European Journal of Hospital Pharmacy: Science and Practice, 2014
Background Several molecular targeted agents (MTA) have been approved recently for the treatment ... more Background Several molecular targeted agents (MTA) have been approved recently for the treatment of metastatic renal cell carcinoma (mRCC). However data on the use of these drugs in clinical practice are limited. Purpose To describe the prescription patterns of MTA (sunitinib, pazopanib, sorafenib, everolimus, temsirolimus and bevacizumab) in patients with mRCC in a tertiary hospital. Materials and methods Retrospective observational study of all patients who received at least one cycle of MTA for the treatment of mRCC from August 2006 to January 2013. Variables obtained from the computer system included date of birth, sex, tumour histology (predominant clear cell histology (CCH) or non-clear cell histology (n-CCH)), treatment line number and first and last dispensing date. Results 83 patients, average age of 63 (SD ± 10.6) (81% male), were dispensed at least one treatment of MTA. 72% of patients showed predominantly CCH. The median length of treatment was 10 months (range 0.4–66.9). Most of the patients with CCH (n = 59) received sunitinib (n = 42; 71%) or sorafenib (n = 10; 17%) as first-line treatment. 24 patients went through a second line: mainly sorafenib (n = 9; 38%) and sunitinib (n = 6; 25%). 5 patients continued with sunitinib, sorafenib or everolimus as third line. n-CCH patients (n = 24) were treated with sunitinib (n = 18; 75%), sorafenib (n = 3; 13%), or temsirolimus (n = 3; 13%) as first line. Eleven patients received a second-line treatment, principally sunitinib (n = 4; 36%), sorafenib (n = 3; 27%) and temsirolimus (n = 2; 18%). A third line was prescribed to 3 patients (2 temsirolimus and 1 sorafenib). Only 3 patients were retreated with the same drug. Conclusions Sunitinib, followed by sorafenib, are the most commonly used drugs in all lines and histologies of mRCC. Further studies are needed to evaluate any trends in use after pazopanib’s recent approval. No conflict of interest.
3908 INTRODUCTION Chemoimmunotherapy, namely the combination of fludarabine, cyclophosphamide and... more 3908 INTRODUCTION Chemoimmunotherapy, namely the combination of fludarabine, cyclophosphamide and rituximab (FCR), results in a higher response rate and a longer progression-free survival in patients with chronic lymphocytic leukemia (CLL). There is also evidence coming from several historical comparisons, observational, and epidemiological studies and, above all, a large randomized clinical trial (German CLL Study Group – Hallek M et al, Lancet 2010) that FCR prolongs survival. Since additional randomized studies to validate the superiority of FCR over older therapies in CLL are difficult to envisage, other approaches to confirm this observation are worth to be considered. AIM The aim of this study was to ascertain whether chemoimmunotherapy given at any time over the course of the disease, independently of the treatment phase, prolonged survival in a group of unselected patients with CLL from the Hospital Clínic of Barcelona. MATERIALS AND METHODS Out of 1042 consecutive patients...
DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic propert... more DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.
Pegfilgrastim is a G-CSF that can be administered in a single dose 24 h after each cycle of chemo... more Pegfilgrastim is a G-CSF that can be administered in a single dose 24 h after each cycle of chemotherapy. 59 years-old man with a stage III-B peripheral T lymphoma with CD4 expression. Dose-dense chemotherapy was started with CHOP-14 combined with pegfilgrastim as primary prophylaxis. An error in the dispensing system meant that the patient received pegfilgrastim for 4 consecutive days. He remained under observation in hospital. During the 3 days after the last dose of pegfilgrastim, the patient remained stable, with no remarkable symptoms or associated laboratory abnormalities, and was discharged. The case we describe and the available literature lead us to suggest close monitoring as the main measure to be adopted when treating a patient for pegfilgrastim overdose.
DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic propert... more DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.
WHAT IS KNOWN AND OBJECTIVE: It is now estimated that about 5% of cetuximab-treated patients and ... more WHAT IS KNOWN AND OBJECTIVE: It is now estimated that about 5% of cetuximab-treated patients and about 3% of panitumumab-treated patients will develop grade 3-4 hypomagnesemia. The aim of this study was to assess the extent of magnesium monitoring in patients treated with epidermal growth factor receptor (EGFR)-targeting antibodies and to estimate the incidence of hypomagnesemia in these patients at our institution. METHODS: A 2-year retrospective study was carried out. At least four doses of weekly cetuximab or two doses of bi-weekly panitumumab were required for inclusion. Serum magnesium profiles were reviewed from 1 month before treatment until 3 months after treatment discontinuation, and patients with <2 determinations were excluded. RESULTS AND DISCUSSION: Two hundred and one patients received at least one dose of EGFR-targeting antibodies, but only 68 met the inclusion criteria. Seventy patients had <2 magnesium determinations. The overall hypomagnesemia was 58·82% (40...
Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment o... more Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients&#39; follow-up period was defined from the administration of the first dose until February 2011. The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.
It is not unusual to find obese and cachectic patients in the hematology oncology setting. Howeve... more It is not unusual to find obese and cachectic patients in the hematology oncology setting. However, information on dosage in these groups is scarce. The objectives of our study were to explore the dosing strategies applied in the treatment of obese and cachectic cancer patients and to determine whether these strategies are applied in clinical trials. Members of the Spanish Group for the Development of Hematology-Oncology Pharmacy (GEDEFO). We invited all cancer hospital pharmacists to participate in a survey. Descriptive statistics of the dosing strategies approaches. We invited 159 eligible hospitals to participate, and 38 responded to the survey. A total of 50 surveys were received: different strategies were applied by different physicians from the same hospital and by hematology and oncology departments. Body mass index was used to define obesity and cachexia in 40 and 30 % of the cases, respectively. Capping the body surface area (BSA) was the approach most commonly followed (64.1 %) in obese patients, whereas no specific approach was adopted in cachectic patients. In hematology patients, the BSA calculation was based on ideal body weight or adjusted body weight in 16.0 % of cases (n = 2) and 50.0 % of cases (n = 6), respectively; in oncology patients, use of adjusted or ideal body weight was negligible. Actual body weight was the main approach in obese patients (35 surveys) and cachectic patients (48 surveys). Creatinine clearance was assessed mainly using the Cockcroft and Gault equation (around 76.0 % of responses). As for clinical trials, 64.1 % of the respondents (n = 25 hospitals) considered the criteria from each clinical trial individually. Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.
Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment o... more Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients&#39; follow-up period was defined from the administration of the first dose until February 2011. The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.
European Journal of Hospital Pharmacy: Science and Practice, 2014
Background Several molecular targeted agents (MTA) have been approved recently for the treatment ... more Background Several molecular targeted agents (MTA) have been approved recently for the treatment of metastatic renal cell carcinoma (mRCC). However data on the use of these drugs in clinical practice are limited. Purpose To describe the prescription patterns of MTA (sunitinib, pazopanib, sorafenib, everolimus, temsirolimus and bevacizumab) in patients with mRCC in a tertiary hospital. Materials and methods Retrospective observational study of all patients who received at least one cycle of MTA for the treatment of mRCC from August 2006 to January 2013. Variables obtained from the computer system included date of birth, sex, tumour histology (predominant clear cell histology (CCH) or non-clear cell histology (n-CCH)), treatment line number and first and last dispensing date. Results 83 patients, average age of 63 (SD ± 10.6) (81% male), were dispensed at least one treatment of MTA. 72% of patients showed predominantly CCH. The median length of treatment was 10 months (range 0.4–66.9). Most of the patients with CCH (n = 59) received sunitinib (n = 42; 71%) or sorafenib (n = 10; 17%) as first-line treatment. 24 patients went through a second line: mainly sorafenib (n = 9; 38%) and sunitinib (n = 6; 25%). 5 patients continued with sunitinib, sorafenib or everolimus as third line. n-CCH patients (n = 24) were treated with sunitinib (n = 18; 75%), sorafenib (n = 3; 13%), or temsirolimus (n = 3; 13%) as first line. Eleven patients received a second-line treatment, principally sunitinib (n = 4; 36%), sorafenib (n = 3; 27%) and temsirolimus (n = 2; 18%). A third line was prescribed to 3 patients (2 temsirolimus and 1 sorafenib). Only 3 patients were retreated with the same drug. Conclusions Sunitinib, followed by sorafenib, are the most commonly used drugs in all lines and histologies of mRCC. Further studies are needed to evaluate any trends in use after pazopanib’s recent approval. No conflict of interest.
3908 INTRODUCTION Chemoimmunotherapy, namely the combination of fludarabine, cyclophosphamide and... more 3908 INTRODUCTION Chemoimmunotherapy, namely the combination of fludarabine, cyclophosphamide and rituximab (FCR), results in a higher response rate and a longer progression-free survival in patients with chronic lymphocytic leukemia (CLL). There is also evidence coming from several historical comparisons, observational, and epidemiological studies and, above all, a large randomized clinical trial (German CLL Study Group – Hallek M et al, Lancet 2010) that FCR prolongs survival. Since additional randomized studies to validate the superiority of FCR over older therapies in CLL are difficult to envisage, other approaches to confirm this observation are worth to be considered. AIM The aim of this study was to ascertain whether chemoimmunotherapy given at any time over the course of the disease, independently of the treatment phase, prolonged survival in a group of unselected patients with CLL from the Hospital Clínic of Barcelona. MATERIALS AND METHODS Out of 1042 consecutive patients...
DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic propert... more DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.
Pegfilgrastim is a G-CSF that can be administered in a single dose 24 h after each cycle of chemo... more Pegfilgrastim is a G-CSF that can be administered in a single dose 24 h after each cycle of chemotherapy. 59 years-old man with a stage III-B peripheral T lymphoma with CD4 expression. Dose-dense chemotherapy was started with CHOP-14 combined with pegfilgrastim as primary prophylaxis. An error in the dispensing system meant that the patient received pegfilgrastim for 4 consecutive days. He remained under observation in hospital. During the 3 days after the last dose of pegfilgrastim, the patient remained stable, with no remarkable symptoms or associated laboratory abnormalities, and was discharged. The case we describe and the available literature lead us to suggest close monitoring as the main measure to be adopted when treating a patient for pegfilgrastim overdose.
DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic propert... more DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.
WHAT IS KNOWN AND OBJECTIVE: It is now estimated that about 5% of cetuximab-treated patients and ... more WHAT IS KNOWN AND OBJECTIVE: It is now estimated that about 5% of cetuximab-treated patients and about 3% of panitumumab-treated patients will develop grade 3-4 hypomagnesemia. The aim of this study was to assess the extent of magnesium monitoring in patients treated with epidermal growth factor receptor (EGFR)-targeting antibodies and to estimate the incidence of hypomagnesemia in these patients at our institution. METHODS: A 2-year retrospective study was carried out. At least four doses of weekly cetuximab or two doses of bi-weekly panitumumab were required for inclusion. Serum magnesium profiles were reviewed from 1 month before treatment until 3 months after treatment discontinuation, and patients with <2 determinations were excluded. RESULTS AND DISCUSSION: Two hundred and one patients received at least one dose of EGFR-targeting antibodies, but only 68 met the inclusion criteria. Seventy patients had <2 magnesium determinations. The overall hypomagnesemia was 58·82% (40...
Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment o... more Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients&#39; follow-up period was defined from the administration of the first dose until February 2011. The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.
It is not unusual to find obese and cachectic patients in the hematology oncology setting. Howeve... more It is not unusual to find obese and cachectic patients in the hematology oncology setting. However, information on dosage in these groups is scarce. The objectives of our study were to explore the dosing strategies applied in the treatment of obese and cachectic cancer patients and to determine whether these strategies are applied in clinical trials. Members of the Spanish Group for the Development of Hematology-Oncology Pharmacy (GEDEFO). We invited all cancer hospital pharmacists to participate in a survey. Descriptive statistics of the dosing strategies approaches. We invited 159 eligible hospitals to participate, and 38 responded to the survey. A total of 50 surveys were received: different strategies were applied by different physicians from the same hospital and by hematology and oncology departments. Body mass index was used to define obesity and cachexia in 40 and 30 % of the cases, respectively. Capping the body surface area (BSA) was the approach most commonly followed (64.1 %) in obese patients, whereas no specific approach was adopted in cachectic patients. In hematology patients, the BSA calculation was based on ideal body weight or adjusted body weight in 16.0 % of cases (n = 2) and 50.0 % of cases (n = 6), respectively; in oncology patients, use of adjusted or ideal body weight was negligible. Actual body weight was the main approach in obese patients (35 surveys) and cachectic patients (48 surveys). Creatinine clearance was assessed mainly using the Cockcroft and Gault equation (around 76.0 % of responses). As for clinical trials, 64.1 % of the respondents (n = 25 hospitals) considered the criteria from each clinical trial individually. Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.
Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment o... more Zoledronic acid (ZA) is an intravenous bisphosphonate approved for the prevention and treatment of cancer skeletal-related events. Our aim was to analyze the prescription patterns of ZA in the cancer outpatient clinic. We performed a retrospective chart review of all patients who received at least 1 dose of ZA from January 2009 until December 2010 in our institution. The patients&#39; follow-up period was defined from the administration of the first dose until February 2011. The sample comprised 345 patients: 31.9 % had breast cancer, 14.5 % prostate cancer, 29.0 % multiple myeloma, and 24.6 % other solid tumors. A total of 4,546 doses were administered; 2,749 (60.5 %) without intravenous chemotherapy. 71.1 % of patients with breast cancer, 86 % with prostate cancer, 60 % with multiple myeloma and 44.6 % with other solid tumors, received ZA without intravenous chemotherapy throughout bisphosphonate treatment. Doses were adjusted in one-third of cases. Administration every 4-weeks was the most frequent schedule. Median duration of treatment varied between 15.0 months for breast cancer and 4.2 months for other solid tumors. Most of ZA prescriptions in cancer outpatients followed the labeled indications. The percentage of ZA doses administered without intravenous chemotherapy was 60.5 %.
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