Cristi Radford, MS, CGC

The biggest newsmaker at the 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO) was a compound whose name and actions sound practically missilelike: T-DM1. Because of its highly targeted and potent effect that spares surrounding healthy tissue, T-DM1 not only has potent antitumor effects but is also very well tolerated.

The drug shortage crisis is easing, but an actual solution to the problem is still elusive, according to participants in a press briefing that addressed the issue at the 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO) held in Chicago, Illinois.

Richard Schilsky, MD, chair of ASCO’s government relations committee and an oncologist at the University of Chicago, indicated, “Patient care has been threatened in many cases. But the good news is that the frequency of drug shortages is beginning to decline.”

Pharmacists are vitally important in enhancing patients’ adherence to oral chemotherapy medications, and there are approaches that pharmacies can take to improve compliance, Sylvia Bartel, RPh, told attendees of the NCCN Pharmacy Program held during the 17th Annual Conference of the National Comprehensive Cancer Network (NCCN) in Hollywood, Florida.

Antipsychotic Controls Breakthrough Nausea and Vomiting

The need to optimize the treatment of patients with cancer while using healthcare resources wisely—in other words, providing “value-based cancer care”—is not a topic of debate, but how to achieve this pressing goal is far from clear. In a panel discussion during the Association for Value-Based Cancer Care’s Second Annual Conference, held in Houston, Texas, strategists from the payer side of the issue discussed the current trends and the challenges they are facing.

Oncology pharmacists should understand the characteristics of 7 emerging drugs and biologics. At the 2012 Pharmacy Program held during the 17th Annual Conference of the National Comprehensive Cancer Network (NCCN) in Hollywood, Florida, Van Anh Trinh, PharmD, of the University of Texas MD Anderson Cancer Center, Houston, and Robert Ignoffo, PharmD, of the University of California San Francisco and the Touro University College of Pharmacy in Vallejo, described the appropriate use of axitinib, crizotinib, ipilimumab, and vemurafenib, and previewed carfilzomib, regorafenib, and vosaroxin.

Outpatient management of febrile neutropenia is appropriate for carefully selected low-risk patients, according to Ashley Morris Engemann, PharmD, Duke University Medical Center, who spoke at the 2012 Pharmacy Program held in Hollywood, Florida, during the 17th Annual Conference of the National Comprehensive Cancer Network (NCCN). Engemann noted that treating patients at home is clearly the patient’s preference and is cost saving. Risk assessment is the first step, as outpatient management is not appropriate for high-risk patients but can be considered in low-risk patients. Read More ›

“Chemotherapy-related nausea and vomiting (CINV) remains a concern despite recent advances. While the 5-HT₃ antagonists and the NK-1 antagonists reduce vomiting, nausea continues to be a persistent problem for our patients,” she said. “There will always be patients, no matter what we do, who still have problems.” Patient risk factors drive the choice of prophylaxis and dose, she said. Young age ( Read More ›

In a randomized phase 2 study of metastatic breast cancer patients, peripheral neuropathy (PN) was less likely to occur in patients receiving eribulin mesylate than with ixabepilone.

“Peripheral neuropathy is a big problem in the treatment of breast cancer. Across the spectrum, patients have it, and we don’t know how to treat it,” said Linda T. Vahdat, MD, of Weill Cornell Medical College in New York, who presented the study at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium (Poster P5-19-02).

An investigational alpha-pharmaceutical not only prevented skeletal-related events (SREs) in patients with prostate cancer with bone metastases in a phase 3 study presented at the 2011 European Multidisciplinary Cancer Congress, but it also improved overall survival. “This is the first drug targeted to bone metastases in prostate cancer to improve survival,” said lead investigator Chris Parker, MD, Royal Marsden Hospital, London. “There are other bone drugs used in prostate cancer, but they help to minimize symptoms; they don’t improve survival. Read More ›

In patients with advanced non–small cell lung cancer with ALK gene rearrangements, treatment with crizotinib provided clinically meaningful antitumor activity, producing responses in 51% of patients, in a multicenter phase 2 study reported at the 2011 European Multidisciplinary Cancer Congress.

