OncoPharm: Recent Episodes
John Bossaer
OncoPharm is a podcast dedicated to all things oncology pharmacy. Most episodes cover updates and recent publications concerning the use of medications in caring for patients we cancer. Periodically, episodes drop devoted to Landmark Clinical Trials in oncology and Fundamentals of Oncology Pharmacy.
This week's episode covers some updates in small cell lung cancer, chemotherapy-induced nausea/vomiting (CINV), SC administration of isatuximab, and Lu-177 vipivotide tetraxetan.Download the Oncology Learning Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
A new drug is approved for ROS1 NSCLC after a prior TKI (with some data in patients after 2 TKIs). Zidesamtinib...easy for you to say.Also, a post hoc analysis of PACIFIC provides some of the best evidence yet of the detrimental effect (?) of PPI use prior to ICI use.Download the Oncology Learning Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
This week's pod covers some brief updates comparing the timelines of the FDA approvals for daraxonrasib vs. enfortuamb vedodin + pembrolizumab, before devoting the rest of the time to the new approval of gedatolisib, a PIK3CA inhibitor, with fulvestrant and maybe palbociclib if you feel like it for metastatic breast cancer in the 2nd line. Oh, in patients WITHOUT PIK3CA mutations.Download the Oncology Learning Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
Did lenalidomide maintenance in multiple myeloma just get limited to 2 years?Endurance Trial, Part 2: https://www.nejm.org/doi/full/10.1056/NEJMoa2600157Learning Oncology Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
is intriguing with possibilities: DOI: 10.1056/NEJMcibr2601002Learning Oncology Companion:https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
is intriguing with possibilities: DOI: 10.1056/NEJMcibr2601002Learning Oncology Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
Lots of bite-size updates in this episode.Capitello-281: capivasertib + abiraterone (+ prednisone + ADT)Adjuvant Belzutifan + Pemroblizumab is FDA approvedDurvalumab approved with BCG for non-muscle invasive bladder cancer Insightful commentary: https://doi.org/10.1200/JCO-25-02670Talquetamab + Durvaluamb - a new safety signal?Learning Oncology Companion: https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
ASCO 2026 is a wrap, and we needed an extra week to digest it all! Here the review list:1. RASolute 302 - daraxonrasib and its standing ovation2. MajesTEC-9 - 2L teclistamab in multiple myeloma in patient population 100% exposed to CD-38 targeting drugs3. Initsmeran autogene + pembrolizumab in resected melanoma. Only a Phase 2 study, but super promising and exciting use of personalized medicine using mRNA technology4. Libretto-043 - adjuvant selpercatinib in RET-fusion positive NSCLC following resection and platinum-based chemotherapy (in most of these patients)5. PROTEUS - meh6. SARC041 - Phase study of abemaciclib vs. placebo in dedifferntiated liposarcoma. The placebo did very poorly7. CROWN at 7-years continues to offer an enticing PFS plateau with lorlatinib use in advanced ALK rearrangement+ NSCLCThe Learning Oncology Companion from KelleyCPharmD:https://www.kelleycpharmd.com/learning-oncology-companion-oncopharm
Pivekimab sunirine, a novel CD-123 antibody drug conjugate is approved for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN). Also, what the heck is BPDCN?Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
The FDA has been a bunch of busy bees with new approvals:1. Sonrotoclax, an exciting new BCL2 inhibitor approved for 3rd-line Mantle Cell Lymphoma2. An all PO regimen of decitabine/cedazuridine + venetoclax is approved for AML.3. Zenoctuzumab gets an FDA approval for cholangiocarcinoma with an efficacy patient population = 194. T-DXd is a good drug and continues to pile on FDA approvals5. Adjuvant atezolizumab in bladder cancer is approved in conjunction with ctDNA serial monitoring to determine who gets treatmentCheck out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
This week's pod has lots of updates!IMHOTEP: Pre-operative doses of pembrolizumab lead to significant pCR rates in dMMR colon cancer. https://doi.org/10.1200/JCO-25-02169Real world rates of PJP suggest room for improvement in prophylaxis, especially those on corticosteroids + additional immunosuppressants. https://doi.org/10.1177/10600280261443794Daraxonrasib given expanded access by FDA before approval: https://www.fda.gov/news-events/press-announcements/fda-permits-expanded-access-investigational-pancreatic-cancer-drugAnd yes, the ivermectin boom was real: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2848862Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
The latest FDA drug approval is vepdegestrant, a heterobifunctional protein degrader, for ESR1 mutated breast cancer. We discuss what that actually means and some possible implications for clinical practice. Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
This is our 1st in a series of podcasts/videos to role out once or twice a year on therapeutic targets in cancer. First up - Trop2Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharmVideo with slides: https://youtu.be/mrDQyYkaF7A
This week we highlight some promising clinical research in the pancreatic cancer space.Daraxonrasib has shown OS benefit vs. chemo in the 2nd-line setting of metastatic pancreatic cancer compared to investigator's choice chemotherapy. Hopefully, we will get the abstract soon and publication shortly thereafter. A personalized mRNA vaccine for early-stage pancreatic cancer has some encouraging results (for those patients who mounted a sizable immune response to the vaccine).Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Pub: https://doi.org/10.1111/jdi.14362Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Discussing the new nab-paclitaxel adjunctive medication, relacorilant, for ovarian cancer. As a glucoCORticoid receptor antagonist, it is hard to pronounce.Also, a 10-year follow-up study of ibrutinib provides big picture insight on the impact of the BTKi era in CLL. Link: https://doi.org/10.1182/blood.2025029971Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Recapping what I learned at HOPA 2026:-Beyond steroids for irAs-IT chemo beyond methotrexate and cytarabine-Pre-emptive CMV management in patients receiving certain bispecifics-semaglutide-alectinib drug interaction-Safety (n = ~40) of MMR vaccine in patients post-Auto transplant on maintenance daratumumabCheck out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Nivolumab-AVD is finally approved for Hodgkin Lymphoma, and primary G-CSF prophylaxis is recommended (?) in the PI. Also, brief NOLA preview for HOPA attendees. The Big Easy Debate: sazerac or hurricane?Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Tazemetostat is withdrawn from the market due to a risk of secondary malignancies.RECITE asks if romiplostim improves platelet counts for patients on oxaliplatin-based regimens with thrombocytopenia. Spoiler - yes it does, but does that make a difference?Check out the Oncology Insights Newsletter: www.kelleycpharmd.com/newsletter-oncopharm
Lots of FDA approval updates to discuss from the past few weeks:-Zongertinib gets approved in 1st line setting for ERBB2 TKD mutated metastatic NSLCLC-Encorafenib approval with cetuximab + FOLFOX-Teclistamab + Daratumumab approved in 2nd line setting for r/r multiple myeloma-Acalabrutinib + venetoclax (but NOT acalabrutinib + venetoclax + obinutuzumab) is approved for CLLCheck out the Oncology Insights Newsletter: https://www.kelleycpharmd.com/newsletter-oncopharm
This week discuss BR.31 trial of adjuvant durvalumab in NSCLC and put it into the context of the positive studies with atezolizumab and pembrolizumab. We also highlight 2 notable presentations at ASCO GU 2026 on perioperative enfortumab vedotin + pembrolizumab in cisplatin-eligible patients with resectable bladder cancer (KEYNOTE-B15) and advjuant pembrolizumab + belzutifan in RCC (LITESPARK-022)Check out the Oncology Insights Newsletter: https://www.kelleycpharmd.com/newsletter-oncopharm
dabrafenib use? This case series says - maybe: https://doi.org/10.1007/s00520-019-4654-2Check out the Oncology Insights Newsletter: https://www.kelleycpharmd.com/newsletter-oncopharm
The EV-303 trial that led to the FDA approval of perioperative enfortumab vedotin + pembrolizumab in cisplatin-ineligible bladder cancer patients in now published in NEJM. We discuss the results and ponder potential future changes to treating bladder cancer in the future.Urinary diversion surgeries: https://jamanetwork.com/journals/jamaoncology/fullarticle/2842595
We have FDA changes to the labels of Axi-Cel (to allow for its use in primary CNS lymphoma) and 5-flourouracil (pre-treatment DPYD testing). Also, pembrolizumab nets another approval, this time in conjunction with paclitaxel for platinum-resistant ovarian cancer (limited to PD-L1 CPS of 1% of greater)
A brief discussion of the Core Communication Skills and how to incorporate them into a chemotherapy education session.Rapport BuildingAgenda SettingInformation ManagementActive ListeningAddressing Feelings*Common Ground
Reviewing the hot-off-the press publication of PATINA, palbociclib in HER-2 amplified breast cancer along with endocrine therapy and HER-2 targeted antibodies.
We review the recent ASCENT-04/Keynote-D19 publication of sacituzuab govitecan + pembrolizumab for PD-L1 CPS of 10% and above TNBC compared to chemo + pembrolizumab alone.Also, a quick recap of ASCO GI earlier this month with mentions of zanidatamab and zolbetuximab. Finally, a check-in on The Pitt.
A Holiday tradition like few other. Are we keeping, regifting, or returning new oncology drugs approved in 2025?
Are we nearing the end of the Platinum Era in bladder cancer? A press release suggests enfortumab vedotin + pembrolizumab in a perioperative approach is better than the current standard of care: neoadjuvant cisplatin-based chemo followed by surgery. We eagerly await seeing this data.Also, a subcutaneous amivantamab/hyaluronidase formulation is approved, which offers a much lower risk of infusion reactions - but some chances for dosing errors based on weights and available dosage forms.
dosing in Multiply Myeloma and renal dysfunctionTrilaciclib and CDK 4/6 inhibition as protection against TP53-mutated clonal hematopoiesis?
DPYD testing is more complicated than one would think! We talk through the steps to consider when initiating DPYD testing at your site. Resources below:Guide for implementing DPYD testing at your site: https://doi.org/10.1002/cpt.3567CPIC Dosing Guidline: https://doi.org/10.1002/cpt.911CPIC DPYD Resources: https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/
We are back with lots of OncoPharm updates:1. The belantamab mafodotin REMS program details are available....and it's a lot. How will belantamab mafodin-regimens be used with the upcoming MAJESTIC-3 data of teclistamab-daratumumab?2. The capecitabine label is updated and calls for pre-treatment DPYD testing 3. Daratumumab gets an FDA approval for high-risk smoldering myeloma based on the AQUILA study Critique of AQUILA: https://doi.org/10.1093/oncolo/oyaf2164. A pertuzumab biosimilar (Poherdy) is approved5. Epcoritamab nets regular approval and a new indication with lenalidomide/rituximab (RR) for Follicular Lymphoma6. Ziftomenib, a new menin inhibitor, is approved for NPM1 relapsed/refractory AML7. Sevabertinib, a new HER2 inhibiting TKI, is approved for ERBB2 mutated NSCLC, with evidence of activity in patients previously treated with HER2-antibody-drug conjugates8. Expected FDA approvals for durvalumab + FLOT in preoperative gastric/GEJ cancer; neoadjuvant pembrolizumb + enforumab vedotin in bladder cancer (non-cisplatin eligible), and tarlatamab regular approval for small cell lung cancer9. Happy Thanksgiving!
[Moving Trailer Voice] This Halloween: They always come back....The latest revival is belantamab mafodotin, FDA approved...again. After being vanquished in DREAMM3, it returned in DREAMM7 and even Daratumumab (in combination with Vd) couldn't overcome this blindingly effective drug (in combination with Vd).This pod reviews belantamab mafodotin's checkered past and wonders what the sequels may have in store for us.
T-DM1 in persistent HER2+ disease after neoadjuvant chemo + surgery2. Keynote-905: Neoadjuvant Enfortumab Vedotin + pembro in cisplatin-ineligible bladder cancer3. POTOMAC: Durvalumab + BCG in non-muscle invasive bladder cancer4. IMvigor011: ctDNA-guided adjuvant atezolizumab in bladder cancer5. Dynamic-III: ctDNA guide de-escalation or escalation of chemotherapy in stage III colon cancer6. HARMONi-6: an excuse to talk about ivonescimab, a bispecific antibody unlike any other currently FDA approved
IL-2, one of the founding fathers of our current immunotherapy landscape, is discussed.
Maintenance therapy with ICIs (atezolizumab or durvalumab) is already established in extensive stage small-cell lung cancer, but lurbinectedin enters the chat with a recent FDA approval. Next up - tarlatamab?IMforte (maintenance lurbinectedin + atezolizumab): https://doi.org/10.1016/S0140-6736(25)01011-6DeLLphi-303 (phase 1b maintenance tarlatamab + ICI): https://doi.org/10.1016/S1470-2045(25)00480-2
Our Landmarks of OncoPharm series returns to discuss PARAMOUNT, a landmark study that helped solidify the role of maintenance pemetrexed in NSCLC.
The long awaited subcutaneous formulation of pembrolizumab is not FDA-approved. We discuss its administration and toxicity & PK differences vs. IV use.Biotin supplementation can interfere with lots of labs cancer patients get routinely - Who knew? (Ahem, not me.) Link: https://doi.org/10.1200/OP-25-00693POLARIX 5-year Data: https://doi.org/10.1200/JCO-25-00925
The 2025 World Conference on Lung Cancer just concluded, and there are several notable updates concerning treatment of EGFR-mutated NSCLC.1. The COMPEL study tries to find the value of continuing osimertinib (with the addition of chemotherapy) after progression on osimertinib. The results are, well, compelling!2/3. We now have updates on the OS benefits of osimertinib + chemotherapy (FLAURA2) and amivantamab + lazertinib (MARIPOSA) compared to osimertinib monotherapy in initial treatment of metastatic disease.4. NEOADAURA tries to determine if neoadjuvant osimertinib has value, but longer follow-up will be needed to assess this practice.
