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Truong J, Yeung SST, Kletas V, de Lemos M, Schaff K, Nakashima L. Utilization and toxicity patterns of 2-weekly (Q2W) versus 4-weekly (Q4W) nivolumab for treatment of adjuvant and metastatic melanoma at BC cancer. J Oncol Pharm Pract 2023:10781552231199048. [PMID: 37654194 DOI: 10.1177/10781552231199048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Nivolumab, an immune checkpoint inhibitor used to treat several malignancies, is associated with immune-related adverse events (IrAEs). Original dosing for melanoma was 3 mg/kg (maximum 240 mg) every 2 weeks (Q2W). Based on simulation studies depicting similar efficacy and toxicity to original dosing, extended interval dosing of 6 mg/kg (maximum 480 mg) every 4 weeks (Q4W) was introduced. OBJECTIVE This study will compare safety between Q2W and Q4W dosing at BC Cancer in melanoma patients. METHODS Retrospective chart review for reported incidence, onset, and severity of IrAEs in melanoma patients treated with nivolumab Q2W and Q4W dosing was completed. Fisher's test was conducted for first incidence IrAEs using Microsoft Excel. RESULTS Seventy-one patients were identified (Q2W n = 35, Q4W n = 36). Baseline characteristics were similar in both groups. No statistically significant difference was found in incidence of IrAEs between Q2W and Q4W dosing (Q2W 40% vs Q4W 50%, p = 0.477). Rash was most common (Q2W 79% vs Q4W 50%) followed by hypothyroidism (Q2W 33% vs Q4W 20%). Median onset of IrAEs seemed later with Q4W dosing (Q2W cycle 1 vs Q4W cycle 4). Regardless of dosing, most IrAEs were grade 1-2 in severity (Q2W 100% vs Q4W 89%). CONCLUSION Q4W dosing is associated with comparable incidence and potentially later onset of IrAEs compared to Q2W dosing. Most IrAEs in both dosing groups were similar and mild. Therefore, Q4W dosing offers a safe alternative to Q2W dosing while providing benefits including decreased workload for staff, decreased clinic visits, and viral exposure by patients.
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Walker A, Chan A, Labra CC, de Lemos ML, Geirnaert M, Albert-Marí MA, Atik EA, Borlagdan J, Crespo A, Danilak M, Kandemir EA, Lim C, Alabelewe RM, Mutiara R, Tewthanom K, Yim B, Nakashima L. International society of oncology pharmacy practitioners (ISOPP) position statement: The role of oncology pharmacy practitioners in immunotherapy treatment with immune checkpoint inhibitors for malignant conditions. J Oncol Pharm Pract 2022:10781552221090199. [PMID: 35382638 DOI: 10.1177/10781552221090199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oncology pharmacists, pharmacy technicians and assistants are key members of the multidisciplinary health care team (MHT) caring for patients receiving immunotherapy with immune checkpoint inhibitors. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on the role of oncology pharmacy practitioners in caring for patients receiving immune checkpoint inhibitors.Four key recommendations were identified: 1) participation as an integrated, collaborative member of the MHT;2) provision of education and training for patients, students, residents, fellows and other members of the MHT;3) involvement in clinical governance to optimise the use of immune checkpoint inhibitors and4) involvement in research and development in the field of immunotherapy.In summary, oncology pharmacy practitioners play essential roles within the MHT in caring for patients receiving immune checkpoint inhibitors.