Rearrangements in ALK are seen in up to 5% of patients, and crizotinib—a firstin- class, oral, potent, and selective small molecular—competitively inhibits ALK.

Read More ›

SAN FRANCISCO—A number of interventions can help reduce breast cancer among women at high risk, but uptake is sluggish, and there can be confusion about which agent to prescribe to a given patient. Seema Khan, MD, professor of surgery at Northwestern University Feinberg School of Medicine, Chicago, addressed the topic of pharmacologic risk reduction at the 2011 Breast Cancer Symposium.

SAN FRANCISCO—For patients with colorectal cancer (CRC), advances in molecular profiling have led to an ex - plosion in novel agents specific for targets above and beyond the epidermal growth factor receptor (EGFR). Joseph Tabernero, MD, director of clinical research at Vall d’Hebron Institute of Oncology in Barcelona, Spain, previewed the future of treatment for CRC at the 2011 Gastrointestinal Cancers Symposium.

CHICAGO—At the ASCO session “Moving the Bar in Upper GI Malignancies,” 2 speakers examined whether recent trials of targeted agents are clinically meaningful or just statistically positive, and whether value is being gained for the enormous amount of money being spent in treating noncolo rectal gastrointestinal (GI) cancer.

Eileen Mary O’Reilly, MD, of Memorial Sloan-Kettering Cancer Center, weighed in by examining the bottom line of the major trials.

ORLANDO—High-dose melphalan followed by an autologous hematopoietic stem-cell transplant is standard initial therapy for multiple myeloma; however, the toxicity and efficacy of this treatment is variable. “The sources of this variability are not well understood,” said Dan T. Vogl, MD, of the Multiple Myeloma Program at the Abramson Cancer Center in Philadelphia. “We hypothesized that variation in melphalan pharmacokinetics would explain differences in outcomes after transplant.”

SAN ANTONIO—For women with human epidermal growth factor receptor type 2 (HER2)-overexpressing breast cancer, preoperative treatment with agents that block HER2 leads to high rates of pathological complete response (pCR), according to the results of three studies.

The studies used various combinations of trastuzumab, lapatinib, and pertuzumab (a novel monoclonal antibody) in the neoadjuvant setting.

SAN ANTONIO—For women with human epidermal growth factor receptor type 2 (HER2)-overexpressing breast cancer, preoperative treatment with agents that block HER2 leads to high rates of pathological complete response (pCR), according to the results of three studies presented at the 33rd annual San Antonio Breast Cancer Symposium. 

The studies used various combinations of trastuzumab, lapatinib, and pertuzumab (a novel monoclonal antibody) in the neoadjuvant setting. 

SAN ANTONIO—A re-analysis of the Women’s Health Initiative (WHI)—which found an increased risk of breast cancer and heart disease in women taking hormone replacement therapy (HRT)—suggests that estrogen alone, without progesterone, may actually be protective against breast cancer. 

MILAN—Breakthrough pain in cancer patients can be managed easily and effectively with fentanyl pectin nasal spray (FPNS), according to new data.

FPNS can be easily titrated to an effective dose and there is little need for rescue medication, according to David Brooks, MD, of Chesterfield and North Derbyshire Royal Hospital NHS Trust in Chesterfield, United Kingdom.

MILAN—Sexual issues related to cancer and its treatment are substantial—and do not seem to be resolving with the use of new molecular targeted agents instead of endocrine therapy and chemotherapy. This conclusion can be drawn from two studies presented by investigators from Argentina and France.

MILAN—Prolonging chemotherapy until disease progression improves progression- free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer (MBC), according to a systematic analysis conducted in Italy.

The findings address an important debate in oncology, said Alessandra Gennari, MD, of Ospedali Galliera in Genova. “In metastatic breast cancer there is substantial controversy over how long chemotherapy should be continued in the absence of significant toxicity, after the achievement of disease control,” said Gennari.