The 5-year+ follow-up from CARTITUDE-1 has people asking if cilta-cel can cure multiple myeloma? We discuss this data and the broad comparison to the other BCMA-targeting CAR-T product, idi-cel and a recent comparison on plasma cell leukemia.CARTITUDE-1 Long-Term F/U: https://doi.org/10.1200/JCO-25-00760Cilta-cel & ide-cel in plasma cell leukemia: https://doi.org/10.1182/bloodadvances.2025016966
The potential breakthrough in RNA vaccine technology has been increasingly discussed on social media. This episode looks at one promising study and its early, early results so far.UF GBM study: https://doi.org/10.1016/j.cell.2024.04.003RNA Treatment Vaccine Review: https://doi.org/10.1002/ctm2.1384
Malignant Hematology Updates:Venetoclax dosing strategies continue to evolveHMA/Ven + IDH1/2 inhibitors: https://doi.org/10.1200/JCO-25-00640HMA/Ven + revumenib: https://doi.org/10.1200/JCO-25-00914Venetoclax + CPX-351: https://doi.org/10.1002/ajh.27723APOLLO: https://doi.org/10.1200/JCO-25-00535Iland APOLLO editorial: https://doi.org/10.1200/JCO-25-01496ctDNA assessment vs. PET in Large B-Cell Lymphoma: https://doi.org/10.1200/JCO-25-01534
A new ERBB2 (HER2) targeting TKI is approved for NSCLC. We review the characteristics of the drug and summarize the current landscape in treating HER-mutated advanced NSCLC.
This week's episode discusses the first-in-class agent, dordaviprone and a randomized control trial that demonstrated an oncology pharmacists led to decreased rates of adverse drug reactions (ADRs) in a Hem/Onc clinic.Dordaviprone data: https://doi.org/10.1200/jco.23.01134Alabassi AK, et al. Role of a designated pharmacist in reducing adverse drug reaction rates and preventing potential medication errors in hematology-oncology: a randomized controlled trial. JCO Oncology Practice: https://doi.org/10.1200/OP-25-00158
More isn't always better. Our Landkmarks of OncoPharm series covers lessons learned from the ProMACE-CytaBOM regimen for NHL.ProMACE-CytaBOM: https://www.annalsofoncology.org/article/S0923-7534(20)31592-1/pdfRCT vs. CHOP (& others): https://www.nejm.org/doi/full/10.1056/NEJM199304083281404
A few supportive care updates:1. Skin prophylaxis to prevent severe dermatologic toxicity with Nivo/Ipi.Note* published in JCO Oncology Practice (NOT JAMA Oncol as stated in the episodeLink: https://doi.org/10.1200/OP-25-001002. Stampede-Metformin and how metformin has some beneficial effects in prostate cancer patients who don't have diabetesLink: https://doi.org/10.1016/S1470-2045(25)00231-1
Antiandrogen withdrawal is an historically well described phenomenon where prostate cancer patients experience PSA responses AFTER stopping their anti-androgen. But does this happen with today's 2nd generation antiandrogens?
A plethora of recent updates:-Pembrolizumab (perioperative) in head & neck cancer (Keynote-689)-Prostate cancer updates on cabozantinib/atezolizumab (yes, really) and talazoparib-Pirtobrutinib improves PFS in CLL-Zanubrutinib has a new dosage form on the way-Another mitomycin product approved with "reverse thermal properties"-A new regimen for FL of tafasitamab/rituximab/lenalidomide-A comparison of the new ROS1-inhibitor, taltrectenib, compared to other 1st-line treatment options
A recap of notable updates from ASCO 20251. Destiny-Breast092. BREAKWATER3. ATOMIC4. Delphi-3045. CM 816 OS update6. C-POST7. Matterhorn
Our Landmarks of OncoPharm series returns to discuss the CLEOPATRA study, which established docetaxel, trastuzumab, pertuzumab (THP) as a standard first-line regimen for metastatic HER2-amplified breast cancer.
If you've been struggling with how to talk to patients about ivermectin for cancer, then this podcast is for you.1. Cancer misinformation on social media (Loeb, et al): https://doi.org/10.3322/caac.218572. Clinician communication with patients about cancer misinformation (Bylund, et al): https://doi.org/10.1200/OP.22.00526
Discussing recent FDA approvals of penpulimab, avutometenib, defactinib, and telisotuzumab vedotin.
A splashy large study and two small studies suggest IV Mg in pre-hydration fluids can decrease the risk of cisplatin kidney injury.Gupta et al. JAMA Oncol (2025): doi:10.1001/jamaoncol.2025.0756PRAGMATIC. ESMO Open (2022): https://doi.org/10.1016/j.esmoop.2021.100351Yamamoto et al. Anticancer Res (2015): https://pubmed.ncbi.nlm.nih.gov/25862878/
This episode summarizes recent updates on:Tumor infiltrating clonal hematopoiesis (TI-CH) and its apparent negative impact on solid tumors (https://www.nejm.org/doi/full/10.1056/NEJMoa2413361)Updated dostarlimab data on MMRd use in rectal cancer and other solid tumors in the neoadjuvant (definitive?!?!) setting (https://www.nejm.org/doi/full/10.1056/NEJMoa2404512)Phase 1 study of 7 + 3 + Venetoclax (https://doi.org/10.1182/blood.2024026700)Zongertinib, a new HER2 TKI (https://www.nejm.org/doi/full/10.1056/NEJMoa2503704)
BRCA revision mutations may explain some of the limited benefit seen in long-term follow-up studies with PARP inhibitors.Bibliography:1: BRCA reversion mutations predict resistance. https://doi.org/10.1158/2159-8290.CD-18-07152: SOLO3 Final OS Data. https://doi.org/10.1200/JCO.24.009333: Elucidating acquired PARP inhibitor resistance in advanced prostate cancer. https://doi.org/10.1016/j.ccell.2024.10.015
Recapping HOPA 25 and PortlandGreat food (not discussed, the most excellent ETSU dinner at Arden)COCOONPharmacists make everyone's job easier and keep patients out of the EDA few more tidbits too!
FDA expands approvals for durvalumab (bladder cancer) and Lutetium-177 vipivotide tetraxetan (pre-taxane in metastatic prostate cancer). Portland has places.
We discuss reduced dose apixaban for months 6+ of treating cancer-associated VTE (API-CAT) and the impact (or lack thereof) of pausing BTK-inhibitors around vaccination (IMPROVE)
A Foundations of OncoPharm episode on Topotecan. (Originally to be released week of 3/27)
The updated Keynote 811 OS results convert an accelerated approval for pembrolizumab to a regular approval, albeit restricted by PD-L1 CPS status of 1 or higher.
There is a decent track record with mixed results for cryotherapy to prevent taxane-induced peripheral neuropathy. The POLAR trial adds to this body of evidence that trends in favor of cryotherapy. Compression therapy is another alternative. Both are studied in POLAR.POLAR: doi:10.1001/jamaoncol.2025.0001
Ten of the top herb-chemotherapy interactions.About Herbs website: https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/searchAlso, search 'About Herbs' in your app store.
Two recent publications suggest modifications to standard subcutaneous daratumumab pre-meds is safe...and saves time!Padmaraju et al experience from Chicago Med Center: https://doi.org/10.1093/oncolo/oyae158Vazirnia et al experience from Mayo Clinic: https://doi.org/10.1200/OP.23.00470We end summarizing some emerging evidence about the need, or lack thereof, for pre-paclitaxel H2RAs.
We take a deep look at the recently published, and guideline changing, AMPLIFY trial of fixed-duration acalabrutinib in CLL.Link: DOI: 10.1056/NEJMoa2409804
Morbidity & Mortality (M & M) are common case conferences to learn from unfortunate cases to improve care in the future. This episode looks at two recently published case reports.1. Fatal tumor lysis syndrome following a lack of venetoclax ramp-up in AML: https://www.jhoponline.com/issue-archive/2024-issues/december-2024-vol-14-no-6/rapid-onset-of-fatal-tumor-lysis-syndrome-in-a-patient-with-acute-myeloid-leukemia-receiving-azacitidine-and-venetoclax-without-a-ramp-up-schedule-a-case-report2. CD4+ T-cell lymphoma harboring a CAR integration into TP53: https://www.nejm.org/doi/full/10.1056/NEJMoa2411507
Dipping into the archives (technology issues with new computer) to re-release the Foundations of OncoPharm episode on rituximab. Where did that 375 mg/m2 dose come from anyway?
FDA approves two new treatment regimens:1. Acalabrutinib + BR for untreated mantle cell lymphoma patients deemed ineligible for autologous HSCT2. Sotorasib + panitumumab for KRAS-G12C mutated metastatic colorectal cancer (after chemotherapy, including oxaliplatin and irinotecan)
HOPA Pharmacy Outcomes & Practice-Based Collaboration Survey: https://www.surveymonkey.com/r/MXNVRBRDexamethasone Dosing Intensity in Multiple Myeloma: https://doi.org/10.1182/blood.2024025939Talquetamab + Teclistamab: https://doi.org/10.1182/blood.2024025939postMONARCH: https://doi.org/10.1200/JCO-24-02086
We discuss recent approvals of ensartinib and nivolumab-hyaluronidase as well as new front-line option for BRAV-V600E mutated metastatic colorectal cancer.
Weighing the Pros & Cons of the accelerated approval pathway as it relates to oncology. An updated draft guidance document from FDA regarding this pathway and some compelling data regarding the public's perceived value of newly approved drugs for cancer.Article: Preferences for speed of access versus certainty of the survival benefit of new cancer drugs: a discrete choice experiment. Forest R, et al. Lancet Oncology 2024. Link: https://doi.org/10.1016/S1470-2045(24)00596-5
Looking back at new approvals from 2024 - what to keep, re-gift, or return?And yes, as soon as this was recorded 2 new drugs were approved.
Lots of recent clinical trial updates to discuss:AQUILA: Daratumumab for high-risk smoldering multiple myelomaCheckmate 8HW: Nivo/Ipi for MSI-high/MMRd metastatic colorectal cancerDESTINY-Breast06: T-DXd in HER2-low MBC after hormonal treatment, but without previous chemo for MBCARMANI: Switch maintenance ramucirumab-paclitaxel in metastatic gastric/GEJ cancerHELEN-006: Neoadjuvant nab-paclitaxel/trastuzumab/pertuzumab vs. TCHP in breast cancerSONIA: finally published!
A first-in-class approval of a bispecific HER2-HER3 monoclonal antibody for NRG1 fusion (+) NSCLC and pancreatic cancer.
The 1st menin inhibitor, revumenib, is approved for relapsed/refractory acute leukemias.Understanding the Pathway: https://doi.org/10.1200/JCO-24-01265
A nice editorial succinctly summarizes a framework for thinking about how to incorporate anthracyclines into the treatment of early stage breast cancer patients. Anthracyclines in Early Breast Cancer: The Long Goodbye -https://doi.org/10.1200/JCO-24-0191610-year Outcomes of READ trial: https://doi.org/10.1200/JCO.24.00836Bonus - Practical Guide for Testing for Pharmacogenomics: https://doi.org/10.1200/OP.24.00191
Reviewing the data to support use of dexamethasone solution mouthwash for PIK3/AKT/mTOR inhibitor-induced stomatitis, caused by drugs like everolimus, alpelisib, capivasertib, & inavolisib.SWISH: https://doi.org/10.1016/s1470-2045(17)30109-2Alliance MIST Trial: https://doi.org/10.1053/j.seminoncol.2023.01.001
The first Cldn 18.2 targeting monoclonal antibody has been improved. Let's talk about it!
Discussing two excellent articles from earlier this month.S1826: N-AVD vs. Bv-AVD (DOI: 10.1056/NEJMoa2405888)& INTERLACE: induction chemo prior to concurrent cisplatin/RT in locally advanced cervical cancer (DOI: https://doi.org/10.1016/S0140-6736(24)01438-7)
Reviewing 3 recent AML publicationsDouble-Dauno (90 mg/m2 vs. 60 mg/m2): https://doi.org/10.1200/JCO.24.00235AML60+ Risk Stratification: https://doi.org/10.1200/JCO.23.02631Decitabine-Ven as bridge to Allo HSCT: https://doi.org/10.1016/S2352-3026(24)00241-2
MSI-high/MMRd rectal cancer treatment guidelines are being re-written. A brief synopsis of why treatment guidelines are changing so quickly in this space.Also, listeners helped out in explaining the ribociclib storage & stability change. Hint: https://www.novartis.com/news/novartis-implements-manufacturing-adjustments-ribociclib-ensure-alignment-latest-regulatory-standards-ebc-end-q2
FDA has been busy the last week approving:-ribociclib x 3 years in high risk stage II & III breast cancer based on the NATALEE trial as well as a new storage requirement-osimertinib indefinitely following chemoradiation in stage III EGFR-mutated NSCLC-amivantamab + chemotherapy following progression on osimertinib (Mariposa-2)-a subcutaneous formulation of atezolizumab-isatuximab + VRD for multiple myeloma-pembrolizumab + chemotherapy for metastatic pleural mesothelioma
Recapping just some of the notable data coming out of ESMO 2024:-Final OS results from Keynote-522 (perioperative pembrolizumab in TNBC)-AMBASSADOR (adjuvant pembrolizumab in bladder cancer) -NIAGRA (perioperative durvalumab in bladder cancer)-ADRIATIC (discussed on ASCO recap Pod, but publication now available)-LEANOX (impact of lean body mass adjustment on oxaliplatin dose)
LMS04 final OS results are published for doxorubicin + trabectedin in Leiomyosarcoma. Plus, a natural experiment of what happens in small cell lung cancer during an IV etoposide shortage. Finally, a nice paper provides some examples of how oncology pharmacists can bridge the care gap between oncology and primary care.LMS04: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2403394IV etoposide shortage: https://doi.org/10.1200/OP.24.00394Primary care - oncology pharmacy collaboration: https://doi.org/10.1177/10781552241279303
This is chapter 1 of a keynote address from summer 2024 on putting together the pieces of oncology pharmacy - with an emphasis on how our knowledge of drug dosing changes with time.Video/slides available at YouTube: https://youtu.be/1Oae8AV5Af4
We all know we aren't supposed to make cross-trial comparisons, but it happens anyway. So, let's compare FLARUA2 (osimertinb + chemo) and the newly FDA-approved MARIPOSA regimen (lazertinib + amivantamab) to see what we can (and can't) take away from such a dangerous cross-trial comparison.
