioye
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Jasmine Marshal
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Jamila Mayoya
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Danchau Le
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Mouch Fadel
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Omonike A Olaleye
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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4
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Ajewole VB, Solomon JM, Schneider AM, Heyne KE. Development and implementation of an electrolyte replacement protocol in the outpatient oncology infusion centers of a large academic healthcare system. J Oncol Pharm Pract 2020; 26:1871-1877. [DOI: 10.1177/1078155220907671] [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
Background Patients receiving chemotherapy frequently experience electrolyte imbalances. Electrolyte replacement is, therefore, a necessity as patients may experience life-threatening symptoms. Study objective: The objective of this study was to evaluate the occurrence of low serum potassium and magnesium, and identify the rate of replacement for patients with low serum potassium and magnesium levels. Based on our findings, we developed and implemented a nursing-driven electrolyte replacement protocol. Methods Preimplementation phase – A retrospective review for serum potassium and magnesium values obtained during infusion clinic visit between 1 August and 31 October 2016 was conducted. Implementation phase – A nursing-driven electrolyte replacement protocol with medication order “smart-set” and order selection intelligence within EPIC Beacon was developed and implemented in May 2017. Postimplementation phase – The postimplementation phase data were collected from 1 August to 30 November 2017 using a similar approach as the preimplementation phase. Results Preimplementation phase – During the preimplementation phase of the study, a total of 1495 serum potassium levels and 1193 serum magnesium levels were obtained. Among the 152 patients who needed potassium replacement, 34% ( n = 52) were replaced and among the 118 serum magnesium levels that needed replacement, 30% ( n = 35) were replaced. Postimplementation phase – 3979 serum potassium and 2707 magnesium levels were obtained. Among the 170 patients who needed potassium replacement, 75% ( n = 127) were replaced. Among the 142 patients who needed magnesium replacement, 73% ( n = 104) were replaced. Conclusion A 121% increase in potassium replacement and a 143% increase in magnesium replacement were identified after implementing this protocol.
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Affiliation(s)
- Veronica B Ajewole
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Jenna M Solomon
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
- Department of Pharmacy, Women & Infants Hospital, Providence, RI, USA
| | - Amy M Schneider
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
- Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA
| | - Kirk E Heyne
- Department of Medical Oncology/Hematology, Houston Methodist Hospital, Houston, TX, USA
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5
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Thompson J, Onyenaka C, Oduguwa E, Dongarwar D, Gendra S, Coker V, Kutse S, Blanco M, Nwangwu O, King C, Enamorado E, Bakare O, Ajewole VB, Spooner KK, Salemi JL, Aliyu MH, Salihu HM, Olaleye OA. Trends and Racial/Ethnic Disparities in the Rates of Pre-eclampsia by HIV Status in the US. J Racial Ethn Health Disparities 2020; 8:670-677. [PMID: 32754847 DOI: 10.1007/s40615-020-00826-3] [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] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preeclampsia and HIV account for a significant proportion of the global burden of disease and pose severe maternal-fetal risks. There is a dearth of literature regarding racial/ethnic disparities in preeclampsia associated with HIV/AIDS in the US. METHODS We retrospectively analyzed data from the National Inpatient Sample (NIS) database from 2002 to 2015 on a cohort of hospitalized pregnant women with or without preeclampsia and HIV. Joinpoint regression models were used to identify trends in the rates of preeclampsia among pregnant women living with or without HIV, stratified by race/ethnicity over the study period. We also assessed the association between preeclampsia and various socio-demographic factors. RESULTS We analyzed over 60 million pregnancy-related hospitalizations, of which 3665 had diagnoses of preeclampsia and HIV, corresponding to a rate of 0.61 per 10,000. There was an increasing trend in the diagnosis of preeclampsia among hospitalized, pregnant women without HIV across each racial/ethnic category. The highest prevalence of preeclampsia was among non-Hispanic (NH) Blacks, regardless of HIV status. CONCLUSION The increase in rates of pre-eclampsia between 2002 and 2015 was mostly noted among pregnant women without HIV. Regardless of HIV status, NH-Blacks experienced the highest discharge prevalence of preeclampsia.
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Affiliation(s)
- Jamalena Thompson
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Collins Onyenaka
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77098, USA.