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Affiliation(s)
- Andrew Walker
- 4014The Calderdale And Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, 8788University of California, Irvine, California, USA
| | | | | | | | | | | | - Jared Borlagdan
- 6684Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Crespo
- 573450Cancer Care Ontario (Ontario Health), Toronto, Ontario, Canada
| | | | | | - CheaXin Lim
- 60294The Brunei Cancer Centre, Bandar Seri Begawan, Brunei Darussalam
| | | | - Rina Mutiara
- 364090Drcipto Mangunkusumo Hospital, Dki Jakarta, Indonesia
| | - Karunrat Tewthanom
- Faculty of Pharmacy, 93820Silpakorn University, Meaung, NakhonPathom, Thailand
| | - Barbara Yim
- 25430JHS Hospital of Cook County, Chicago, Illinois, USA
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Lee C, Markarian A, Ladha F, Nakashima L, de Lemos M, Schaff K, Woo S, Gerrie A. Real-world incidence of venetoclax toxicities in British Columbia. J Oncol Pharm Pract 2022:10781552221084616. [DOI: 10.1177/10781552221084616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Venetoclax is used to treat relapsed/refractory chronic lymphocytic leukemia (r/r CLL). Tumour lysis syndrome (TLS) is a serious toxicity associated with venetoclax, and real-world studies suggest that the incidence may be higher than in clinical trials. The purpose of this study is to describe the incidence of venetoclax toxicities in British Columbia (BC). Methods Retrospective review of electronic medical charts for patient characteristics and clinical outcomes of patients treated with venetoclax for r/r CLL in BC. Patients were classified according to their risk for developing TLS. The incidence of TLS was categorized based on laboratory metrics or clinical diagnosis. Other non-TLS toxicities were also collected. Results Of 33 patients identified, 40%, 33%, and 27% were at low, intermediate, and high risk for TLS, respectively. Laboratory TLS occurred in 1/33 patients (3%), and no clinical TLS was reported. Grade 3 or 4 toxicities occurred in 19/33 patients (58%). Of these, neutropenia was the most common, occurring in 16 patients (84%) followed by thrombocytopenia, which occurred in 8 patients (42%). Conclusions The incidence of TLS in patients treated with venetoclax for r/r CLL in BC was lower than in other real-world studies. Findings may warrant further investigation to determine if the higher incidence of TLS in real-world reports may be mitigated through modifying TLS risk categorization and associated prophylactic measures. Neutropenia was the most common grade 3 or 4 venetoclax toxicity reported, and the incidence in BC is comparable to other centres.
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Fazel SS, Keefe A, Shareef A, Palmer AL, Brenner DR, Nakashima L, Koehoorn MW, McLeod CB, Hall AL, Peters CE. Barriers and facilitators for the safe handling of antineoplastic drugs. J Oncol Pharm Pract 2021; 28:1709-1721. [PMID: 34612752 DOI: 10.1177/10781552211040176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Antineoplastic drugs are widely used in the treatment of cancer. However, some are known carcinogens and reproductive toxins, and incidental low-level exposure to workers is a health concern. CAREX Canada estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in workplace settings. While policies and guidelines on safe handling of antineoplastic drugs are available, evidence suggests that compliance is low. In this paper, we identify barriers and facilitators for safe handling of antineoplastic drugs in workplace settings. METHODS We utilized a unique method to study public policy which involved compiling policy levers, developing a logic model, conducting a literature review, and contextualizing data through a deliberative process with stakeholders to explore in-depth contextual factors and experiences for the safe handling of antineoplastic drugs. RESULTS The most common barriers identified in the literature were: poor training (46%), poor safety culture (41%), and inconsistent policies (36%). The most common facilitators were: adequate safety training (41%), leadership support (23%), and consistent policies (21%). Several of these factors are intertwined and while this means one barrier can cause other barriers, it also allows healthcare employers to mitigate these barriers by implementing small but meaningful changes in the workplace. CONCLUSION The combination of barriers and facilitators identified in our review highlight the importance of creating work environments where safety is a priority for the safe handling of antineoplastic drugs. The results of this study will assist policy makers and managers in identifying gaps and enhancing strategies that reduce occupational exposure to antineoplastic drugs.
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Affiliation(s)
- Sajjad S Fazel
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Arshiya Shareef
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada
| | - Alison L Palmer
- CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Darren R Brenner
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mieke W Koehoorn
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Chris B McLeod
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Amy L Hall
- 142123Government of Canada, Charlottetown Prince Edward Island, Canada
| | - Cheryl E Peters
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Jang A, Nakashima L, Ng T, Fung M, Jiwani S, Schaff K, Suess J, Goncalves R, Jang D, Kuik K, Labelle S, Pow A. A real-world data approach to determine the optimal dosing strategy for pembrolizumab. J Oncol Pharm Pract 2020; 27:635-643. [PMID: 32539663 DOI: 10.1177/1078155220929756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cancer drug therapy costs continue to rise and threaten the sustainability of Canada's public healthcare system. Previous studies have calculated potential savings utilizing different dosing regimens of cancer treatments. Our objectives were to determine the financial impact of drug wastage and to explore cost-effective dosing regimens for pembrolizumab. METHODS This was a retrospective study reviewing data for non-small cell lung cancer and melanoma patients at all six BC Cancer Regional Centres during fiscal years 2017 and 2018. Pembrolizumab waste amounts recorded in pharmacy wastage logs were totalled. Estimates of the number of vials used were compared between vial sharing and non-vial sharing practices to determine the cost differences. Costs for dosing regimens used during fiscal years 2017 and 2018 were compared to 2 mg/kg weight-based dosing (to a maximum of 200 mg), 2 mg/kg dosing rounding down within 5% and 10%, and flat dosing of 200 mg. RESULTS There were a total of 202 non-small cell lung cancer and 182 melanoma patients with 2948 doses dispensed. Documented wastage was valued at $1,829,047.44 (8.65%) and across all six centres, vial sharing could reduce costs by $3,207,600.00 using the 100 mg vials. Compared to fiscal years 2017 and 2018, 2 mg/kg dosing (to a maximum of 200 mg) was the most cost-effective, decreasing costs by $222,719.20; flat dosing of 200 mg was the most expensive, increasing costs by $6,625,260.40. CONCLUSIONS Having smaller vial sizes, practicing vial sharing, and using weight-based dosing all improve cost savings. Further investigations on the allocation of resources to optimize drug use and minimize wastage are needed.