A mixed bag of Phase III results for using olanzapine with moderately emegotenic chemotherapy (MEC).Inui, et al: https://doi.org/10.1200/JCO.24.00278Ostwal, et al: doi:10.1001/jamanetworkopen.2024.26076
A new cellular therapy is approved for synovial sarcoma and the anticipated approval has occurred for the dual IDH1/IDH2 inhibitor, vorasidenib.
FDA appears to change its stance on evaluating perioperative (adjuvant followed by neoadjuvant) ICI study designs in NSCLC.Also, a simple blood test is approved to detect colorectal cancer, but there are several limitations compared to colonoscopy.
Did you know high-dose chemotherapy with autologous stem cel rescue was a "standard" breast cancer treatment ~30 years ago? This story involves changing practices based on Phase II data and outright clinical trial fraud, and retractions of publications.On-site review of Bezwoda study: https://doi.org/10.1016/S0140-6736(00)90024-2Oral History: https://cancerhistoryproject.com/institutions/nccns-bob-carlson-talks-about-the-day-he-stormed-out-of-a-meeting-with-transplanters/
Reflections from vacation on 1) How similar the chef training experience on The Bear mirrors some pharmacy residency training and 2) being a resource to family/friends with oncology questions.
Running through recent updates on epcoritamab, adagrasib + cetuximab for colorectal cancer, endometrial cancer, adjuvant dabrafenib/trametinib melanoma follow-up data, and topical capsaicin for delayed CINV.Also, a brief travelogue on my inaugural trip to ATOPP (advanced topics for oncology pharmacy professionals) Summit.
The MARIPOSA study suggests there may be a new preferred first line regimen (amivantamab + lazertinib) for metastatic EGFR-mutated NSCLC, as this regimen improved PFS compared to osimertinib.
An experimental regimen for DLBCL piques my interest.VenetoclaxibrutinibPrednisoneObinutuzumabRevlimid (lenalidomide)Link: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2401532
A new drug is approved for MDS. While some will likely benefit from this new agent, the more enticing news is that inhibiting telomerase may be an attractive target for many malignancies.
Lots and lots of updates from the past weekend's ASCO annual meeting.1. ADRIATIC (consolidation durvalumab in limited stage SCLC)2. NADINA (neoadjuvant Nivo/Ipi in stage III melanoma)3. *NICHE-2 (neoadjuvant Nivo/Ipi in dMMR colon cancer)4. CheckMate 8HW (Nivo/Ipi in dMMR metastatic colon cancer)5. TRANSMET (liver transplantation in colon cancer with liver mets)6. Eposec (FLOT > CROSS in adenocarcinoma of the esophagus)7. LAURA (forever osimertinib in stage III EGFR-mutated NSCLC post-chemoRT)8. CROWN (5 year update of lorlatinib in ALK+ NSCLC)9. Destiny Breast-06 (T-DXd vs. chemo in HER-2 low and "ultra" low MBC who haven't received chemo in metastatic setting)10. ASC4FIRST (Asciminib first line in CML. Funny title, amirite?)
ASCO & ONS (along with pharmacist representation) released updated safety standards for preparing, administering, and monitoring chemotherapy. Look for a calendar invitation to review your site's policies soon.Link: https://doi.org/10.1200/OP.24.00216
A new drug for small-cell lung cancer, a bispecific, targeting DLL3 on small-cell lung cancer and CD3 on T-cells is FDA approved. But, infigratinib's FDA approval for cholangiocarcinoma is withdrawn.
QT interval prolongation is a common hurdle to taking care of cancer patients. We dive into what QT interval prolongation is, why it matters, risk factors, and prevention/management strategies.
The non-Award Winning series of Landmarks in OncoPharm returns to discuss a Next Big Thing in NHL that wasn't any better than plain old CHOP.From April 1993, it's Pro-MACE-CytaBOMLink: https://www.nejm.org/doi/full/10.1056/NEJM199304083281404
Tisotumab vedotin garners a regular FDA approval for metastatic cervical cancer with OS benefit data.A lingering question that demands a focused RCT: What is the optimal dose of methotrexate in primary CNS lymphoma? I'm glad I'm not the only one with this question: https://doi.org/10.1177/10781552231176754What, some BRAF mutations in colorectal cancer might respond to EGFR-mab therapy? https://doi.org/10.1200/OP.21.00160
Lots of recent updates to cover this week...1. Adjuvant pembrolizumab of RCC demonstrates OS improvement in NEJM publication (DOI: 10.1056/NEJMoa2312695)2. Yet adjuvant nivolumab did not demonstrate OS improvement in the adjuvant setting. There may be a few reasons for this (https://doi.org/10.1200/JCO.2024.42.4_suppl.LBA358)3. A cytokine-fusion protein, nogapendekin alfa inbakicept, is approved for intravesicular use in BCG-unresponsive bladder cancer. This agent appears to activity in NSCLC too...4. The Phase II APPLE trial provides some evidence than deferring osimertinib to the second-line setting in metastatic EGFR-mutated NSCLC may yield similar OS to first-line use of osimertinib. (https://doi.org/10.1200/JCO.23.01521)5.The METALLICA study provides a nice roadmap for empiric metformin use when starting alpelisib (https://doi.org/10.1016/j.eclinm.2024.102520)6. Does CPX-351 cause less intestinal damage than 7 + 3? And could that explain the discordance between time of neutropenia and infection rates? A mouse model suggests yes. (https://doi.org/10.1200/jco.2017.77.6112)
What I learned (or relearned?) at HOPA's 2024 Annual Conference: updates in Neuro Oncology, fedratinib toxicity, and bispecific antibodies in multiple myeloma.Also, fam-trastuzumab deruxtecan (T-DXd) garnered a site-agnostic approval for HER2 amplified solid tumors.Finally, the ALINA study, adjuvant alectinib in ALK+ NSCLC, was published in this week's NEJM.
Tumor Lysis Syndrome (TLS) is a foundational topic for all oncology clinicians. We discuss the what, the why, prevention, and treatment.
Discussing four papers that caught our eyes from the last few weeks:Pazopanib vs. placebo following metastatectomy. Always concerning when placebo has an OS advantage.ECOG-ACRIN E2810: https://doi.org/10.1200/JCO.23.01544Gemcitabine vs. Gem + Paclitaxel (Taxol) in pancreatic cancer patients after FOLFIRINOX: https://doi.org/10.1200/JCO.23.00795An RNA assay to predict gemcitabine sensitivity: https://doi.org/10.1200/JCO.22.02668Management of skin cancers with ICIs in kidney transplant patients: https://doi.org/10.1200/JCO.23.02570
Two recent publications suggest more people may be choosing non-colonoscopy screening practices in the future. One is a new stool DNA test, while the other is a blood test.How do they compare to the gold standard of colonoscopy?Cell-free DNA blood test: DOI: 10.1056/NEJMoa2304714Next generation stool DNA test: DOI: 10.1056/NEJMoa2310336
EV-302 is finally published, and you have to squint to find any major critiques. Enfortumab bedouin + pembrolizumab fully arrives as a standard 1st-line regimen of advanced urothelial cancer.Also, nivolumab gets a 1st-line FDA approval for urothelial carcinoma in conjunction with cisplatin + gemcitabine based on CHECKMATE-901.
Two nice studies have been recently published in the supportive care realm.SPARED asks if we can omit dexamethasone on days 2-4 following cisplatin-based chemotherapy.D-TORCH asks if topical diclofenac can prevent capecitabine-induced hand-foot syndrome.SPARED: https://doi.org/10.1038/s41416-023-02493-7 D-TORCH: https://doi.org/10.1200/JCO.23.01730
An exciting new cellular therapy, lifileucel, is approved for metastatic melanoma. The FLAURA2 trial of osimertinib + chemotherapy has led to an FDA approval, but questions remain about a possible new standard of care. And a few minor updates on tepotinib.
New updates on metastatic pancreatic cancer (NAPOLI-3), upper tract urothelial cancer (POUT), and the drug-drug interaction between ivosidenib and azole antifungals.NAPOLI 3: https://doi.org/10.1016/S0140-6736(23)01366-1POUT (final OS): https://doi.org/10.1200/JCO.23.01659Ivosidenib Azole Antifungal DDIs: https://doi.org/10.1002/cncr.35251
You know about small cell lung cancer, but let's talk about small cell carcinoma of the prostate.
In oncology we are always asking questions about which treatment option is best. And that focus on the next best treatment may prevent us from rethinking some fundamentals of current practice. Three recent studies illustrate this and made me ask:Do we need a Port or PICC for every testicular cancer patient?Study: https://doi.org/10.1200/OP.23.00580Editorial: https://doi.org/10.1200/OP.23.00730Is vaginal estrogen safe if breast cancer patients?Study: https://jamanetwork.com/journals/jamaoncology/article-abstract/2811413Does paclitaxel work differently than we always thought?Study: https://doi.org/10.1371/journal.pbio.3002339
...on FDA approvals for belzutifan for RCC, pembrolizumab + cisplatin/RT for cervical cancer, erdafitinib (FGFR3 alterations only) for bladder cancer.Plus, early morning ICIs (https://doi.org/10.1016/j.ejca.2024.113571)&FLAG-Ida-GO in AML from NCRI AML 19 (https://doi.org/10.1200/JCO.23.00943)
Special guest Ryan Beechinor joins the pod to discuss his recent paper on the obstacles in the development of generic lenalidomide. It's a fantastic read, and this episode will be a fantastic listen!Link: https://doi.org/10.1016/j.jcpo.2023.100446
Foundations of OncoPharm episode on lenalidomide (Revlimid) and its MOA, use, dosing, & toxicity.
A Holiday Tradition returns as we review 14 new OncoPharm drugs approved this past year and ask Keep, Re-Gift, or Return.
Small bites of updates coming out of ASH's 2023 annual meeting on CLL, multiple myeloma, and lymphoma.
Our Landmarks of OncoPharm series returns to talk about 2008's VISTA study, which ushered bortezomib into the front line setting, albeit with a now outdated alkylating agent-based backbone.VISTA (VMP vs. MP): https://www.nejm.org/doi/full/10.1056/nejmoa0801479
The recent approval of nirogacestat, the first gamma secretase inhibitor on the market, provides a great opportunity to discuss desmoid tumors and Notch signaling.Review article: https://doi.org/10.1002/onco.13627Also, a new T-cell malignancy warning for most CAR-T products. And, is belantamab mafodotin coming back based on the DREAMM-7 results?
FDA has approved two new kinase inhibitors: one for ROS1 (+) NSCLC and one for PIK3CA/AKT/PTEN altered breast cancer.
This week's Pod dives into a new VEGF-R inhibitor, fruquintinib. We also ask if FLAURA2, osimertinib + chemotherapy in combination, will become a new standard of care in EGFR-mutated metastatic NSCLC.
Aggressive hematologic malignancy publications can be challenging to interpret and translate to clinical practice.We look at two recent studies to illustrate this point. Elderly AML: 10-day decitabine vs. 7 + 3 (https://doi.org/10.1016/S2352-3026(23)00273-9)Burkitt Lymphoma: R-CODXO-M/R-IVAC vs. DA-R-EPOCH (https://doi.org/10.1016/S2352-3026(23)00279-X)
Out Landmarks of OncoPharm series returns to chronicle how treatment of stage III NSCLC has changed over time with an overview of three studies.1. Dillman (1990) NEJM (sequential chemo --> RT): https://doi.org/10.1056/nejm1990100432314032. Albain (1995) JCO (concurrent cisplatin/etoposide + RT): https://pubmed.ncbi.nlm.nih.gov/?term=76365303. Albain (2009) Lancet (concurrent cis/etposide + RT --> surgery --> consolidation chemo): https://doi.org/10.1016/s0140-6736(09)60737-6
Lots of practice changing new information came out of last week's ESMO conference.This Pod is packed with updates on NSCLC, bladder cancer, gastric cancer, medullary thyroid cancer, KRAS G12C colorectal cancer.....and even bendamustine (non-ESMO update).
