HOPA Annual Conference 2019

Session descriptions and speaker information for Friday, April 5, at HOPA's Annual Conference.

8:30–9:30 am

Breakout Session: Ambulatory Practice (301) (0.1 CEU)

UAN 0465-0000-19-020-L04-P
Included in Virtual Meetingblue K

The Oncologist’s Orbuculum: Emerging Biomarkers to Predict Response to Immune Checkpoint Inhibitors

Despite increasing indications for immune checkpoint inhibitors (ICIs), many questions remain about how to best predict response to these agents. The presenter will discuss the current data supporting the use of biomarkers to predict response to ICIs.

Programmed death-ligand 1 (PD-L1) expression, as determined by various immunohistochemistry assays, is perhaps the most familiar biomarker, but it lacks a clear threshold to predict response. Emerging data suggest that tumor mutational burden may predict response to the ICIs and may be used to determine the need for combination therapy versus single-agent therapy. Genetic information is also being incorporated into treatment algorithms; for example, pembrolizumab has been approved for the treatment of microsatellite instability–high or mismatch repair–deficient solid tumors regardless of the specific tissue of origin. Genetic analyses of patients treated with ICIs are developing specific genetic signatures that predict response, such as the identification of comutations in K-ras-mutant lung cancer that predict a lack of response to single-agent PD1 inhibitors. Finally, aspects of the tumor microenvironment, including the presence of tumor-infiltrating lymphocytes, T-regulatory lymphocytes, and baseline serum lymphocyte-neutrophil ratio, may allow practitioners to identify tumors that may benefit from treatment strategies that increase tumor immunogenicity prior to treatment with ICIs.

Amber Proctor, PharmD BCOP CPP


Immunotherapy Use in the First-Line Setting for Metastatic NSCLC

NCCN guidelines for non-small-cell lung cancer (NSCLC) have been updated with the addition of immunotherapy combined with chemotherapy as first-line treatment for both squamous and nonsquamous histology. The synergy of immunotherapy and systemic chemotherapy will change our practice in treating this population. The presenter will discuss these new combination treatments and their applications on the basis of landmark trials: their appropriate indications, challenges in their use, and the new dilemma they pose for sequencing in NSCLC.

Milena Wong, PharmD BCOP

8:30–9:30 am

Breakout Session: Hematopoietic Cell Transplant (302) (0.1 CEU)

UAN 0465-0000-19-021-L04-P blue K

Updates on the Pharmaceutical Care of Hematopoietic Stem Cell Transplant Recipients

This session will review recent research on adult hematopoietic stem cell transplantation (HSCT). Pharmacists often oversee post-HSCT vaccination policies, so the presenter will review recent data on two new vaccines (RZV and HepB-CpG) and determine appropriate placement for transplant recipients. In addition, pharmacists are on the front lines with regard to prophylaxis and management of infections following allogeneic HSCT, so data on letermovir for CMV prophylaxis in seropositive allo-HSCT recipients will be reviewed. Finally, pharmacists often assist in designing evidence-based transplant conditioning regimens for patients in special cases such as desensitization procedures for patients identified as having donor-specific antibodies (DSAs). The session will review common approaches for DSA reduction to improve the likelihood of successful engraftment in patients undergoing haploidentical SCT.

Gerard Mascara, PharmD BCOP


Pharmacokinetic Considerations of Conditioning Regimens in Stem Cell Transplantation

Karen Sweiss, PharmD BCOP

The conditioning regimen in stem cell transplantation serves multiple roles, depending on the disease, type of transplant, and patient. Each drug in the conditioning regimen (busulfan, melphalan, cyclophosphamide, and antithymocyte globulin) has a unique pharmacokinetic and pharmacodynamic profile. Outcomes such as graft-versus-host disease, survival, and toxicities depend on the drugs given during conditioning. The pharmacokinetics of these drugs is very important, and consideration of various pharmacokinetic (PK) properties are being studied because of their implications for the outcomes of patients undergoing transplant. The presenter will discuss PK considerations regarding many of the drugs pharmacists administer during conditioning and how studies have evaluated efficacy and toxicity based on these PK variables, focusing on melphalan, busulfan, high-dose cyclophosphamide, and antithymocyte globulin. Their PK profiles and relevance for stem cell transplantation will be reviewed. Studies evaluating the pharmacokinetics and pharmacodynamics of these drugs will be analyzed. Attendees will gain an understanding of how pharmacokinetics is involved in the administration, dosing, and pharmacotherapeutic profile of these drugs and its impact on outcomes in transplant.

8:30–9:30 am

Breakout Session: Practical Issues for Clinicians (303) (0.1 CEU)

UAN 0465-0000-19-022-L04-P
Included in Virtual Meeting blue K

The Use of Complementary and Alternative Therapy in Clinical Trials

Early-stage oncology clinical trials are conducted within strict parameters and enroll patients who have failed standard therapies. These patients have limited options and are more likely to be looking beyond standard medicine practice and into the area of complementary and alternative medicine (CAM), specifically herbal and homeopathic therapies. Because of the lack of reliable data on potential clinically significant drug interactions with these products, determining whether they are allowed on trial can be complex. Various factors should be assessed when considering CAM therapy use in this patient population before providing the best recommendations to the oncology team and patient that adhere to protocol and sponsor requirements.

