Session descriptions and speaker information for Thursday's sessions at HOPA's Annual Conference.
Ambulatory Practice (201) 0.1 CEUs
Management of Cardiovascular and Metabolic Adverse Effects of Oral Chemotherapy
Lisa Lohr, PharmD BCOP BCPS
Management of the toxicities of oral chemotherapy agents is crucial to maintaining patients on treatment and maximizing the efficacy of the treatment. These toxicities include cardiovascular adverse effects (left ventricular dysfunction, hypertension, QT prolongation) and metabolic adverse effects (hyperglycemia, hyperlipidemia, hypothyroidism). The etiology, agents involved, diagnosis, and grading of these toxicities will be reviewed. Development of treatment algorithms to mitigate these toxicities can facilitate evidence-based, consistent assessment and treatment. Example treatment algorithms for each toxicity will be reviewed.
Managing the Ramp-Up with Venetoclax
Laura Tang, PharmD BCOP
Venetoclax is a highly selective inhibitor of BCL-2 that was recently approved by the U.S. Food and Drug Administration for patients with chronic lymphocytic leukemia who have a 17p deletion and have received at least one prior therapy. Initial studies demonstrated an increased risk of tumor lysis syndrome, resulting in abnormal biochemistries and (in the most severe cases) death. Because of the risk of tumor lysis syndrome, the package insert has specific recommendations for an initial dosing ramp-up schedule as well as admission requirements for initiation of therapy. Additionally, venetoclax is a major substrate of cytochrome P450 3A4 (CYP3A4) and has specific dosing recommendations based upon concomitant use with CYP3A4 inhibitors and inducers. I will review my personal experience with the toxicities and review guidelines on how to appropriately manage these patients.
Practical Issues for Clinicians (202) 0.1 CEUs
Practical Issues for Clinicians Managing Immune-Related Adverse Events with Immune Checkpoint Inhibitors
Christopher Campen, PharmD BCOP
In this presentation we will review key concepts in the management of immunotherapy toxicities. We will use case-based examples to define common and uncommon toxicities of immunotherapy, review differences between single-agent and combination immunotherapy, and discuss management strategies for immunotherapy toxicities. The target audience is pharmacists working in clinical practice.
Overcoming the Blood-Brain Barrier: New Opportunities for Treatment of Brain Metastases in Non-Small-Cell Lung Cancer
Samantha N. Reiss, PharmD BCOP
Lung cancer is the leading cause of death in the United States, and brain metastases are a frequent complication of NSCLC, with about 25%–40% of patients developing brain metastases. Many first-generation tyrosine kinase inhibitors (TKIs) for treatment of epidermal growth factor receptor (EGFR)– and anaplastic lymphoma kinase (ALK)–mutant lung cancers have poor blood-brain barrier penetration, allowing the central nervous system (CNS) to serve as a sanctuary site of disease. With advances in treatment, many second- and third- generation TKIs, such as osimertinib, alectinib, and brigatinib, have increased blood-brain barrier permeability and have been shown effective in controlling and treating CNS metastases. This presentation will review the pathophysiology of the blood-brain barrier and mechanisms of permeation of oncologic agents to cross the blood-brain barrier; compare EGFR TKIs’ and ALK TKIs’ pharmacokinetics, cerebrospinal fluid penetration, and safety profile; and provide evidence-based literature on TKIs’ intracranial efficacy.
Rare Malignancies (203) 0.1 CEUs
The Square Peg in the Round Hole: Associated Issues in the Treatment of Adults with Pediatric Solid Tumors
Christy S. Harris, PharmD BCOP BCPS
Few data are available on the rare patients in their 20s–50s who develop a cancer considered a pediatric tumor. Even with Children’s Oncology Group trials extending inclusion to ages beyond 18–21, very few patients in this group are captured in the data for sufficient separate analysis and recommendations. Most information is found in sporadic case reports but often does not provide many details important for day-to-day management and treatment of these patients. Tolerance and toxicity with aggressive pediatric regimens can be different in the adult patient and will be discussed in this session. Cases involving adults with Ewing sarcoma, neuroblastoma, osteosarcoma, and Wilms tumor will be discussed, as well as how the pharmacist can make a specific contribution to the care and treatment of these patients.