This week we discuss the continued push to introduce 2nd generation androgen inhibitors earlier into treatment with the EMBARK trial.Nivolumab and pembrolizumab, pemrolizumab and nivolumab. Again and again. Their role (and approvals) for adjuvant melanoma make sense. But what to think about their use for NSCLC in the neoadjuvant setting?West commentary: https://dailynews.ascopubs.org/do/should-induction-chemoimmunotherapy-lead-us-broaden-our-definition-resectability-nsclc
Encorafenib + binimetinib gets FDA-approval for metastatic NSCLC, but how does it compare to dabrafenib/trametinib? Plus, a new pediatric approval for dabrafenib/trametinib means more dosage form options.
Trying to make sense of the limited information put out via Press Release the last 2 weeks for mobocertinib, pembrolizumab + enfortumab vedotin, nivolumab, and more.
From the Foundations of OncoPharm archives - the history and groundbreaking STI 571 (imatinib).
It's another Landmarks of OncoPharm episode looking at the carboplatin-paclitaxel regimen in ovarian cancer from 20 years ago.carboplatin/paclitaxel vs. cisplatin/paclitaxel: https://pubmed.ncbi.nlm.nih.gov/?term=37643542
An experimental drug for EGFRm NSCLC, patritumab deruxtecan (HER3-DXd), raises some eyebrows and a new agent is FDA-approved for hematopoietic stem cell mobilization (motixafortide).
You read it in every solid tumor paper - RECIST - criteria. This Pod discusses some of the details of the Response Evaluation in Solid Tumors (RECIST) criteria along with the pros and cons of its use - including a modification of the criteria for use with immunotherapy.
Empiric dose reductions for variant DPYD alleles isn't necessarily new, but the outcomes of patients treated with those dose reductions isn't well described. Dutch researchers provide some much needed evidence.Link: https://pubmed.ncbi.nlm.nih.gov/?term=37639651Is there a role for ICIs in dMMR/MSI-h pancreatic cancer? This retrospective says, uh maybe probably.Link: https://pubmed.ncbi.nlm.nih.gov/?term=37625102
A Foundations of OncoPharm episode on nab-paclitaxel, with a focus on the pharmaceutical differences from conventional paclitaxel.
A combination product is now available of niraparib + abiraterone for use in mCRPC.
Another BCMA-CD3 agent is approved for r/r multiple myeloma and melphalan hepatic arterial infusion for metastatic uveal melanoma is approved.
Talquetamab is approved for r/r multiple myeloma and the STOP-CA trials asks if atorvastatin can prevent anthracycline cardiotoxicity.
STOP-CA: https://jamanetwork.com/journals/jama/fullarticle/2807988
The Ruby trial leads to an FDA approval for dostarlimab + chemo in advanced/recurrent endometrial cancer, but only dMMR/MSI-H patients.
Quizartinib's label and REMS program provide some clear, but concerning, warnings about its toxicity.
By listener request! What is BCOP, why pursue it, and some simple tips on studying for the exam.
A Landmark of OncoPharm from 2004: FOLFIRI --> FOLFOX or FOLFOX --> FOLFIRI.
Some interesting dosing to discuss in this study.
Link: https://pubmed.ncbi.nlm.nih.gov/?term=37379692
We welcome Dr. Donald Harvey to the podcast to discuss Phase 1 clinical trials in oncology. Topics include goals of Phase 1 trials, how these early studies are conducted, how doses are determined, and some limitations of current practices.
We welcome Jacqueline (Jackie) Saunders to the podcast to talk about investigational drug services (IDS) in oncology and how pharmacists manage the storage, preparation, & delivery of experimental drugs.
This episode... More evidence to support the use of neoadjuvant ICI/chemo in stage III NSCLC to obtain pCR published this week with NADIM II.
Time to rethink giving ICI/TKI combination therapy to favorable-risk metastatic RCC patients? (Finally, I'm not the only one saying this anymore.)
NADIM II: https://www.nejm.org/doi/full/10.1056/NEJMoa2215530 FDA Pooled Analysis Favorable Risk metastatic RCC: https://doi.org/10.1016/j.eururo.2023.05.030
This week's Pod looks at the 2nd CD20-CD3 bispecific T-Cell engager approved this year (or at all), glofitamab, and the TALAPRO-2 study of combining talazoparib to enzalutaimide.
TALAPRO-2: https://doi.org/10.1016/S0140-6736(23)01055-3
We highlight notable data from this month's ASCO annual meeting.
- SONIA: sequence (1st or 2nd-line) CKD 4/6i in MBC
- ADAURA OS results and low rate of osimertinib use in control arm
- Keynote 671: perioperative pembrolizumab in NSCLC
- PROSPECT: Can radiation therapy be omitted in locally advanced rectal cancer?
- Nivo-AVD vs. Bv-AVD in stage III Hodgkin's (ages 12+)
- ZUMA-7: 2nd line Axl-Cel OS benefit in aggressive NHL (early relapse/refractory disease)
- CARTITUDE-4: Cilta-Cel earlier in MM treatment
Olaparib + Abiraterone is FDA approved for mutated-BRCA prostate cancers. Olaparib has a bit of convoluted story to unpack in this patient population.Have we finally found a way to minimize the peripheral neuropathy from paclitaxel.....with cilostazol?PROpel: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200043Cilostazol RCT: https://doi.org/10.1002/phar.2830Cilostazol effect on Schwann cells: https://doi.org/10.1016/j.neuropharm.2021.108514
We discuss the newly approved CD20-CD3 T-cell engager for subcutaneous (SC) administration to treat DLBLC after 2 or more lines of therapy.
A recent paper serves as a good prompt to discuss trimodality treatment for muscle-invasive bladder cancer and the data supporting its use.Zlotta et al: https://doi.org/10.1016/S1470-2045(23)00170-5
Today's Pod discusses...1) A large trial comparing 4 different CLL treatments GAIA-CLL13: https://www.nejm.org/doi/full/10.1056/NEJMoa22130932)Adding Cabozantinib + Nivo/Ipo vs. Nivo/Ipi in intermediate/poor risk mRCCCOSMIC-313: https://www.nejm.org/doi/full/10.1056/NEJMoa22128513) A potential future biomarker for predicting response to PD-(L)1 targeted therapiesFunctional PD-1/PD-L1 Engagement: https://pubmed.ncbi.nlm.nih.gov/?term=36821809
Talking 3rd-line treatment of metastatic colon cancer. Tipiracil-trifluridine + bevacizuamb vs. tipiracil-trifluridine alone. And a bit on the theory of "bevacizumab beyond progression."SUNLIGHT: https://www.nejm.org/doi/full/10.1056/NEJMoa2214963
Quizartinib vs. Placebo(?) + Chemo in newly diagnosed AML. We add a bit of context about quizartinib's history leading up to this study preview possible role in therapy if approved in the future.Link: https://doi.org/10.1016/S0140-6736(23)00464-6
We take a peak at an intriguing study (n = 29) that gave some metastatic RCC patients receiving nivolumab + ipilimumab a supplement of a bacterium (n = 19) and a control group. We discuss what to look for in the future studies that are likely to follow with similar methods.
The Landmarks of OncoPharm series returns to discuss NSABP's B18 story of neoadjuvant vs. adjuvant AC in stages I & II breast cancer from 1998.B18: https://pubmed.ncbi.nlm.nih.gov/?term=36989610Flashback Flashforeward: https://pubmed.ncbi.nlm.nih.gov/?term=36989608
Lots of updates:Olanzapine increases weight gain, QOL in some advanced cancer: https://pubmed.ncbi.nlm.nih.gov/?term=36977285Chemotherapy Toxicity - When Less is More: https://www.nejm.org/doi/full/10.1056/NEJMcibr1202395Pembro + Chemo improves PFS > chemo alone in advanced endometrial cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa2302312Enfortumab vedotin + pembrolizumab gets an accelerated approval for cisplatin-ineligible patients with urothelial carcinoma. Safety signals seen.
With new Pod this week, we're re-releasing the 2nd episode from way back in 2017 that provides a historical overview of how the use of EGFR TKIs changed from their use in all NSLCLC to only with activating mutations.
Not that you always need extended gram positive coverage, but if you did...As is often the case with this Pod, this is mostly providing historical context.Link: https://doi.org/10.1086/500139
Prompted by a recent JCO review article (link below), it seemed like a good idea to discuss risks of ovarian dysfunction in women of childbearing potential, what drugs have the highest risk, and fertility preservation techniques.Review article: https://pubmed.ncbi.nlm.nih.gov/?term=29620997Cyclophosphamide dose equivalent calculator: https://www.oncofertilityrisk.com/CED.html
We review a clever study looking at neoadjvuant & adjuvant pembrolizumab vs. only adjuvant pembrolizumab in melanoma.Link: 10.1056/NEJMoa2211437We also discuss some updates on abemaciclib and osimertinib
Landkarmks of OncoPharm: Dose-Adjusted EPOCH (+ R)This episode focuses on the pharmacodynamic rationale for the protocol and delivery, not so much the details of the literature supporting its use.Wilson et al 2002, Blood: https://doi.org/10.1182/blood.V99.8.2685
Cannabinoids appear to impact immune system function, so could cannabis use blunt the effect of immune checkpoint inhibitors? I don't know, brah. Maybe?Review: https://pubmed.ncbi.nlm.nih.gov/?term=35749680Cannabis associated with poorer ORR: https://doi.org/10.1634/theoncologist.2018-0383Cannabis associated with poorer TTP & OS: https://doi.org/10.3390/cancers12092447
Ide-Cel vs. "standard" treatment in relapsed/refreactory multiple myeloma study - the KarMMa-3 trial - is discussed.Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2213614
CodeBreak200: docetaxel vs. sotorasib in 2nd-line metastatic NSCLC (KRAS-G12C). A new safety signal emerges.https://doi.org/10.1016/S0140-6736(23)00221-0 A new survival prediction model for elderly patients with AML not receiving intensive therapy.https://doi.org/10.1002/cncr.34609
First - despite what you'll hear - it is pirTobrutinib, not pirobrutinib.Second - lots of great information on the current state of targeted therapies in adjuvant NSCLC and on two exciting new drugs: elacestrant and pirtobrutinib.
Tucatinib's FDA-approval (with trastuzumab) for HER2 amplified metastatic colorectal cancer launches a new era of targeted therapy in colorectal cancer.Targeting HER2 (amplified in ~3-5% of advanced colorectal cancers) in colorectal cancer will likely evolve over the coming years, so a brief history on how it has evolved so far may be helpful.
The Landmarks in OncoPharm series returns to discuss adjuvant interferon in melanoma.ECOG 1684: https://pubmed.ncbi.nlm.nih.gov/?term=36649675Commentary on E1684: https://ascopubs.org/doi/abs/10.1200/JCO.22.02354
Broad, big picture overview of breast cancer and its treatment.Ambitious.Do not recommend listening at 1.5x
New Year - New Drug, mosunetuzumab (a CD3-CD20 T-cell engager) is approved for r/r Follicular Lymphoma.And an intriguing retrospective cohort study found a higher rate of neutropenia with same-day pegfilgrastim in patients receiving dose-dense AC. Link: https://doi.org/10.1177/10781552221148116
This gift-giving season, we ask whether we want to Keep, Re-gift, or Return new oncology drugs approved this past year.
The FDA's pilot program, project renewal, uses capecitabine for its first label makeover. What's new & what are the possible implications of the DPYD warning now in the prescribing information?
Thought on:Double Dauno, but they said it better --> (https://open.spotify.com/episode/0eHEl3bUdZdg3mynUiNMG6?si=88cdab4b882e4667)Blinatumumab FTWThe end of "the" neutropenic diet?
Tumor-Infiltrating Lymphocytes (TILs) getting closer to entering practice.Updated survival results published from DESTINY-Breast03 (T-DXd vs. T-DM1).A new IDH1 inhibitor, olutasidenib, is FDA-approved for relapsed or refractory AML.
Recent voluntary withdrawals from the US market of belantamab-mafodotin and atezolizumab's indication for bladder cancer have us weighing (again) the pros & cons of the accelerated approval program.Also, FDA approves the 1st fecal transplant product.
We review the 5-year update of CheckMate 227 and the POSEIDON to generate the hypothesis that CLTA-4 inhibition has a role in PD-L1 negative metastatic NSCLC.
CM 227 update: https://pubmed.ncbi.nlm.nih.gov/?term=36223558 POSEIDON: https://pubmed.ncbi.nlm.nih.gov/?term=36327426 Editorial: https://pubmed.ncbi.nlm.nih.gov/?term=36331243
The International Nonproprietary Names (INN) unit from WHO decided to drop the -mab suffix from new drug names. Instead, -tug, -bart, -ment, and -mig will be used. We have some thoughts.
INN Report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122354/#
New Drug Approvals! -Tremelimumab, the 2nd CTLA-4 inhibitor, finally gets approved. -Teclistamab, an excited BCMA-CD3 T-cell engager for multiple myeloma.
Landmarks of OncoPharm episode on maintenance pemetrexed in NSCLC.
Switch maintenance: https://doi.org/10.1016/s0140-6736(09)61497-5 Continuation maintenance (PARAMOUNT): https://doi.org/10.1016/S1470-2045(12)70063-3
We discuss a phase I study (CALM) of an allogeneic anti-CD19 CART-T product, using aprepitant (?) for pruritis from EGFR TKIs, and the widely discussed NordICC study on colonoscopy screening.
CALM: https://doi.org/10.1016/S2352-3026(22)00245-9 Aprepitant vs. desloratidine: https://doi.org/10.1002/cncr.34474 NordICC: https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 NordICC editorial: https://www.nejm.org/doi/full/10.1056/NEJMe2211595
A new FGFR inhibitor, futibatinib, is approved.
Is ESR1 mutation monitoring the next thing in HR+ metastatic breast cancer? The PADA-1 trial offers insight.