Christy Harris, PharmD BCOP


Managing the Patient on Medical Marijuana

Medical marijuana is now legal in 30 states, yet most practicing pharmacists are unfamiliar with managing a patient using medical marijuana and may even be uncomfortable doing so. This session will provide practical tips for managing patients using medical marijuana in addition to cancer treatment and supportive care. Using practical case examples, the presenter will focus on indications for use, common and serious adverse events, drug interactions, appropriate monitoring, education, and documentation.

Lisa Holle, PharmD BCOP FHOPA

8:30–9:30 am

Breakout Session: Practice Management (304) (0.1 CEU)

UAN 0465-0000-19-023-L04-P blue K

In the Driver’s Seat: Implementation of Pharmacist-Led Precision Oncology Services

Precision oncology clinics are on the rise, thanks to advances in next-generation sequencing. Pharmacists are uniquely positioned to take a leading role in these multidisciplinary ventures—in synthesis and presentation of genomic data, patient clinic visits, and drug procurement. In this example from a single institution, learn how a pilot precision oncology program led to the justification of continued pharmacist services.

Elizabeth Gustafson, PharmD BCOP


Considerations and Practical Implications for Implementation of a CAR-T Program in a Health-System Setting

This session will cover the pertinent considerations for pharmacy staff and pharmacists relating to the development of a CAR-T program based on experience at the Mayo Clinic. The presenters will (1) highlight structuring of the CAR-T program, financial considerations and the delegated parties responsible for overseeing the financial aspects of CAR-T therapy, and the challenges and considerations for whether pharmacy medication-use policies and procedures should be applied to CAR-T therapy; (2) provide an overview of risk evaluation and management strategy (REMS) program requirements with CAR-T therapy, including the necessary training and documentation; and (3) provide an overview of the development of a clinical pharmacist practice as part of the CAR-T program.

Adrienne Nedved, PharmD MPA BCOP
Scott Soefje, PharmD MBA BCOP FCCP

9:45–11 am

Advocacy Session (Non-CE)

Advocacy Updates (305)

This session will provide an overview of the current political landscape as it affects hematology/oncology pharmacists, an update on HOPA’s health policy agenda, and a discussion of ways that you can advocate on behalf of hematology/oncology pharmacists.

Jeremy Scott, MA
Tim Tyler, PharmD FCSHP FHOPA
Sarah Nichelson, JD

9:45–11 am

General Session (0.125 CEU)

UAN 0465-0000-19-039-L04-P
Included in Virtual Meeting red A

DEBATE—Immunotherapy Rechallenge: Knowing When Enough Is Enough (306)

Immunotherapy is one of the most promising new therapeutic options for a variety of tumor types. Studies have demonstrated durable responses and survival benefit with these agents in both treatment-naïve and heavily pretreated patients. Despite these unprecedented results, concerns about frequent and often severe immune-related adverse effects that necessitate treatment delays or holds exist. Attend this session to hear a dynamic debate on these agents' optimal place in therapy, if and when it is safe to rechallenge patients experiencing disease progression or treatment-related adverse effects, and whether concurrent steroids affect treatment outcomes. A case-based approach will be used to highlight issues pertinent to immunotherapy treatment decisions.

Val Adams, PharmD
Leigh Boehmer, PharmD BCOP
Sara Butler, PharmD BCOP BCPS

9:45–11 am

General Session (0.125 CEU)

Prophylaxis Versus Preemptive Therapy for CMV: What Is the Best Approach? (307)

UAN 0465-0000-19-040-L04-P
Included in Virtual Meeting blue K

Cytomegalovirus (CMV) infection is a significant cause of morbidity and mortality in hematopoietic cell transplant (HCT) recipients. The two most common strategies employed to prevent CMV disease are universal prophylaxis and preemptive therapy. Both strategies must be balanced by clinical effectiveness and the risk of drug-induced toxicity. The recent FDA approval of letermovir for prophylaxis of CMV adds a new twist. Join the presenters for a lively case-based debate on preemptive versus prophylactic strategies for treating CMV disease in HCT recipients.

Rebecca Tombleson, PharmD BCOP
Shane Cross, PharmD BCPS
Ila Saunders, PharmD BCOP

1:30–2:30 pm

Research Session (0.1 CEU)

UAN 0465-0000-19-047-L04-P blue K

Completed Research Platform Presentations (308)

Presenters will discuss the findings from their recently completed research endeavors. This is a great chance to hear about groundbreaking results, especially if you weren’t able to view these posters during the Thursday reception.