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Affiliation(s)
- Ashley Jang
- Provincial Pharmacy, BC Cancer, Vancouver, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | | | - Tonya Ng
- Provincial Pharmacy, BC Cancer, Vancouver, Canada
| | - Mayo Fung
- Provincial Pharmacy, BC Cancer, Vancouver, Canada
| | | | | | | | | | - Dennis Jang
- Provincial Pharmacy, BC Cancer, Vancouver, Canada
| | | | | | - Alison Pow
- Provincial Pharmacy, BC Cancer, Vancouver, Canada
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Abstract
This article will provide an overview of the evolving nature of cancer treatment, the benefits and challenges of these new treatments, and the leadership strategies required to manage the evolution from a system perspective. The number and complexity of novel cancer therapies, while offering improved patient outcomes, has become a challenge for the healthcare system due to the high cost of these new therapies. In Canada, the implementation of the pan-Canadian Oncology Drug Review and the pan-Canadian Pharmaceutical Alliance helps to streamline the review and negotiating process and to ensure consistency across provinces. Strategies to support these processes include ensuring safe patient treatment, patient counselling, clinician education, and practice innovation.
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Moore M, Nakashima L. Erratum in the Cancer Drug Manual, 2nd Edition. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529700300109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marianne Moore
- British Columbia Cancer Agency, Vancouver Cancer Centre Department of Pharmacy 600 West 10th Avenue Vancouver, British Columbia, Canada V5Z 4E6
| | - Lynne Nakashima
- Clinical Services British Columbia Cancer Agency, Vancouver Cancer Centre Department of Pharmacy 600 West 10th Avenue Vancouver, British Columbia, Canada V5Z 4E6
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Spina S, Nakashima L, Swenerton K. A retrospective review of gemcitabine use in advanced epithelial ovarian cancer. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529900500405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In North America, epithelial ovarian cancer (EOC) is the fifth most common cause of cancer death among women. Many drugs are used in the treatment of EOC, with gemcitabine showing recent promise. The objective of this study was to determine whether gemcitabine is a beneficial treatment option for patients with EOC. Methods. The charts of 20 heavily pretreated women (median: four previous treatment protocols, range: 1-6) with a histological diagnosis of EOC were retrospectively reviewed to determine response. Eligible patients were treated with gemcitabine at a starting dose of 800 mg/m2 as an intravenous infusion on days 1, 8, and 15 of each 28-day cycle. The patients had a median age of 56 years (range 37-81). Results. Response to treatment was assessed both clinically and serologically (CA-125 tumor marker was monitored). Of the 20 enrollees, 17 were evaluable clinically and 16 were evaluable serologically (2 were not evaluable by either technique). There were two (12%) patients with a clinical partial response, six (35%) patients with clinical stable disease, nine (53%) patients with clinical progressive disease, and three patients that were not evaluable clinically. There were four (25%) patients with sero-logical partial response, six (38%) patients with stable serological disease, six (38%) patients with serological progressive disease, and four patients that were not evaluable serologically. Physician-reported toxicity included fatigue; however, this information was recorded inconsistently. Conclusion. Gemcitabine showed modest activity in heavily pretreated EOC with a 12% clinical partial response rate and a 25% serological partial response rate. No serious toxicities were encountered.
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Affiliation(s)
- Sean Spina
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
| | - Lynne Nakashima
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
| | - Ken Swenerton
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
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Abstract
Hypercalcemia is a common complication of cancer and occurs in 10—20% of patients. Although treatment of the underlying cancer is the optimal therapy, this may not be prac tical or available for many patients. This re port details our approach to the management of hypercalcemia at the British Columbia Can cer Agency, Vancouver Cancer Centre. The recommended approach to therapy is hydra tion followed by pamidronate and if needed, calcitonin. If no response is noted, plicamy cin may be used as a second line agent. In patients with multiple myeloma and lym phoma, prednisone is also suggested.