What the heck is GPRC5D (rhymes with CAR-T)?
PADA-1: https://doi.org/10.1016/S1470-2045(22)00555-1
GPRC5D CAR-T in Myeloma: https://www.nejm.org/doi/full/10.1056/NEJMoa2209900
Sodium thiosulfate is now FDA-approved to minimize the risk of ototoxicity in some children receiving cisplatin.
Selpercatinib is granted a 'regular' approval for RET-fusion (+) NSCLC and an accelerated approval for other solid tumors.
ESMO 2022 is wrapped and two studies in particular have caught our eyes: NICHE-2: neoadjuvant Nivo/Ipi in MMR-d colon cancer CODEBREAK: sotorasib vs. docetaxel
Updates on billiary track cancer - a role for durvalumab?
And pemigatinib - an approval in r/r myeloid/lymphoid neoplasms.
Plus, an oral suspension of ibrutinib is approved and more evidence ICI combination should be given early in BRAF-mutated metastatic melanoma (rather than waiting until disease progression on TKIs)
The Landmarks of OncoPharm series return to discuss the now standard-of-care temozolomide + RT for glioblastoma multiforme (GBM)
Stupp et al: https://www.nejm.org/doi/full/10.1056/NEJMoa043330
Effect of MGMT (the gene, not the band) on temozolomide effect (from the same NEJM issue) referenced, thought not discussed in this episode: https://www.nejm.org/doi/full/10.1056/NEJMoa043331
Dr. Amir Ali joins the Pod to cover the Foundations of OncoPharm on asparaginase products
In light of trastuzumab deruxtecan's approval for HER-mutated NSCLC, it's worthwhile to look back at the history of HER-targeted therapy in NSCLC and why/how targeted HER-mutated disease will affect practice.
New OS data is out for adjuvant atezolizumab in NSCLC - how does it compare to the original DFS data?
Plus, lots of recent FDA expanded approvals to discuss.
An infamous study that led to a drug approval of limited benefit, but still made its way into an episode of Better Call Saul.
Erlotinib + gemcitabine vs. gemcitabine: https://doi.org/10.1200/jco.2006.07.9525
Several recent large trials just released long term follow-up results on overall survival. We look at what how treatment principles may change based on these mature data.
ECHELON-1 - Hodgkin's (A+AVD vs. ABVD) POLO - Pancreatic (olaparib maintenance vs. placebo) Keynote 355 - mTNBC (pembrolizumab + chemo vs. chemo) APHinity - adjuvant HER+ breast (pertuzumab/trastuzumab vs. trastuzumab) E1912 - CLL (ibrutinib/rituximab vs. FCR)
Discussion with a Lupus Nephritis patient (and Pharm.D. student) about manifestations and treatments of SLE and Lupus Nephritis.
Sifting through and summarizing lots of data on concomitant use of ICIs and PPIs.
Suggested readings: 1. All the drugs: https://pubmed.ncbi.nlm.nih.gov/33154150/ 2. Pooled atezolizumab study: https://pubmed.ncbi.nlm.nih.gov/35183773/ 3. Clostridium butyricum may be a thing: https://pubmed.ncbi.nlm.nih.gov/35655708/ 4. AKI risk: https://doi.org/10.21873/invivo.12570 5. Is this all noise?: https://pubmed.ncbi.nlm.nih.gov/35280736/ 6. Abx & PPIs: https://doi.org/10.3389/fimmu.2021.716317
Acetaminophen (or paracetamol) & immune checkpoint inhibitors are ubiquitous in oncology practices. So, when new translational research suggests APAP may decrease the effectiveness - well that seems like something worth talking about.
Impact of acetaminophen on the efficacy of immunotherapy in cancer patients: https://doi.org/10.1016/j.annonc.2022.05.010
Hepatotoxicity risk factors with ICIs: https://doi.org/10.1097/cji.0000000000000347
Febrile neutropenia updates on...
Short duration antibiotics: https://doi.org/10.1016/S2352-3026(22)00145-4
Same-day pegfilgrastim: https://doi.org/10.2217/fon-2022-0365
Maya Leiva, PharmD, BCOP joins the Pod once again this Pride month to give us some LGBTQ clinical pearls on carboplatin dosing in trans patients and pregnancy/teratogenicity chemo counseling.
LGBT Cancer Network: https://cancer-network.org
Maya Leiva, PharmD, BCOP joins the Pod for Pride to give an overview of cancer screenings in the transgender population.
Looking at some interesting articles as possible predictors of what to expect next in NSCLC and AML.
NADIM: https://pubmed.ncbi.nlm.nih.gov/?term=35576508
Ven + Intensive Chemo: https://doi.org/10.1016/S2352-3026(22)00100-4
The Landmarks of OncoPharm series returns to discuss 2 landmark studies (and 1 editorial) in head & neck cancer.
Editorial: https://ascopubs.org/doi/pdf/10.1200/JCO.22.00274
EUORTC Study: https://www.nejm.org/doi/full/10.1056/NEJMoa032641
Intergroup Study: https://www.nejm.org/doi/full/10.1056/NEJMoa032646
Treatment-free remission (TFR) rates in CML of close to 80% have recently been described (https://doi.org/10.1002/ajh.26550).
The AGILE study. If you can't say anything nice.
Checking back in on CHECKMATE 816 (neoadjuvant Nico-Chemo in NSCLC) and Keynote-177 (pembrolizumab in MSI-H/dMMR colorectal cancer).
Catching on recent FDA approvals on relatlimab/nivolumab (it's relatLimab not relatimab) as well as Lu-PSMA-177 based on the VISION trial.
Open up your Yelp app and check out Leukemia Pharmacist & Boston denizen Jessie Signorelli's recommendations for eating, drinking, & sight seeing in Boston.
Also, great educational programming awaits!
We look at two recent studies that illustrate a framework for how we identify risk factors and possible predictors of chemotherapy toxicity.
Paclitaxel and skeletal muscle mass: https://doi.org/10.1111/bcp.15244
Sex differences of toxicity risk: https://doi.org/10.1200/jco.21.02377
Results from VESPER are now published, so we revisit neoadjuvant ddMVAC and its place as SOC in bladder cancer. Nivolumab nets a new approval with chemo for neoadjuvant treatment of NSCLC. A new CAR-T product is approved for multiple myeloma.
The Landmarks of OncoPharm series returns to discuss the origins of "7 + 3"
7 + 3 > 5 + 2: https://doi.org/10.1182/blood.V58.6.1203.1203
We discuss the evolution of metastatic prostate cancer treatments leading up to last week's publication of ARASENS.
Also, PROPEL and MAGNITUDE hint at an earlier role in therapy of PARP-inhibitors in prostate cancer. Maybe.
Foundations of OncoPharm: BCG and its fascinating history and role in non-muscle invasive bladder cancer.
History of BCG: https://pubmed.ncbi.nlm.nih.gov/17997439/
This week we hype the seemingly negative impact of KIR2DS1/HLA-C2/C2 genotype on rituximab benefit in aggressive lymphomas.
We also cover updates in breast cancer (pembrolizumab in TNBC; AIs in pre-menopausal women) and cervical cancer (cemiplimab).
KIR & Rituximab: https://doi.org/10.1016/S2352-3026(21)00369-0
Keynote-522 Update w/ EFS analysis: https://www.nejm.org/doi/full/10.1056/NEJMoa2112651
Premenopausal Breast Cancer AIs vs. Tam Meta-Analysis: https://doi.org/10.1016/S1470-2045(21)00758-0
Cemiplimab in cervical cancer: https://www.nejm.org/doi/full/10.1056/NEJMoa2112187
We quickly cover some of the ASCO GI highlights from a couple weeks ago and delve deep into the role of ICIs in metastatic esophageal caner. Finally, does tebentafusp's approval tell us anything about the future intersection of immunotherapy and precision medicine?
Dr. Howard McLeod joins the pod to talk Precision Medicine and the role pharmacists can play using pharmacogenomics and tumor genomics in cancer care.
https://www.drhowardmcleod.com
Topic covered include the latest updates to the seminal Hallmarks of Cancer work, adjuvant pembrolizumab for stage IIB/IIC melanoma, a prospective study of UGT1A1 testing, and Keynote-775.
Hallmarks of Cancer: New Dimensions. https://cancerdiscovery.aacrjournals.org/content/12/1/31
UGT1A1 Genotype-guided dosing of irinotecan: https://doi.org/10.1016/j.ejca.2021.12.009
Keynote-775: https://www.nejm.org/doi/full/10.1056/NEJMoa2108330
We're joined by Dr. Ryan McDade to hear about working as a Clinical Pharmacy Lead for Humana Specialty Pharmacy.
Reviewing some big news from ASH21 concerning DLBCL that has us asking, "the more the change, the more R-CHOP remains the same?" Also, we talk CAR-T (ZUMA-7 & BELINDA), sotorasib, a possible way to predict poor response to ICI (HLA-A*03), and Evusheld as a possible way to protect those patients destined to a poor vaccine response from COVID.
The 2nd episode in our Career Paths series features Dr. Morgan Randolph. She gives great insight into her role as pediatric oncology pharmacist and the choice between a PGY2 in Pediatrics or Oncology for those considering that decision.
Lots of updates to discuss from dasatinib dosing to ICI/TKI sequencing in BRAF-mutated metastatic melanoma to adjuvant chemo in node (+) breast cancer to some FDA approval updates.
Discussing one of the more intriguing studies of the year looking at whether metastatic melanoma survival is effected by what time of day immunotherapy is administered.
Link: https://doi.org/10.1016/S1470-2045(21)00546-5
What is a medical science liaison (MSL) and what do they do? Our 1st episode in a series highlighting different career options for oncology pharmacists featuring Dr. Christan Thomas.
From IMPOWER 010 to NIFTY to CONFIRM to SOLO, there's lots to discuss on this episode.
Adjuvant atezolizumab for select NSCLC patients now FDA approved.
5-year f/u of olaparib maintenance in mBRCA ovarian cancer smells funny: https://doi.org/10.1016/S1470-2045(21)00531-3
CONFIRM: https://doi.org/10.1016/S1470-2045(21)00471-X
NIFTY: https://doi.org/10.1016/S1470-2045(21)00486-1
Palbociclib-PPI Interaction? https://doi.org/10.1016/j.esmoop.2021.100231
We return to our Landmarks of OncoPharm series to dive deep into an article that provided some of our foundational understanding of how anthracycline cardiotoxicity risk is influenced by rate of administration.
Link: https://pubmed.ncbi.nlm.nih.gov/2910423/
FDA approves 2-years of abemaciclib plus endocrine therapy for high-risk HR+, HER2(-) patients. Quite a bit to discuss about this. Also, FDA expands indications for pembrolizumab (of course) and brexucabtagene autoleucel.
NOTE: A 5cm breast tumor is a T3 lesion, not a T2 as misstated in this episode.
Dr. Ali McBride joins the Pod to spar over same-day vs. next-day pegfilgrastim. (There is some audio feedback early in the Pod that we clean up after a few minutes. Apologies!)
Bibliography: Burris et al: https://pubmed.ncbi.nlm.nih.gov/20808556/ AOC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819939/ McBride et al (CHOP): https://www.futuremedicine.com/doi/10.2217/fon-2021-0532 McBride et al (NHL): https://doi.org/10.18553/jmcp.2021.21010
Lots to discuss from ESMO 2021 to new drug approvals.
First, we discuss the updates in cervical cancer from ESMO (pembrolizumab with chemo) and the newly approved tisotumab-vedotin.
Then, we discuss another new agent, mobocertinib and its scary QT prolongation profile as well as cabo-confusion in thyroid cancer.
Finally, we discuss the potentially practice changing, but preliminary, data from ESMO in bladder cancer (VESPER) and HER2+ MBC (DESTINY-Breast03).
Discussing the updated results after the 2nd randomization of CASSIOPEIA looking at daratumumab maintenance following ASCT.
Link: https://doi.org/10.1016/S1470-2045(21)00490-3
Discussing the use of mycophenolate mofetil (MMF) for ITP (https://www.nejm.org/doi/full/10.1056/NEJMoa2100596) as well as regulatory updates on atezolizumab and zanubrutinib.
Belzutifan, the 1st hypoxia-inducible factor (HIF) inhibitor is FDA-approved. Plus, expanded indication approvals for nivolumab, dostarlimab, lenvatinib/pembrolizumab, & Ivosidenib. Finally, my Top 5 Rolling Stones Songs (14:30).
Looking into the data behind the FDA & CDC's allowance for a booster mRNA vaccine for immunocompromised patients.
A recent patient experience serves as a reminder than TKIs, like cabozantinib, can produce many "minor" toxicities that can really add up and affect QOL.
Two recent publications to discuss:
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The publication of a study discussed on our ASCO '21 Pod on acalabrutinib vs. ibrutinib and patient implications (https://ascopubs.org/doi/pdf/10.1200/JCO.21.01210)
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A good illustration of the "crossing of the curves" and interpreting Kaplan-Meier curves using alloHSCT vs. 5-aza in MDS patients. https://ascopubs.org/doi/pdf/10.1200/JCO.20.02724
Two breast cancer updates (pembrolizumab in TNBC and adjuvant AI duration) and two cGVHD updates (belumosudil and ruxolitinib).
The almost-award winning* Landmarks in OncoPharm series returns to discuss the landmark Armstrong et al 2006 NEJM paper on using intraperitoneal chemotherapy in stage III ovarian cancer.