HAART to Heart: Updates on the Management of AIDS-Related Kaposi Sarcoma
Catherine Lee, PharmD BCOP BCPS
The therapeutic challenge of managing AIDS-related Kaposi sarcoma presents opportunities for a multidisciplinary approach to HIV/AIDS cancer care. This session will provide an overview of AIDS-related Kaposi sarcoma and treatment and monitoring strategies using antiretroviral medications and local or systemic therapies.
Geriatrics (204) 0.1 CEUs
Treatment of Glioblastoma in the Elderly—When Less Is More
Lisa Modelevsky, PharmD BCOP
Treatment of glioblastoma in the elderly is controversial. Elderly patients have been poorly represented in landmark glioblastoma trials, with median ages of participants approximating 55 years. This lack of data on the elderly makes treating glioblastoma in this population difficult. Because of this research gap, elderly patients often receive standard radiation and temozolomide treatment, resulting in higher morbidity and mortality than is seen in the majority of studies. Over the past 15 years, studies have evaluated the utility of abbreviated radiation versus full-course radiation, treating with temozolomide monotherapy, standard radiation with lower doses of temozolomide, or abbreviated radiation with temozolomide in elderly patients with glioblastoma. Results from these studies, most of which are retrospective, have been conflicting and ultimately confusing. This session for both beginner and advanced practitioners will focus on primary literature associated with this topic and help give clarity on how we can better support our elderly glioblastoma patients.
Cognitive Impairment in Older Adults with Cancer: Time to Remember the Intersection Between Cancer, Cognitive Impairment, and Chemotherapy
Ginah Nightingale, PharmD BCOP
Cancer and neurocognitive disorders, such as cognitive impairment, are serious diseases that disproportionately affect older adults and are associated with a high degree of morbidity and mortality. Additionally, chemotherapy-related cognitive impairment can occur during or after chemotherapy and can worsen pre-existing cognitive decline, a major concern for many people. Complex questions and gaps exist regarding the intersection between cancer, chemotherapy, and cognitive impairment---specifically what screening tests are optimal for detecting cognitive impairment, how to best measure the severity of cognitive impairment in cancer patients, what constitutes appropriate levels of intervention in the setting of abnormal findings, how to determine which chemotherapy regimens are associated with causing cognitive impairment, and what strategies exist to prevent development or slow progression of cognitive impairment. Answers to these questions are needed if we are to better understand how the presence of pre-existing cognitive impairment or chemotherapy-associated cognitive impairment affects treatment-related adverse effects, hospitalization, post-treatment surveillance, cancer recurrence, and patient-reported outcome measures. This presentation will focus on current research gaps, highlighting the lack of clinical trials that screen for cognitive impairment and the challenges in measuring chemotherapy-associated cognitive impairment. The major challenges faced by oncology healthcare providers, including pharmacists, are knowing how to optimally manage these coexisting conditions and fully understanding the ways that they affect cancer-related and qualify-of-life outcomes.
Practice Leadership (205) 0.1 CEUs
Peer Review of Journal Articles: How Exactly Do I Do That?
Lisa Holle, PharmD BCOP FHOPA
Peer review of journal articles is a common job responsibility of researchers and academics, but for clinicians performing peer review offers a way to enhance one’s career and make an important contribution to the scientific community. Very little training is provided to those who perform peer review of journal articles, whatever their background. This session will identify opportunities for peer review and provide some tips and guidance for peer reviewing of journal articles.
Improving the Quality of Cancer Care Through Patient Experience: Patient-Reported Outcomes in Clinical Trials Versus Clinical Practice
Suwicha Limvorasak, PharmD BCOP
Measurement of patient-reported outcomes (PROs) is an essential component of cancer care, allowing for monitoring of toxicity and identification of patients at risk for toxicity. Capturing patient perspectives on disease and treatment in a valid, reliable, and reproducible way is the goal of PRO measures. Selecting the correct PRO for clinical use is important if patients are to complete their reports in a reasonable amount of time and if clinicians are to review and interpret results quickly and efficiently. Use of PRO data is limited in current oncology value assessment tools such as the American Society of Clinical Oncology value framework, the National Comprehensive Cancer Network evidence blocks, and the European Society for Medical Oncology magnitude-of-clinical-benefit scale. Future attempts at quantifying patient-defined value could include incorporation of PRO and quality-of-life measures in clinical trials as well as a clinical pathway to help assess the quality of cancer care. Various PRO tools used in clinical trials and current clinic practice will be discussed, with the focus on three aspects of PRO use: (1) improving care for individual patient where survival is not the only clinically meaningful end point; (2) analyzing data to improve care and outcomes overall; and (3) weighing considerations in feasibility and implementation of PRO collection.