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77098, USA
| | - Sumaya Gendra
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Vidella Coker
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Seun Kutse
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Mayra Blanco
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Onyinye Nwangwu
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Charlee King
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Elza Enamorado
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Oluwatoyin Bakare
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Veronica B Ajewole
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jason L Salemi
- College of Public Health, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Muktar H Aliyu
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77098, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Omonike A Olaleye
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
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6
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Dongarwar D, Ajewole VB, Oduguwa E, Ngujede A, Harris K, Ofili TU, Olaleye OA, Salihu HM. Role of Social Determinants of Health in Widening Maternal and Child Health Disparities in the Era of Covid-19 Pandemic. Int J MCH AIDS 2020; 9:316-319. [PMID: 32765962 PMCID: PMC7397329 DOI: 10.21106/ijma.398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We present a conceptual model that describes the social determinants of health (SDOH) pathways contributing to worse outcomes in minority maternal and child health (MCH) populations due to the current COVID-19 pandemic. We used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes in the categories Z55-Z65 to identify SDOH that potentially modulate MCH disparities. These SDOH pathways, coupled with pre-existing comorbidities, exert higher-than-expected burden of maternal-fetal morbidity and mortality in minority communities. There is an urgent need for an increased infusion of resources to mitigate the effects of these SDOH and avert permanent truncation in quality and quantity of life among minorities following the COVID-19 pandemic.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Veronica B Ajewole
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Ahone Ngujede
- College of Business, Columbia Southern University, Orange Beach, AL, USA
| | - Kiydra Harris
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Theresa U Ofili
- College of Business, Columbia Southern University, Orange Beach, AL, USA
| | - Omonike A Olaleye
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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7
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Ajewole VB, Ngujede AE, Oduguwa E, Dongarwar D, Kaur M, Knight C, Jackson M, Nguyen U, Roshan T, Simpson J, Vouffo I, Olaleye OA, Salihu HM. A Surveillance System for the Maternal and Child Health (MCH) Population During the COVID-19 Pandemic. Int J MCH AIDS 2020; 9:350-353. [PMID: 32832200 PMCID: PMC7433297 DOI: 10.21106/ijma.411] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent for coronavirus disease 2019 (COVID-19), and its ensuing mitigation measures have negatively affected the Maternal and Child Health (MCH) population. There is currently no surveillance system established to enhance our understanding of SARS-CoV-2 transmission to guide policy decision making to protect the MCH population in this pandemic. Based on reports of community and household spread of this novel infection, we present an approach to a robust family-centered surveillance system for the MCH population. The surveillance system encapsulates data at the individual and community levels to inform stakeholders, policy makers, health officials and the general public about SARS-CoV-2 transmission dynamics within the MCH population.
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Affiliation(s)
- Veronica B Ajewole
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Ahone E Ngujede
- College of Business, Columbia Southern University, Orange Beach, AL, USA
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Manvir Kaur
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Cecelia Knight
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Science, Engineering, and Technology, Texas Southern University, Houston, TX, USA
| | - Maresha Jackson
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Jessie Jones School of Business, Texas Southern University, Houston, TX, USA
| | - Uyen Nguyen
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Tasha Roshan
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Jordan Simpson
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Igor Vouffo
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Science, Engineering, and Technology, Texas Southern University, Houston, TX, USA
| | - Omonike A Olaleye
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA
| | - Hamisu M Salihu
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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8
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Ajewole VB, Cox JE, Swan JT, Chikermane SG, Lamoth B, Iso T, Okolo LO, Ford CL, Schneider AM, Hobaugh EC, Baker KR. Incidence of chemotherapy-induced peripheral neuropathy within 12 weeks of starting neurotoxic chemotherapy for multiple myeloma or lymphoma: a prospective, single-center, observational study. Support Care Cancer 2019; 28:1901-1912. [PMID: 31359183 DOI: 10.1007/s00520-019-05006-6] [Citation(s) in RCA: 5] [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: 04/18/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) may necessitate chemotherapy dose reduction, delay, or discontinuation. This pilot study tested feasibility of patient enrollment, CIPN screening, and data collection in cancer patients for a future clinical study that will assess the safety and efficacy of an intervention that may prevent CIPN. METHODS This prospective, observational, single-center, pilot study included adults with newly diagnosed lymphoma or multiple myeloma receiving neurotoxic chemotherapy. Patients were enrolled between September 2016 and February 2017. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire was completed by patients at 3 time points: baseline, week 6, and week 12. The primary outcome was change in the neurotoxicity score between these time points. RESULTS Of 33 patients approached for consent, 28 (85%) provided consent and were enrolled. The FACT/GOG-Ntx questionnaire was completed by 28 (100%) at baseline, 25 (89%) at week 6, and 24 (86%) at week 12. Average (standard deviation) neurotoxicity scores were 36.5 (6.6) at baseline, 34.0 (8.3) at week 6, and 30.6 (7.6) at week 12. Neurotoxicity scores changed from baseline by - 2.7 points (95% CI - 5.5 to 0.1; p = 0.061) at week 6 and - 6.0 points (95% CI - 5.6 to - 0.8; p = 0.012) at week 12. Clinically meaningful declines (decrease of > 10% from baseline) in neurotoxicity score were detected in 36% (9 of 25) at week 6 and in 67% (16 of 24) at week 12. CONCLUSION Sixty-seven percent of patients experienced clinically significant CIPN within 12 weeks of starting chemotherapy. Feasibility metrics for enrollment, consent, CIPN assessment, and follow-up were met.