Link: https://www.nejm.org/doi/full/10.1056/nejmoa052985
*not really
A foundational topic in oncology - managing toxicities of tamoxifen and AI's in breast cancer patients. An excellent evidence-based review was recently published, and is worth our time on the Pod.
Link: https://doi.org/10.1016/S1470-2045(20)30666-5
So-called negative trials still offer information. We discuss ECOG-ACRIN EA1131 in breast cancer and TOURMALINE-MM1 in myeloma in this epidose.
EA1131: https://ascopubs.org/doi/pdf/10.1200/JCO.21.00976 TOURMALINE-MM1 (final OS analysis): https://ascopubs.org/doi/pdf/10.1200/JCO.21.00972
Why is learning oncology so hard? To get the students perspective I ask a few pharmacy students why in hopes of learning how to better teach and precept oncology trainees.
Two new drugs approved in the last week: 1. sotorasib, a drug for a specific KRAS mutation (G12C) in 2nd line metastatic NSCLC 2. infigratinib, basically a "me too" FGFR inhibitor approved for metastatic cholangiocarcinoma
We all discuss the latest adjuvant CHECKMATE study (nivolumab in urothelial carcinoma) and a recent study of seropositivity in cancer patients following COVID vaccination.
Discussing a first of its kind drug, amivantamab, a bispecific (MET & EGFR) monoclonal antibody just approved for advanced exon20 insertion NSCLC (2nd line).
The Foundations of Oncopharm series tackles veneotoclax with special guest, Dr. Kayleigh Marx - clinical pharmacy specialist in leukemia. She tells us everything we need to know and consider when using venetoclax for leukemia patients.
Drug-drug interaction references: 1. https://doi.org/10.1002/jcph.858 2. https://doi.org/10.1016/j.clinthera.2017.01.003 3. https://doi.org/10.1002/jcph.730 4. https://doi.org/10.1007/s12325-018-0793-y
ASCO releases updated guidelines for the dosing of cancer drugs in patients with obesity. Not a ton new from the original guidelines, but worthy of discussion.
Link: https://ascopubs.org/doi/full/10.1200/JCO.21.00471
Two brand new drugs to discuss and their possible roles in practice. Plus, updates on the treatment of HER2-amplified gastric cancer and colorectal cancer.
An abbreviated edition of our Landmarks in #OncoPharm series returns to discuss weekly cisplatin + radiotherapy for locally advanced cervical cancer. As a bonus, we cover a new study establishing FOLFOX as the standard-of-care for 2nd line treatment of metastatic biliary cancer. All of this is discussed against the backdrop of the relative importance (or lack thereof?) of obtaining an approved indication.
First, we review some early evidence of antibody response following COVID vaccination in patients with multiple myeloma and CLL.
Then, we discuss nivolumab's approval with chemo for first-line treatment of gastric cancer (& GEJ & adenocarcinoma of the esophagus) and the MANHATTAN study and its high rate of MRD-negativity in myeloma.
5-yr OS data is published for pembrolizumab in PD-L1 > 50% NSCLC and a new drug is approved for the 1st time while recording the Pod.
Immunotherapy (IO) takes a few steps back as several prior accelerated approvals are withdrawn...with possibly more bad news to come.
Updates on COVID-19 vaccination in cancer patients on immune-checkpoint inhibitors (new data!) and those getting imaging studies after vaccination.
We quickly run through the AMBORO (April 6 published online in J Clin Oncol) trial demonstrating improvements in patient care with the inclusion of a clinical pharmacist (or pharmacologist) in managing PO antineoplastics.
Updates on the use of immune-checkpoint inhibitors in esophageal and gastro-esophageal junction (GEJ) cancers.
First, adjuvant nivolumab (Checkmate 577). Then, pembrolizumab + chemo for initial treatment of metastatic disease (Keynote 590). Also, we mention 2 new approvals for myeloma: the 1st CAR-T for the disease and an expanded indication for isatuximab.
The Landmarks of OncoPharm series returns to discuss 2 pivotal trials that ushered in the age of aprepitant and NK-1 receptor anagonists for CINV.
Aprepitant in HEC: https://ascopubs.org/doi/pdf/10.1200/JCO.2003.01.095
Aprepitant in MEC: https://ascopubs.org/doi/pdf/10.1200/JCO.2005.09.050
Tivozanib's FDA approval for mRCC was a long time in the making, but what is its role?
Disappointing atezolizumab results for adjuvant treatment of bladder cancer (IMvigor-010).
Preliminary data on antibody responses to COVID-19 vaccination in cancer patients.
This week, two indolent lymphoma updates: 1. CAR-T (Axl-Cel) for follicular lymphoma 2. Is there a preferred platinum salt in DHAP for Mantle cell lymphoma* patients heading to transplant? (https://pubmed.ncbi.nlm.nih.gov/33658645/)
*Yes, I know - not really an indolent lymphoma in this case.
Melphalan flufenamide, a drug that makes tumor cell kinetics cool again, is our main topic. Also, brief updates on lorlatinib (ALK+ mNSCLC) and nivolumab/cabozantinib (mRCC).
Topics covered: 1. Trilaciclib's approval to minimize bone marrow suppression 2. Cemiplimab's approval for mNSLC with high PD-L1 expression 3. A brief anti-BCMA CAR-T phase II trial in multiple myeloma 4. Confirmation of enfortumab vedotin's benefit in metastatic bladder cancer 5. More of the same with lenvatinib + pembrolizumab in mRCC
Happy Birthday to a drug that ushered in its own era! We discuss its history and development and just a little bit about its benefit, role, and a few clinical pearls.
Discussing the latest TKI approval, umbralisib, and its familiar toxicity profile. Also, a few final words on a new CAR-T product and a cemiplimab expanded approval.
In light of teptinib's recent FDA-approval for exon-14 skipping MET altered metastatic NSLCC, we compare tepotinib to its predecessor in this space - capmatinib.
With the recent FDA-approval of nivolumab + cabozantinib for metastatic renal cell carcinoma (mRCC, we review Checkmate-9ER results and how they compare to other combination treatments in mRCC. We then end by discussion preliminary recommendations on vaccinating patients with cancer agains COVID-19.
Checkmate-9ER abstract: https://oncologypro.esmo.org/meeting-resources/esmo-virtual-congress-2020/nivolumab-cabozantinib-vs-sunitinib-in-first-line-treatment-for-advanced-renal-cell-carcinoma-first-results-from-the-randomized-phase-iii-checkmate-9er-trial
Discussing recent FDA approvals for expanded indications for trastuzumab-deruxtecan for gastric cancer (based on DESTINY-Gastric01) and SC daratumumab for AL amyloidosis.
DESTINY-Gastric01: https://www.nejm.org/doi/full/10.1056/NEJMoa2004413
Our landmarks of OncoPharm series returns to discuss JBR10, adjuvant cisplatin/vinorelbine in NSCLC.
JBR10: https://www.nejm.org/doi/pdf/10.1056/NEJMoa043623 JBR10 Update: https://pubmed.ncbi.nlm.nih.gov/19933915/ LACE meta-analysis: https://pubmed.ncbi.nlm.nih.gov/18506026/
The 1st episode of 2021 covers 5 FDA updates from December 2020 -Pralsetinib for RET-mutated medullary thyroid cancer -The new HER2-targeting margetuximab -Selinexor and the Boston study -Relugolix, an oral GnRH antagonist -Adjuvant osimertinib approved (ADAURA)
Our Foundations of Oncopharm series returns to discuss the history and use of trastuzumab.
Highlighting some of the bright spots, oncopharm & otherwise, for our Holiday episode. Best new drug? Best study? Best movie to take my mind off of a pandemic? Enjoy this episode with a glass of Holiday Cheer.
COVID-19 Vaccines are here!!! Will they work in patients on chemo? What about immunotherapy? Without firm answers to such questions we might as well talk about mRNA vaccines, the breakout star of 2020.
First up we discuss RxPonder and what it adds to adjuvant treatment of breast cancer in the context of TailoRx.
Then we discuss a recent study (https://jamanetwork.com/journals/jama/fullarticle/2774295)of additional capecitabine following adjuvant chemo in TNBC and what it adds in the context of CREATE-X.
Final OS results are now available for IDEA - 3 vs. 6 months of adjuvant chemotherapy for colon cancer: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30527-1/fulltext
Keynote-177 (pembrolizumab for MSI-H/dMMR metastatic colorectal cancer) was presented at ASCO, but interim results are now published as well: https://www.nejm.org/doi/full/10.1056/NEJMoa2017699
The Landmarks in OncoPharm series returns to discuss the practice-changing CLOT trial of a LMWH vs. a vitamin K antatogist for treating cancer-associated VTE.
CLOT: https://www.nejm.org/doi/full/10.1056/nejmoa025313
Pembro gets an approval for triple negative breast cancer with quite high PD-L1 expression based on Keynote-355 (https://ascopubs.org/doi/10.1200/JCO.2020.38.15_suppl.1000).
Some reassuring information on TKI discontinuation in CML from the LAST study (doi:10.1001/jamaoncol.2020.5774) and an interesting method of identifying predictors of TKI adherence in CML (https://journals.sagepub.com/doi/pdf/10.1177/1078155220970616).
The BELLINI trial of venetoxlax in multiple myeloma was put on hold last year due to increased mortality. It's now published (https://doi.org/10.1016/S1470-2045(20)30525-8), so we take a look at the data and the myriad of supportive care concerns.
Discussing three recent publications: 1. Updated results of Keynote-426 (https://doi.org/10.1016/S1470-2045(20)30436-8) 2. Ph+ ALL tx with dasatinib/prednisone --> blinatumomab (https://www.nejm.org/doi/full/10.1056/NEJMoa2016272) 3. Decitabine + G-CSF to prevent AML relapse following alloHSCT (https://ascopubs.org/doi/pdf/10.1200/JCO.19.03277)
Another month, another 2 expanded FDA-approvals: nivolumab/ipilimumab for malignant pleural mesothelioma and pembrolizumab for relapsed/refractory classical Hodgkin's lymphoma.
Fulvestrant's standard dosing is now 500 mg IM on Days 1, 14, 29 & then monthly thereafter. Its initial FDA-approved doing was half that with no loading dose, 250 mg IM monthly.
So, how did we come to underdose an antineoplastic for almost a decade?
Foundations in #OncoPharm returns to discuss everyone's favorite antineoplastic, dexamethasone, which is also an anti-emetic, and an oncology pre-med among other things.
Another week, another 2 studies of checkpoint inhibitors in NSCLC to talk about.
IMpower 110: https://www.nejm.org/doi/full/10.1056/NEJMoa1917346
Checkmate-153: https://ascopubs.org/doi/full/10.1200/JCO.20.00131
Updates from ESMO 2020 & more on: Bladder Cancer (JAVELIN Bladder 100 & DANUBE) Lung Cancer (ADAURA & CROWN) Breast Cancer (ASCENT, IMPASSION 130/131, monarchE) And the first major publication of drugging the "undrugable" KRAS
The Landmarks in OncoPharm series returns to discuss a major breakthrough in treating advanced prostate cancer, TAX-327, which at the time established docetaxel as a new standard of care for metastatic prostate cancer that was (at that time) considered hormone-refractory.
TAX 327: https://www.nejm.org/doi/full/10.1056/NEJMoa040720
We have a new drug, pralsetinib, to discuss. It's the 2nd RET inhibitor approved for RET-fusion (+) metastatic NSCLC.
After brief diatribes on PO azacitidine and COMBI-AD's 5-year non-OS analysis, we focus on BROCADE3 and the background on BRCA-mutated metastatic breast cancer treatment.
BROCADE3: https://doi.org/10.1016/S1470-2045(20)30447-2
Chemotherapy-induced alopecia is the next in our series on Foundational #OncoPharm topics.
Our Landmarks in #OncoPharm Series returns to discuss ATAC: Anastrozole or Tamoxifen Alone or in Combination for adjuvant breast cancer treatment.
VIALE-A: Veneoxlax + azacitidine, a new standard of care for elderly or unfit AML patients, is now published. Lots of supportive care and management concerns to discuss: tumor lysis syndrome, prophylactic anti-microbials, G-CSF use (?), and dose modification for hematologic toxicity.
Link: https://doi.org/10.1056/nejmoa2012971
Lots of new options for B-cell malignancies of all ages!
We discuss brexucabtagene autoleucel (CAR-T for mantle cell lymphoma, tafasitamab (anti CD-19 monoclonal antibody), and belantamab mafadotin (anti-BCMA antibody drug conjugate).
Finally, for good measure we review the newly approved regimen of atezolizumab with vemurafenib/cobimetinib for BRAF-mutated metastatic melanoma.
We summarize the changes to ASCO's latest Antiemetic Guidelines update as well as their guidelines for chemotherapy-induced peripheral neuropathy (CIPN).
Then, we take a look at the PO decitabine approval and ponder the question, does low albumin decrease tolerability to some TKIs?
We're joined by Dr. Karen Fancher, oncology pharmacist, to talk about her breast cancer story from diagnosis to shared-decision making treatment plans with her oncologist to treatment toxicity.
While this is a topic best covered with case examples, we do our best to provide the basics in 20 minutes.
Experienced clinicians may not be aware of the How Long study briefly discussed in this episode: https://doi.org/10.1016/S2352-3026(17)30211-9
FDA ended June with 5 new approvals. selinexor for r/r DLBCL pembrolizumab for cutaneous squamous cell carcinoma pembrolizumab for MSI-h/dMMR met. colorectal cancer avelumab maintenance for met. bladder cancer *SC trastuzumab/pertuzumab/hyaluronidase
A primer on primary endpoints used in oncology clinical trials. Tailored for those new to in-depth evaluations of oncology literature.