John G. Kuhn Keynote Lecture 0.1 CEUs
"There will be drugs”: Lessons from Lung Cancer’s Therapeutic Oil Boom
Ross Camidge, MD PhD
In the last 10 years two revolutions have occurred in the treatment of lung cancer, particularly non-small-cell lung cancer: the personalized medicine revolution and the immunotherapy revolution. Each has led to a boom in U.S. Food and Drug Administration drug approvals and National Comprehensive Cancer Network recommendations. But with each development have come lessons to be learned about side effects, acquired resistance, drug interactions, gaps in our clinical development strategies, and how these two revolutions overlap.
As we keep patients with advanced lung cancer alive longer, we are turning the condition into a chronic disease, with the need to manage multiple co-occurring independent and dependent disease-related and iatrogenic conditions at the same time. In addition, we now have to take on some of the challenges of maintaining normality in someone who wants to continue living life to the fullest despite having advanced cancer. The teamwork of pharmacists and medical oncologists in research and standard of care has never been more important.
Significant Papers in Hematology/Oncology (206) 0.125 CEUs
Ashley Morris-Engemann, PharmD BCOP CPP
The focus of the hematology section of this presentation will be on recent advances in the management of leukemia, lymphoma, and multiple myeloma. The presentation will provide necessary background on the topics discussed and will emphasize trial methodology, outcomes, and implications for clinical practice.
Emily Mackler, PharmD BCOP
The session will provide high-level, critical coverage of practice-changing papers on hematology, oncology, and supportive care that were published in the year preceding HOPA’s annual conference. Review of the selected articles will focus on current practice trends, stated objectives, critical evaluation of study design, and interpretation of results.
BCOP Session 3 (BC3) 0.125 CEUs
Management of Chimeric Antigen Receptor T-Cells
Brandon Shank, PharmD BCOP CPH
Chimeric antigen receptor (CAR) T-cell therapies newly approved by the U.S. Food and Drug Administration have a distinct side-effect profile, and many practitioners lack familiarity with management of these side effects. These treatments have the potential to improve survival outcomes over those associated with conventional chemotherapy for both adults and pediatric patients. This session aims to teach pharmacists how to adapt their monitoring and management of these patients in inpatient and outpatient settings, compared to patients receiving chemotherapy-based regimens. The efficacy data will be briefly discussed, along with an extensive review of the pathophysiology and management of cytokine release syndrome (CRS) as well as CAR-T-cell-related encephalopathy syndrome (CRES). A practical case-based discussion applying the limited data for monitoring and managing patients with CRS and CRES will help learners apply the concepts covered. Supportive care management of other non-CRS and non-CRES toxicities will be discussed. The session will conclude with a discussion of opportunities for interventions for pharmacists caring for patients undergoing CAR T-cell therapy and the logistical challenges of implementing CAR T-cell therapies.
Molecular Tumor Boards, Pathways, and Precision Medicine (207) 0.15 CEUs
Cyrine Eliana Haidar, PharmD BCOP BCPS; Patrick Kiel, PharmD BCOP BCPS; Jill Kolesar, PharmD MS BCPS FCCP; Christine Walko, PharmD BCOP FCCP
Precision medicine is an emerging field that uses genomic sequencing to direct treatment options for patients. Oncology clinical pharmacists have been at the forefront of precision medicine efforts since their inception, and molecular tumor boards, often led by clinical pharmacists, are leading care optimization. This session aims to provide insight into current and emerging practices in molecular tumor boards across the nation. Key topics will include assessment of tumor somatic mutations, germline mutations, and the role of the clinical pharmacist in directing therapy. Real-life case and outcomes will be presented to illustrate this emerging field. This session is geared to practitioners of all levels, and researchers and administrators will gain valuable insights into precision medicine.