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Affiliation(s)
- Lynne Nakashima
- B.C. Cancer Agency, Vancouver Cancer Centre, Pharmacy Department, Vancouver, British Columbia, Canada
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10
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Nakashima L, Keller O, Speck S, Swenerton K. Significant hypersensitivity with paclitaxel managed by a 50 hour infusion. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529500100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paclitaxel is a new antineoplastic agent isolated from the bark of the Western Yew tree. It can be associated with hypersensitivity reactions. Usually these reactions are prevented through the use of a premedication regimen including dexamethasone, diphenhydramine, and cimetidine. Some patients, however, have difficulty tolerating the paclitaxel despite premedication. We report the case of a patient who developed a hypersensitivity reaction to paclitaxel. We were able to administer the paclitaxel by extending the infusion time to ap proximately 50 hours. This strategy could poten tially be used for patients whose hypersensitivity reaction appears rate related.
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Affiliation(s)
| | - Oliver Keller
- Department of Medical Oncology, Vancouver Cancer Centre
| | | | - Kenneth Swenerton
- Department of Gynecological Oncology Affiliation, BC Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia
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11
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de Lemos ML, John L, Nakashima L, O'Brien RK, Taylor SCM. Advising Cancer Patients on Natural Health Products— A Structured Approach. Ann Pharmacother 2004; 38:1406-11. [PMID: 15252195 DOI: 10.1345/aph.1e062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Many patients with cancer (45–60%) use natural health products (NHPs). Pharmacists often find it difficult to advise these patients effectively. OBJECTIVE: To explore pharmacists' perceptions of the information needed to advise cancer patients on NHPs and develop a structured counseling approach. METHODS: A qualitative study was conducted using a focus group of pharmacists from an integrated cancer care organization in Canada. The outcome measures were the definitions of and reasons for the information needed to advise patients on NHPs and a counseling approach using laymen terms. RESULTS: Eight focus group sessions took place, from which 6 categories of information emerged: role of the advisor, evaluation of evidence, assessment of efficacy, assessment of toxicity, monitoring parameters, and provision of a closure. A patient counseling approach was developed based on this information. CONCLUSIONS: The findings provided a description of and rationale for categories of information needed to advise cancer patients on NHPs. A structured, step-by-step approach to counseling these patients was developed.
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Affiliation(s)
- Mário L de Lemos
- Provincial Systemic Therapy Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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12
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Spina S, Nakashima L, Swenerton K. A retrospective review of gemcitabine use in advanced epithelial ovarian cancer. J Oncol Pharm Pract 1999. [DOI: 10.1191/107815599678840507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Gelmon KA, Tolcher A, O'Reilly S, Campbell C, Bryce C, Shenkier T, Ragaz J, Ayers D, Nakashima L, Rielly S, Dulude H. A phase I-II study of bi-weekly paclitaxel as first-line treatment in metastatic breast cancer. Ann Oncol 1998; 9:1247-9. [PMID: 9862057 DOI: 10.1023/a:1008445123416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Single-agent bi-weekly paclitaxel was studied as first-line metastatic treatment for breast cancer in a phase I-II trial. PATIENTS AND METHODS Thirty-eight women with metastatic breast cancer were enrolled. Thirty-seven are evaluable for toxicity, 35 for response. RESULTS The MTD was defined at 160 mg/m2 q two weeks with dose limiting toxicity in two patients consisting of hematological toxicity (1) and neurotoxicity (2). Twenty patients were treated at 150 mg/m2, the recommended dose. Response rates were two CRs and nine PRs (overall 61%) at the RD of 150 mg/m2 and three CRs and 11 PRs for an overall RR of 67% for the two top doses. CONCLUSIONS The good drug tolerance, response rates, and convenience over weekly treatment suggest this may be a worthwhile regimen.