Topics on this week's Pod include: -Lurbinectedin in SCLC -Nivolumab is esophageal cancer -Pembrolizumab for TMB-high cancers -Gemtuzumab ozogamicin for pediatric AML -Venetoclax + HMA for adult (unfit) AML -Gardasil for prevention of SCCHN -Perhaps the biggest non-oncopharm news of the year?
Recapping lots of updates from ASCO 2020.
Then (20:00) we chat with Shannon Hough, oncology pharmacy specialist, to talk about her ASCO abstract (https://meetinglibrary.asco.org/record/185996/abstract) on pharmacist interventions in managing CINV.
Another week, another two new approved indications in NSCLC. We cover Checkmate-9La (Nivo/Ipi + 2 cycles of chemo) and ALTA-1L (1st Line brigatinib in ALK-rearranged NSCLC).
Finally, we cover an interesting case report highlighting the need to determine CNS penetration of kinase inhibitors.
(Lots of ASCO talk next week!)
There are 2 new Immunotherapy (without chemo) options for untreated metastatic NSCLC. We try to make sense of this evolving landscape.
Then, we run through the latest TKI, ripretinib. Finally, we discuss a new approval for Kaposi sarcoma and our obligatory PARP inhibitors update of the week.
We now have a RET inhibitor, selpercatinib. This new drug for NSCLC and thyroid cancer is discussed as well as RET in general as a target.
Then, we cover olaparib's latest approval for use in conjunction WITH bevacizumab for maintenance in HRD ovarian cancer based on PAOLA-1 (19:30).
Finally, we run through IMBrave 150 (atezolizumab + bevacizumab) which may establish a new standard of care in HCC (22:20) and briefly discuss olanzapine for cancer-associated N/V and Ivosidenib for IDH1-mutated cholangiocarcninoma.
RET fusions: https://doi.org/10.1016/j.ctrv.2019.101911
PAOLA-1: https://www.nejm.org/doi/full/10.1056/NEJMoa1911361
IMbrave150: https://www.nejm.org/doi/full/10.1056/NEJMoa1915745
Olanzapine: https://jamanetwork.com/journals/jamaoncology/article-abstract/2765323
Ivosidenib in cholangiocarcinoma: https://doi.org/10.1016/S1470-2045(20)30157-1
First, we discuss the FDA approval of daratumumab hyaluronidase for subcutaneous administration and compare its administration to SC administration of rituximab hyaluronidase and trastuzumab hyaluronidase.
We end by discussing the 1st FDA-approved drug for MET exon 14 skipping mutations, capmatinib. We also discuss how a receptor tyrosine kinase could skip.
Topics of discussion: Q 6 week pembrolizumab dosing schedule FDA approved Updates on possible PARP inhibitor use. Niraparib for ovarian maintenance. Olaparib in prostate cancer (5:28) The monarcHER study of abemaciclib in HER+ MBC (12:20) The GRIFFIN study of Dara+VRD in myeloma (17:00)
Five (5!) new #oncopharm products to discuss. First, sacituzumab govitecan. Then, (9:30) tucatinib. Finally, (18:40) mitomycin gel, pemitgatinib, and selumetinib.
Our 1st Journal Club.
- Read this: https://www.futuremedicine.com/doi/10.2217/fon-2018-0787
- Ask how, or if, this would change practice.
- Listen.
First, we run through 4 recent FDA-approved expanded indications for HCC, small cell lung cancer, MDS-related anemia, and BRAF-v600e-mutated colorectal cancer.
Then, we review the evidence that warranted bevacizumab's FDA-approval for metastatic breast cancer way back in 2008 (E2100) and its subsequent labeled indication removal by the FDA (Avado & Ribbon-1).
Why talk about old news? Perhaps there's a lesson here as we consider using untested drugs...
E2100: https://www.nejm.org/doi/full/10.1056/nejmoa072113 Avado: https://www.ncbi.nlm.nih.gov/pubmed/20498403 Ribbon-1: https://www.ncbi.nlm.nih.gov/pubmed/21383283
Reviewing the lasted DOAC study in treating cancer-associated VTE: Caravaggio. We compare it the other major DOAC studies in this patient population. Caravaggio: https://www.nejm.org/doi/full/10.1056/NEJMoa1915103
Also, announcing our first journal club! This will be our 4/16 Pod. It is especially for an oncology APPE students missing out on an oncology experience, but all are welcome to participate. Journal Club link: https://www.futuremedicine.com/doi/pdf/10.2217/fon-2018-0787
The Foundations of OncoPharm series returns with a unique chemotherapy drug: bleomycin.
Also, Covid Thoughs (14:00).
Recent updated survival analyses for CLEOPATRA and Keynote-189 (6:45) require some historical context to truly see their impact. Finally, #AskOncoPharm returns (15:05) with a listener question about infusion rates when restarting daratumumab.
We all should do what we can to "flatten the curve" and that includes our patients on treatment. While there is no such thing as elective chemo, there are some practical ways we can minimize patients needing to come into our facilities.
Looking back at a 2012 NYT op-ed (https://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html) that led to a 50% price decrease in a biologic cancer medication.
A plethora of #oncopharm updates!
Isatuximab is approved and neratinib gets another breast cancer indication (2:00)
Pembrolizumab with chemo for triple-negative breast cancer (8:50)
New EPOC updated survival analysis on FOLFOX+cetuximab in isolated liver metastatic colon cancer (15:00)
Precision medicine in pancreatic cancer (19:30)
Cladribine + rituximab for hairy cell leukemia (23:30)
Two recent publications add to our knowledge concerning the utility of CYP2D6 genotyping and tamoxifen.
TARGET-1: https://www.ncbi.nlm.nih.gov/pubmed/31821071
Tamoxifen D/C rates by 2D6 genotype: https://www.ncbi.nlm.nih.gov/pubmed/31800347
You've heard of CAR-T therapy, and now it's time to learn about CAR-NK cells.
Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1910607
Drug-drug interactions are a key consideration when determining which NK-1 antagonist to use in patients receiving highly emetogenic chemotherapy. We discuss the issues for (fos)aprepitant, netupitant, & rolapitant.
A nice aprepitant review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595939/) and the case for an aprepitant-vincristine interaction (https://doi.org/10.1177/1078155219870840).
All the need-to-know items about the latest #oncopharm approved drug, tazemetostat, to start the Pod. We end (9:15) with a brief discussion of how gut bacteria may lead to gemcitabine resistance.
New Drug Update! We discuss the efficacy and safety data surrounding avapritinib's approval as well as its likely role in GIST management.
How common are upon safety concerns from FDA on newly approved #oncopharm agents? Does the accelerated approval process lead to more safety updates? We discuss (https://doi.org/10.1634/theoncologist.2019-0653).
We also look at a possible way to mitigate 6-MP hepatoxicity (5:45) using allopurinol (https://doi.org/10.1080/10428194.2019.1702183).
Finally (10:55) we review the most recent FDA indications for olaparib and pembrolizumab.
Kicking off the 2020 Pod season with the last FDA-approval of 2019 - trastuzumab deruxtecan.
Closing out the year discussing FDA's approval of enfortumab-vedotin for urothelial cancer and a new, but pharmacologically unique, TKI with activity in CML (12:45). Happy New Year!
The Foundations of #OncoPharm series combines with a thematic critique of an animated Holiday classic to examine the links between The Grinch and Arsenic Trioxide.
Reviewing pertinent abstracts from ASH's 2019 annual meeting. Abstracts discussed: LBA-1 (blinatumomab), 2640 (venetoclax-azoles interactions), 2639 (FLAG/CLAG vs. CPX-351 in sAML), LBA-6/862/860 (myeloma), and 3310 (PK-targeted dosing of melphalan for autoHSCT). Search here: https://ash.confex.com/ash/2019/webprogram/start.html
The Landmarks in #OncoPharm series returns with dose-dense AC, published in JCO in 2003 by Citron et al.
Link: https://www.ncbi.nlm.nih.gov/pubmed/12668651
The menu: sirolimus vs. prednisone for standard risk aGVHD, levofloxacin prophylaxis in myeloma patients (9:00), acalabrutinib's approval for CLL/SLL (12:00), OS analysis from osimertinib's FLAURA (14:30), optimal sequencing of abiraterone & enzalutamide (23:20), some novel non-malignant heme drugs (26:45), outro music (30:00), 2 new drugs for sickle cell (30:30), pecan pie.
BTK-targeting therapy approved again! Zanubrutinib approved for Mantle Cell Lymphoma (2nd line) - how does it compare to ibrutinib and acalabrutinib?
Examining the effects of antibiotics, corticosteroids (6:45), and cannabis (12:05) on immunotherapy effectiveness.
ASCO's updated 2017 antiemetic guidelines recommend NK-1 antagonists to prevent CINV with standard Q 3 week carboplatin (i.e. AUC 5-6), but how good are the data to support that? We dive into the supporting data.
The basic must-know information for carboplatin, for students, residents, or anyone looking for a refresher.
ADAM VTE (apixaban for cancer-associated VTE) results have been published - let's talk about it. Also, what are the implications of long term ibrutinib on CV health? A new Blood paper offers some possible answers.
Weighing the risks & benefits of immunotherapy rechallenge in patients with a prior immune-related adverse event (irAE). Reference: https://www.ncbi.nlm.nih.gov/pubmed/31461381
Reviewing the recent Lancet publication of CASPIAN (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32222-6/fulltext) --> durvalumab + chemo in extensive stage small cell lung cancer.
Recapping updates from ESMO 2019. Topics include FLAURA (osimertinib), 5-year OS analyses of immunotherapy in metastatic NSCLC & melanoma, EGFR/BRAF/MEK inhibition in BRAF-V600E colorectal cancer, PARP inhibitors in ovarian cancer, and a possible cabazitaxel comeback.
The Landmarks in #Oncopharm series returns on the 10-year anniversary of this landmark paper (https://www.nejm.org/doi/10.1056/NEJMoa0904544) comparing daunorubicin 90 mg/m2 vs. 45 mg/m2 for AML induction.
Discussion of FDA's approval of lenvatinib & pembrolizumab for endometrial cancer followed by a comparison of TITAN v. ENZAMET prompted by apalutamide's latest approval.
Recapping the NY Times (https://www.nytimes.com/interactive/2018/10/26/magazine/netflix-diagnosis-series-joe.html) & Netflix collaboration "Diagnosis" about a possible Ibrutinib ADR. We also the discuss the value of case reports for the #OncoPharm community.
The 2nd installment of the OncoPharm Morbidity & Mortality series discussed a published case report (https://www.ncbi.nlm.nih.gov/pubmed/28782406). We discuss the approach to take when a patient experiences unexpectedly extreme toxicity and the role pharmacogenetics may play. Suggested resource: https://cpicpgx.org
The Foundations of #OncoPharm series returns with all the must-know information for irinotecan.
Running through the drug information highlights of the latest approved #oncopharm agents: entrectinib and fedratinib.
This week we look at the NEJM publication earlier this month (https://www.nejm.org/doi/full/10.1056/NEJMoa1817073) of E1912. Points of discussion include IGHV mutational status, PFS vs. OS as endpoints in CLL, the benefit of rituximab in addition to ibrutinib, and ibrutinib toxicity in younger vs. older CLL patients.
(Also, apologies to my APPE student for dropping this Pod after your journal club on this paper.)
Updates on ASCO's updated VTE guidelines with a focus on prophylaxis for ambulatory cancer patients (1:15) and VTE treatment (12:50). Pembrolizumab's latest FDA-approval is discussed (16:00), as is pexidartinib's FDA-approval (18:00), and finally a comparison of BCOP pass rates by training status (22:34).
Darolutamide has been FDA-approved. We discuss its differences and similarities to other 2nd-generation anti-androgens (enzalutamide & apalutamide) - especially potential drug interactions!
Our Landmarks in #OncoPharm series returns to the breast cancer patient population to review the landmark 2008 NEJM article from Sparano et al (https://www.nejm.org/doi/full/10.1056/NEJMoa0707056) investigating the optimal taxane regimen to follow adjuvant AC.
A brief discussion on FDA's approval decision on selinexor and its possible role in therapy. Then, a more in-depth details on its MOA, dosing, and toxicity profile.
An overview of pain management principles in cancer patients. Topics covered include the role of NSAIDs, bisphosphonates, and opioids in treating or preventing pain. Also discussed: bowel regimens & opioid conversions.
The Foundations in #Oncopharm series returns with the story of a failed contraceptive candidate that became the first (?) targeted therapy for use in cancer. Tamoxifen's use, MOA, toxicities, and drug interactions are also discussed.
We open up the Ask #OncoPharm inbox to answer a listener question - What advice do you have before starting my PGY2 Oncology Pharmacy Residency?
Discussing recent FDA-approvals of pembrolizumab for metastatic or unresectable, recurrent Head & Neck Cancer (1st line) and Small Cell Lung Cancer (3rd line)
A newly approved drug for relapsed/refractory diffuse large B-cell lymphoma is discussed as well as PBR.
Concise reviews of 6 studies from ASCO '19. #Oncopharm agents discussed include olaparib, ribociclib, pembrolizumab, dabrafenib/trametinib, and *losartan.
*caveats apply
Discussing the 1st PI3-kinase inhibitor approved for a solid tumor, alpelisib for HR(+), HER2(-) metastatic breast cancer as 2nd line treatment. Worth sharing with her endocrine/DM colleagues...