Efficacy and Tolerability of Age-Adjusted HyperCVAD in Older Patients with Newly Diagnosed Acute Lymphoblastic Leukemia
J. Michael Savoy, PharmD BCOP

Primary Growth Factor Prophylaxis in Breast Cancer Patients Receiving TCHP
Laura Boehnke Michaud, PharmD BCOP CMQ FASHP

Description of the Role of Pharmacist Independent Double Checks During Cognitive Order Verification of Outpatient Intravenous Anticancer Therapy
Jennifer Philippon, BS, and Julie Kennerly-Shah, PharmD MS MHA BCPS

1:30–2:30 pm

Gneral Session (0.1 CEU)

Do the DOACs Deliver? Direct Oral Anticoagulants for the Treatment of VTE in Adult and Pediatric Oncology Patients (309)

UAN 0465-0000-19-024-L04-P
Included in Virtual Meeting red A

Venous thromboembolism (VTE) risk is increased by 4–7 times in cancer patients and is the second leading cause of death for cancer patients. Traditionally, subcutaneous low-molecular-weight heparin (LMWH) has been the standard of care for treatment of VTE in both adult and pediatric oncology patients based on landmark trials and guidelines. However, many providers are using the direct oral anticoagulants (DOACs) as an alternative agent because of their advantages in convenience, cost, and quality of life when compared to the use of LMWH. Because use of DOACs in clinical practice is increasing, oncology pharmacists must be knowledgeable about new advances in anticoagulation to determine the optimal regimen for oncology patients with VTE. The presenters will review current treatment practices for VTE treatment and evaluate recent data comparing DOACs to LMWH in adult oncology patients and emerging safety and efficacy data on the use of DOACs in the pediatric population.

Jennifer Thackray, PharmD BCPPS BCPS
Prakirthi Yerram, PharmD BCOP BCPS

1:30–2:30 pm

BCOP Session (0.1 CEU)

Current Strategies in the Management of Chemotherapy-Induced Nausea and Vomiting (CINV) (BC4)

UAN 0465-0000-19-035-L04-P
Included in Virtual Meeting red A

This session will review recent literature and FDA approvals that have shaped the pharmacologic management of CINV. Topics covered will include current consensus guidelines; the use of recently approved agents such as rolapitant, netupitant, fosnetupitant, aprepitant emulsion, and granisetron extended-release injection and their emerging place in therapy; and a discussion of multiple clinical controversies that could have an impact on patient care. Practical approaches to prophylaxis and control of breakthrough CINV using brief patient cases and audience responses will enhance active learning and highlight the role of the oncology pharmacist in the management of CINV.

Michael Berger, PharmD BCOP

2:45–4:15 pm

Incoming President’s Remarks
General Session (0.1 CEU)

UAN 0465-0000-19-025-L04-P
Included in Virtual Meeting blue K

The Right to Try Investigational Anticancer Therapies (310)

In May 2018, the federal Right to Try Act of 2017 was enacted, allowing a provider and patient to work directly with a manufacturer to procure access to an investigational drug and bypass the FDA’s expanded-access program. This session will explore the rationale for the Right to Try Act and its implementation, including the applicable population, medications eligible for use, the pathway for obtaining agents, role(s) of the pharmacist, and concerns for patients, other clinicians, and society.

R. Donald Harvey, PharmD BCOP FCCP FHOPA

4:30–5:15 pm

Flipped Classroom (0.075 CEU)—Additional 0.5 CE prework available

UAN 0465-0000-19-026-L04-P
Included in Virtual Meeting blue K

Measurable Residual Disease in Hematologic Malignancies (311)

Minimal (or measurable) residual disease (MRD) is the persistence of residual malignant cells in patients during or after treatment. Various methods of quantification of MRD exist, including multiparameter flow cytometry, quantitative real-time polymerase chain reaction, and next-generation sequencing. Although MRD assessment is routinely used for certain disease states, such as chronic myelogenous leukemia, its use in clinical trials and routine practice varies for other hematologic malignancies. This session will provide information on MRD testing, including review of practical and clinical limitations of various methodologies in relation to certain disease states. The evolving role of MRD in the monitoring of patients with acute lymphocytic leukemia, acute myelogenous leukemia, and multiple myeloma will be discussed. Finally, the potential value of MRD assessment as it correlates to clinical outcomes and drug approval process will be evaluated.

Amber Clemmons, PharmD BCOP

4:30–5:15 pm

Flipped Classroom—additional (0.075 CEU)—0.5 CE prework available for live attendees

Basics of Good Question Writing (312)

UAN 0465-0000-19-027-L04-P
Not included in Virtual Meeting blue K

Writing multiple-choice questions is a necessary evil for many pharmacists, but it can be made less frustrating. The ability to write a good question is essential for assessing audience understanding and retention of important content as well as for writing items for the Board of Pharmacy Specialties (BPS) exams. Recognizing the most common issues associated with poor question-writing can enhance your ability to write a good question and make the process of creating multiple-choice questions faster and easier. In this interactive workshop, important concepts will be used to illustrate how a mediocre question can be made into a good exam item. Other tips for writing good questions will be covered, and the audience will have the opportunity to apply this knowledge in a number of examples. Additional types of question options and the style of questions for future BPS exams will also be discussed.

Christy Harris, PharmD BCOP
Casey Williams, PharmD BCOP FHOPA