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Affiliation(s)
- Veronica B Ajewole
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - James E Cox
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Joshua T Swan
- Department of Pharmacy, Houston Methodist, Houston, TX, USA.
- Departments of Surgery and Pharmacy in the Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA.
| | - Soumya G Chikermane
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Beverly Lamoth
- Outpatient Bone Marrow Transplant Services, Houston Methodist Hospital Cancer Center, Houston, TX, USA
| | - Tomona Iso
- Department of Pharmacy, Houston Methodist, Houston, TX, USA
- Department of Pharmacy, Houston Methodist Research Institute, Houston, TX, USA
| | - Laura O Okolo
- Hematology Services, Houston Methodist Hospital Cancer Center, Houston, TX, USA
| | - Christen L Ford
- Outpatient Infusion Services, Houston Methodist Hospital Cancer Center, Houston, TX, USA
| | - Amy M Schneider
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
- Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA
| | - Eleanor C Hobaugh
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Kelty R Baker
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
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9
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Solomon JM, Ajewole VB, Schneider AM, Sharma M, Bernicker EH. Evaluation of the prescribing patterns, adverse effects, and drug interactions of oral chemotherapy agents in an outpatient cancer center. J Oncol Pharm Pract 2018; 25:1564-1569. [DOI: 10.1177/1078155218798150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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
Purpose Although oral chemotherapy offers advantages over intravenous chemotherapy, it creates a unique set of challenges. Potential barriers include treatment complexity, patient responsibility for medication adherence and monitoring, reduced healthcare contact, and increased financial burden. The purpose of this study is to estimate the prevalence of drug-related problems among a sample of patients treated with oral chemotherapy agents. Methods A single-center, retrospective chart review was conducted on patients prescribed oral chemotherapy at our institution between 1 January 2017 and 31 August 2017. The primary endpoint was the incidence of drug-related toxicities within 90 days of starting treatment. Secondary endpoints included incidence of drug–drug interactions, proportion of patients receiving medication education by a clinical pharmacist, and quantification of issues related to medication access. Results Charts of 100 patients were reviewed. Median time to oral chemotherapy receipt by the patient from the day the order was written was eight days. Prior to initiating therapy, 27% of patients received education by a clinical pharmacist. Toxicity checks were conducted by the provider at 30, 60, and 90 days for 80%, 65%, and 48% of patients, respectively. Treatment-related toxicities secondary to oral chemotherapy were reported by 79% of patients, with 55% classified as severe. Potential drug interactions were in 55% of the patients. Conclusion Data from this study have highlighted avenues for pharmacists to make an impact on patients newly started on oral chemotherapy. Opportunities exist to increase patient education, ensure appropriate follow-up, and assess adherence while preventing and managing treatment-related toxicities.
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Affiliation(s)
| | - Veronica B Ajewole
- Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | | | - Manvi Sharma
- The University of Texas Health Science Center, Houston, TX, USA
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10
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Qin Q, Ajewole VB, Sheu TG, Donohue R, Singh M. Successful treatment of a stage IIIC small-cell carcinoma of the ovary hypercalcemic subtype using multi-modality therapeutic approach. Ecancermedicalscience 2018; 12:832. [PMID: 29910829 PMCID: PMC5985749 DOI: 10.3332/ecancer.2018.832] [Citation(s) in RCA: 9] [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: 01/17/2018] [Indexed: 12/22/2022] Open
Abstract
Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare but highly undifferentiated, aggressive malignancy that primarily affects young women. Due to its early onset, unclear familial history and vague presenting symptoms, most SCCOHT patients present late with advanced disease. The prognosis is extremely poor, with <10% disease-free survival for advanced stages. Although several therapeutic regimens have been proposed, to date there is no consensus on the optimal strategy. Here, we describe a successful case of advanced-stage SCCOHT of the left ovary treated with cytoreductive surgery, semi-intense chemotherapy, high-dose consolidative chemotherapy, autologous hematopoietic stem cell transplantation and pelvic radiation with long-term survival. Given the almost universal mortality of advanced SCCOHT in long-term follow-up, we believe this case highlights the importance of prompt diagnosis when a young patient presents with abdominal swelling and hypercalcemia as well as early, aggressive, combined modality treatment. This case is also especially remarkable given the patient underwent fertility preservation surgery, which is not recommended by most of the current literature. However, as therapies improve and more young patients may survive SCCOHT, the question of fertility will increase in relevance. We believe the pros and cons of conservation should be discussed in detail with the patient.
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Affiliation(s)
- Qian Qin
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Veronica B Ajewole
- Houston Methodist Cancer Centre, Houston Methodist Hospital, Houston, TX 77030, USA.,Department of Pharmacy Practice, Texas Southern University College of Pharmacy and Health Sciences, Houston, TX 77004, USA
| | - Tiffany G Sheu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rachel Donohue
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Monisha Singh
- Houston Methodist Cancer Centre, Houston Methodist Hospital, Houston, TX 77030, USA
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