TOP - September 2012, Vol 5, No 6

On July 20, 2012, the FDA granted accelerated approval to carfilzomib injection (Kyprolis; Onyx Pharmaceuticals) for the treatment of patients with multiple myeloma who have received at least 2 prior therapies, including bortez­omib and an immunomodulatory agent, and who have demonstrated disease progression on or within 60 days of the completion of their last therapy.

Two studies presented at the 2012 American Society of Clinical Oncology (ASCO) Annual Meet­ing suggested that abiraterone acetate (AA; Zytiga), an androgen biosynthesis inhibitor,¹ has the potential to be used earlier in the course of prostate cancer than its current US Food and Drug Administration (FDA) indication (ie, after failure of chemotherapy in men with metastatic castration-resistant prostate cancer [CRPC]). A second interim analysis of a phase 3 trial had positive outcomes with AA in men with metastatic CRPC who had not yet received chemotherapy,¹ and a preliminary phase 2 study suggested AA may have a role in the neoadjuvant setting before radical prostatectomy is performed in men with early-stage localized high-risk prostate cancer.² In addition, secondary results from the AFFIRM trial confirmed the superiority of enzalutamide to placebo in men with CRPC following treatment with docetaxel.³

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts due to both increased platelet destruction and suboptimal platelet production.¹ Many therapies are aimed at reducing platelet destruction.² Treatments aimed at increasing platelet production, alone or in combination with existing therapies, provide an opportunity to improve outcomes in patients with ITP.² The thrombopoietin mimetic Nplate^® (romiplostim) is an Fc-peptide fusion protein that stimulates platelet production by binding the thrombopoietin receptor, thereby increasing the body’s natural production of platelets.³ Nplate^® is a thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in patients with chronic ITP who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. Nplate^® is not indicated for the treatment of thrombocytopenia due to myelodysplastic syndrome (MDS) or any cause of thrombocytopenia other than chronic ITP. Nplate^® should be used only in patients with ITP whose degree of thrombocytopenia and clinical condition increase their risk for bleeding. Nplate^® should not be used in an attempt to normalize platelet counts.

Although the 10-year survival rate for prostate cancer is 98%, the disease is still the second leading cause of cancer death for men in the United States. With each new treatment developed, vaccine examined, and screening test created, scientists draw closer to the day when the survival rate for all patients with prostate cancer will be 100%. The following numbers reflect today’s prostate cancer statistics.

SG is a 29-year-old female, recently married, who was referred to the hematology clinic due to a platelet count of 11 × 10⁹/L. Additionally, she recently had 3 nosebleeds and heavy menstrual bleeding. She had dismissed them as another sign of stress from her hectic schedule, including her recent wedding, teaching full-time, and evening graduate school. A detailed and extensive review of her history and physical, serum chemistries, CBC, and peripheral smear does not reveal any potential underlying causes for her thrombocytopenia. She is negative for HCV and HIV, and her blood type is AB negative. Because her platelet count is <100 × 10⁹/L without an identifiable cause, she is diagnosed with primary immune thrombocytopenia. What are considerations for appropriate first-line therapy?

Motor toxicities of chemotherapy-induced peripheral neuropathy (CIPN) are likely to lead to falls, deficits in physical performance (PP), and functional losses, according to a substudy of a phase 3 clinical trial in patients with CIPN reported at the 2012 Annual Meeting of the American Society of Clinical Oncology.¹

Men diagnosed with low-risk prostate cancer are more likely to choose active surveillance as their primary treatment if their care is managed by a multidisciplinary team, according to a recent study (Aizer AA, et al. J Clin Oncol. 2012;30:3071-3076).

In this month’s issue of The Oncology Pharmacist (TOP), we explore the growth of specialty pharmacies and the implications for our relationship with patients. Author Lea Ann Hansen discusses the evolution of specialty pharmacy and the function it serves in the treatment of cancer and how this affects patients. As Hansen points out in her article, “In many cases, the complicated nature of administration or possible adverse events with specialty drugs necessitate intensive patient monitoring.”

The evolution of drug research and development toward oral therapies for cancer over the past decade has created a number of questions for the oncology healthcare provider. Will insurance companies pay for these exceptionally expensive medications? How and when will patients receive their medication? Who will be responsible for ensuring patient education and monitoring to maximize safe drug administration and patient compliance? In the accompanying article, Dr Hansen builds a case for specialty pharmacy providers (SPPs) to assume these responsibilities in a marketplace increasingly focused on reducing drug costs while also remaining committed to pharmacovigilance. When appropriately utilized, the SPP can become a benefit to the healthcare team and an additional resource at the disposal of the oncology pharmacist.

The past decade has seen a dramatic upsurge in the utilization of specialty pharmacies for all types of therapeutic modalities, including those for cancer. The cost of cancer care may rise from about $125 billion in 2010 to $207 billion by the end of the decade. By that time, specialty drugs are predicted to account for 2 of every 5 pharmacy dollars spent.¹ The purpose of this article is to explain the evolution of the specialty pharmacy and the functions it can serve in the treatment of cancer and to discuss the potential benefits and challenges of the system from the point of view of the patient.