The Landmarks in #OncoPharm continues down its breast cancer-centric track with the landmark CALGB 9344 trial that established the role of paclitaxel in the adjuvant setting --> https://ascopubs.org/doi/pdf/10.1200/JCO.2003.02.063
The Landmarks in #OncoPharm series returns with a discussion of NSABP B-15, which established AC as a standard adjuvant chemo regimen for breast cancer --> (https://ascopubs.org/doi/abs/10.1200/JCO.1990.8.9.1483)
Running through updated FDA approvals from this month (ivosidenib, T-DM1, ramucirumab, avelumab/axitinib, & venetoclax/obinutuzumab) and how these approvals raise more questions.
The Foundations of OncoPharm returns with imatinib, the 1st TKI. Discussion includes its history (and how imatinib's Phase I study almost didn't happen), uses, and toxicity.
Discussion of 2 important malignant hematology updates: the NEJM publication of the 1st published results of CAR-T therapy in multiple myeloma and the FDA-approval of ivosidenib in frail AML patients (with IDH1 mutations).
Reviewing the REFLECT (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30207-1/fulltext) study and its take-home points on selecting an agent for advanced HCC.
Summary of erdafitinib's FDA-approval including dosing, MOA, toxicity, and (wait 'til the end) prevalence of FGFR mutations. Ifos. Eye-Phos.
Reflections offered from HOPA's 2019 annual conference on cabozantinib, regorafenib, low-dose azacitidine, SC granisetron (this is a thing), clinical trial hope, and opportunities for students in HOPA
Debut of a new feature: OncoPharm M & M, where we'll discuss notable case reports of #oncopharm misadventures....how they happened...and how we can prevent them in the future. Our first installment in this series discusses a drug interaction between idelalisib & diazepam (Case Report Link: https://doi.org/10.1177%2F1078155216653705).
Our Foundations in #OncoPharm returns with etoposide, including a deeper than necessary discussion of the historical medical(?) uses of podophyllotoxins, its MOA, uses, and toxicities.
This week brought several notable updates we discuss: the FDA's concern with a venetoclax clinical trial in multiple myeloma patients, atezolizumab's expected FDA-approval for small cell lung cancer, and some neuro-oncology guideline endorsements.
Brief background on metastatic pancreatic cancer is provided, followed by a brief discussion of the main landmark clinical trials (and one not-so-landmark study) in this difficult disease state.
Coming to a P & T committee meeting near you....it's subcutaneous (S.C.) monoclonal antibodies. We discuss the two currently FDA-approved formulations: rituximab + hyaluronidase and trastuzumab + hyaluronidase.
Providing some clinical pearls learned in the last week regarding patient education for ruxolitinib & alectinib. Then (11:50) we recap follow-up publications from Keynote-24 & the BRIGHT studies, before finishing up the week's journal scan with a discussion of the optimal dose of nivolumab + ipilimumab in melanoma and who may NOT benefit from palbociclib.
Axitinib studies presented at ASCO-GU '19 with simultaneous NEJM publication are discussed, followed by a brief overview (18:50) of darolutamide, a new anti-androgen, and its drug interaction potential.
The Landmarks in Oncology Pharmacy series returns to discuss the International Randomized Study of Interferon vs. STI571 (imatinib) aka IRIS.
CBD use is becoming more widespread in society, including in cancer patients. Potential, and significant, drug interaction concerns should be considered.
Mucositis & stomatitis are basically interchangeable terms for one of the hallmark chemotherapy toxicities. We discuss its pathophysiology, prevalent, and prevention/treatment.
Olaratumab received accelerated approval in 2016 under the condition a phase III study would confirm its benefit. It didn't. We explore some possible explanations why a seemingly promising drug for a tough disease hasn't panned out...
It's always enlightening to talk to a cancer survivor and is an essential part of the patient care process. This conversation touches on chemo-induced toxicities (e.g. ifosfamide neurotoxicity), supportive care advances (olanzapine!), and the anxiety of survivors live with while living scan-to-scan. Brought to you by the Bill Gatton College of Pharmacy.
New year, new chemo regimen to discuss. We go over mFOLFIRINOX for adjuvant pancreatic cancer from the recently published PRODIGE-24 study. We discuss out the regimen is modified, where to find dose reductions, and how many patients required G-CSF.
Keeping it light this Holiday Season with a discussion of the portrayal of pharmacists, notably Mr. Gower from It's a Wonderful Life, in pop culture. Regular Pods return in 2019.
The Landmarks in Oncology Pharmacy series returns with a discussion of MOSAIC: FOLFOX adjuvant chemotherapy for stage ii & STAGE III colon cancer.
Another week, another FDA-approval for AML. We discuss the latest in #oncopharm approvals: the FLT3-inhibitor gilteritinib. For more background reading, try here: https://doi.org/10.1177%2F1078155218802620
The often encountered, seldom studied Elderly AML demographic is discussed in light of recent FDA approvals for glasdegib (new drug) and venetoclax (new indication). Then, (17:30) we discuss the 2nd drug "tissue agnostic" FDA approval by delving into NTRK-fusion-gene tumors and larotrectinib.
Describing the rationale for and rise in widespread ESA use for cancer patients going back 30 years....and why their use has been drastically curtailed in the last decade.
Discussing one of the main workhorse #oncopharm agents: cyclophosphamide. Topics include is bioactivation, myriad of uses, toxicity (hemorrhagic cystits) prevention and management.
Reviewing the latest TKI approved for ALK rearranged metastatic NSCLC. And hey, how 'bout that crazy rifampin hepatotoxicity interaction?
Running through recent notable updates on pembrolizumab, olaparib, atezolizumab, palbociclib and 5F9's introduction.
Discussing the scant evidence regarding influenza vaccination in cancer patients receiving immunotherapy. Warning! - unpublished abstracts are discussed by a guy with laryngitis.
Another new #oncopharm agent was approved. We talk about talazoparib and how it compares to olaparib for germline BRCA-mutated breast cancer.
The Landmarks in Oncology Pharmacy series returns with the P1 study. We review this landmark paper paving the way for breast cancer risk reduction (or chemoprevention) and discuss the mark or lack thereof (frown emoji) it has made in clinical practice.
Dacomitinib & cemiplimab's respective FDA-approvals are discussed followed by a lightning-round review of 4 immunotherapy studies from the last week. We end with dosing updates for 2 multiple myeloma drugs.
The latest #oncopharm approval for duvelisib is discussed as well as the similarities and differences to other PI3K inhibitors previously approved.
Discussing the new pseudomonas exotoxin drug (moxetumomab pasudotox-tdfk) for Hairy Cell Leukemia (3rd line). Lots of supportive care measures required, surprisingly, for the pseudomonas exotoxin drug.
Celebrating World Marrow Donor Day by recapping the HSCT donation experience of your favorite podcast host.
5-FU: both its mechanisms, all its toxicities, most of its uses, and some of its history are discussed.
The debut of our mailbag (Ask OncoPharm) to give some tips to new oncology pharmacists. Then (13:10) we review the RELEVANCE study of rituximab/lenalidomide in follicular lymphoma.
It's flu shot season, so we're taking a pseudo-systematic review of influenza vaccination in patient receiving chemotherapy. Questions addressed include: How effective is influenza vaccination for cancer patients? What's the optimal timing of vaccination during chemo?
Small cell lung cancer is reviewed, including the milestone advances (chemo + RT, omitting surgery, cis/etoposide) of the past leading up to the latest advance (15:20) - FDA-approval of nivolumab in the 3rd-line setting.
Mogamulizumab-kpkc (MOAs, administration, toxicity) and its FDA-approval is discussed followed by (9:00) updates lenvatinib (a good update) and azithromycin (a bad update) in cancer patients.
We explore the origins of rituximab's dose, geek out on the NNT in DLBC, and discuss other "need to know" tidbits.
Catching up the recent FDA-approvals for iobenguane I-131 (and its myriad of precautions) and lusutrombopag.
After running through recent FDA updates (including ribociclib's approval in PRE-menopausal breast cancer patients), the newly approved ivosidenib is discussed.
Ten years ago a preplanned subgroup analysis changed the NSCLC treatment algorithms. We go back to the beginning with pemetrexed and the studies leading up to the oft-cited Scagliotti that ushered in histology-specific treatment in NSCLC.
We discuss paclitaxel, from its discovery to its uses to toxicity and their management as part of our Landmarks in #OncoPharm series. And if you really, really love this drug - you'll learn where to may homage at a historical marker in....
Our shortest Pod yet! Chemotherapy explosions and photosensitizing antineoplastics are discussed.
The newly FDA-approved BRAF & MEK inhibitors are discussed, along with their possible clinical relevance and some notable differences compared to previously available BRAF & MEK inhibitors.
Immunotherapy takes two steps forward (new FDA approvals)....and two steps backwards. These updates in #oncopharm are discussed before ending (11:45) with discussions of venetoclax's expanded approval in CLL, the bevacizumab approval almost 7 years in the making, and late-breaking information on preventing cisplatin ototoxicity.
The Landmarks in Oncology Pharmacy series returns with a review of 2 ondansetron studies from 1990, published simultaneously in NEJM.
Recapping (some) of the top stories from ASCO18 starting with breast cancer (TAILOR-Rx, PERSEPHONE, SANDPIPER, S0927); then NSCLC (11:35) with Keynote-42 & LOXO-292; then mylemoa (16:50) with a CAR-T update and a new dosing of carfilzomib; before ending (20:30) with CARMENA and PRODIGY-24's new mFOLFIRINOX data for adjuvant pancreatic cancer. Whew!
Previewing this week's ASCO annual meeting and the Plenary Sessions (briefly) and selected abstracts highlighting oncology pharmacy practice.
Avatrombopag's FDA-approval prompts discussion of both the indication and drug itself. Finally, the publication of the SELECT-D study allows us to dig deeper into the data of a DOAC vs. LMWH in cancer-associated VTE.
The release of ASCO's 2018 annual abstracts resulted in widespread media coverage of PERSEPHONE, the largest trial yet investigating 6 vs. 12 months of adjuvant trastuzumab in breast cancer. We get into the history of adjuvant trastuzumab studies and what to watch for going forward.
Recent FDA updates are discussed including combined use of BRAF & MEK inhibitors, frontline daratumumab (10:20), and your next P & T monograph drug to review.
The foundations of #oncopharm series continues with methotrexate. We begin with its origin story and end discussion modern-day use in high doses.
Recent FDA & #oncopharm updates are discussed, including irinotecan in sweat, fostamatinib's FDA-approval for ITP. Then, immunotherapy updates from AACR are reviewed (6:00). Finally (34:00 , osimertinib's updated approval for frontline use in mEGFR NSCLC.
You've heard of NSABP, but have you heard of adjuvant melphalan, 5-FU, & concurrent tamoxifen? Sometimes asking the right question yields answers we don't yet understand.
The Foundations in Oncology Pharmacy continues with vincristine. Its origin, unique toxicity profile, and clinical use is discussed. Periwinkle!
Highlights from last week's HOPA annual conference are discussed, followed by (13:09) a lightning-style run through of #oncopharm updates over the last 2 weeks.
Previewing HOPA18 and its highly anticipated sessions, networking opportunities, and virtual attendance.
PVB's (cisplatin, vinblastine, bleomycin) impressive cure rate for testicular cancer is 1977 is discussed. Then the evolution of the BEP & EP regimen is summarized.
Abemaciclib's up-front approval provides an opportunity to review all 3 currently FDA-approved CDK 4/6 inhibitors. Dosing, drug interaction, and indication differences are discussed.
Durvalumab's FDA-approval for NSCLC and the supporting PACIFIC study are discussed, then the ASCO Immunotherapy Toxicity Management Guidelines (7:45) are reviewed. Also, a plug for patient support groups.
Apalutamide's FDA-approval is discussed, including discussion of its drug interaction potential and a review of the SPARTAN study. Updates (18:15) from ASCO GU and DOAC use in cancer (23:50) also discussed.
The Landmarks series continues with Bonadonna's classic adjuvant CMF regimen in breast cancer in a pre-tamoxifen & pre-ER/PR testing era. Discussion points include number needed to treat (NNT) to prevent recurrence and how chlorambucil was considered for the 'C' in CMF.
Overview of doxorubicin from its Italian origins to its Red Devil alias. Uses and toxicities also discussed, of course.
New Drug Approval: Lutetium-177-dotatate is discussed as well as updates to indications for denosumab (m. myeloma), afatinib, & olaparib.
The Landmarks series continues with DeVita's original MOPP (Hodgkin's Disease) publication from 1970. Discussion points include WBC monitoring, why cyclophosphamide isn't included, and wigs.
The Foundations in Oncology Pharmacy series begins with the penicillin of oncology: cisplatin. Discussion of its history, current uses, & toxicities. Perfect for those new to oncology pharmacy.
Review of recent FDA action re: oncology pharmacy including review of the APHINITIY trial and pertuzumab's subsequent approval in the adjuvant setting. Also, the nilotinib label change allowing for discontinuation in CML patients is discussed.
In the 1st of the Landmarks series, we look back at a pivotal article published in Blood in 1958 on the treatment of acute leukemia.
2017 saw A LOT of #oncopharm approvals. Oncology pharmacist & educator John Bossaer runs through some of the most notable oncology pharmacy trends of the year, include CAR-T cell therapy
Discussion of gefitinib's journey back to the market and lessons to be learned from it by oncology pharmacist & educator John Bossaer.