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Affiliation(s)
- K A Gelmon
- British Columbia Cancer Agency, Vancouver Centre, Canada
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Gelmon KA, O'Reilly SE, Tolcher AW, Campbell C, Bryce C, Ragaz J, Coppin C, Plenderleith IH, Ayers D, McDermott B, Nakashima L, Healey D, Onetto N. Phase I/II trial of biweekly paclitaxel and cisplatin in the treatment of metastatic breast cancer. J Clin Oncol 1996; 14:1185-91. [PMID: 8648373 DOI: 10.1200/jco.1996.14.4.1185] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To determine the maximum-tolerated dose of escalating doses of paclitaxel (Taxol; Bristol-Myers Squibb, Princeton, NJ) administered biweekly with a fixed dose of cisplatin, to assess the toxicity, and to evaluate the activity of this combination in a phase I/II trial in metastatic breast cancer. PATIENTS AND METHODS Twenty-nine women with metastatic breast cancer were enrolled; 27 were assessable for response and 29 for toxicity. All but two of the women had received prior adjuvant chemotherapy, with 23 receiving anthracyclines and six previous cisplatin. RESULTS The initial starting dose of paclitxel 90 mg/m2 and cisplatin 60 mg/m2 became the phase II dose due to dose-limiting neutropenia. Responses were seen in 85% of assessable patients, with three patients (11%) achieving a complete response (CR) and 20 patients (14%) a partial response (PR), for an overall response rate of 85% (95% confidence interval [CI], 66% to 96%). The time to disease progression for patients who achieved a CR was 110 to 200 days, and for those with a PR, it was 96 to 377+ days, with a median time to progression of 7.1 months and a median response duration of 7.9 months. Sites of CR were skin, soft tissue, and lung, and all occurred in women with previous exposure to anthracyclines. Septic events were rare, with two grade 3 infections (7%), only one of which required hospital admission. There were no grade 4 nonhematologic toxicity and minimal grade 3 toxicity. A total of 251 chemotherapy cycles were given -- 16 with paclitaxel alone in five patients. Forty-five percent of patients required dose reductions, while 52% had delays due to neutropenia. CONCLUSION Biweekly paclitaxel and cisplatin is an active combination in the treatment of metastatic breast cancer, including for patients with previous exposure to anthracyclines.
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Affiliation(s)
- K A Gelmon
- British Columbia Cancer Agency, Vancouver, Canada
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15
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Osoba D, Warr DG, Fitch MI, Nakashima L, Warren B. Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus. Can J Oncol 1995; 5:381-400. [PMID: 8853513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nausea and vomiting are the most frequently reported adverse effects of cancer chemotherapy and have a significant impact on patients' daily functioning, quality of life and compliance with chemotherapy. Summarized in this article are the recommendations for the optimal management of nausea and vomiting developed by a multidisciplinary group of health care professionals. Issues relating to chemotherapy-induced nausea and vomiting are discussed; general principles of treatment are reviewed; treatment algorithms based on emetogenicity and types of chemotherapy are presented; and the importance of issues including non-pharmacological approaches, patient education and pharmacoeconomic perspectives are considered. The goal of antiemetic therapy should be no episodes of vomiting or retching and minimal or no nausea. Data from clinical trials support the clear superiority of 5-HT3 receptor antagonists in a variety of clinical situations. Their cost must be considered not only as an isolated item from the institutional perspective, but also from the perspective of the impact of successful therapy on the patient.
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Affiliation(s)
- D Osoba
- Department of Medicine, University of British Columbia, Vancouver
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16
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Nakashima L, Edwards DL. Treatment of Kawasaki disease. Clin Pharm 1990; 9:755-62. [PMID: 2242655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The epidemiology, etiology, diagnosis, and treatment of Kawasaki disease are reviewed. Kawasaki disease, or mucocutaneous lymph node syndrome, is an acute, usually self-limiting, multiple-organ-system disease of childhood that occurs both epidemically and endemically worldwide. The etiology of the disease is unknown but may involve an infectious agent. To be diagnosed, a patient must be febrile for at least five days and show four of five additional clinical features: bilateral conjunctivitis, changes in the oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. The most important complications are cardiac; patients may develop aneurysms or thrombosis of the coronary arteries or myocarditis. Other complications include arthritis, conjunctivitis, and hydrops of the gallbladder. Aspirin, intravenous immune globulin, corticosteroids, and antithrombotic agents have been investigated for use in the treatment of Kawasaki disease with varying results. Current recommendations suggest therapy with aspirin 80-100 mg/kg/day every six hours for the first 14 days after diagnosis and intravenous immune globulin 400 mg/kg/day for the first four days. The dose of aspirin should then be reduced and continued for six to eight weeks if no coronary artery abnormalities are present. Treatment guidelines for Kawasaki disease are being refined. Current evidence supports early use of aspirin and intravenous immune globulin to prevent cardiac complications.
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Affiliation(s)
- L Nakashima
- Clinical Pharmacy Services, British Columbia Cancer Agency, Vancouver, Canada
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