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Amin S, Polley S, DeFrates S, Finnes H, Kinsman K, MacDonald E, Dean L, DeWitt L, Harvey C, Johnston S, Leung TV, Moll EA, Neill GPO, Redic KA, Park SF. National Comprehensive Cancer Network investigational drug service consensus recommendations. Am J Health Syst Pharm 2021; 79:486-491. [PMID: 34849539 DOI: 10.1093/ajhp/zxab455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Sapna Amin
- Division of Pharmacy, MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Polley
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sean DeFrates
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Heidi Finnes
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Katharine Kinsman
- University of Washington Medical Center/Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Elyse MacDonald
- Department of Pharmacy Services, Stanford Health Care, Palo Alto, CA, USA
| | - Latanya Dean
- Stanford Health Care, Department of Pharmacy Services, Palo Alto, CA, USA
| | - Lorri DeWitt
- Barnes Jewish Hospital Investigational Drug Service, St. Louis, MO, USA
| | | | | | | | - Emily A Moll
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Gerald P O' Neill
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly A Redic
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Sharon F Park
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
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Pai S, Blaisdell D, Brodie R, Carlson R, Finnes H, Galioto M, Jensen RE, Valuck T, Sepulveda AR, Kaufman HL. Defining current gaps in quality measures for cancer immunotherapy: consensus report from the Society for Immunotherapy of Cancer (SITC) 2019 Quality Summit. J Immunother Cancer 2021; 8:jitc-2019-000112. [PMID: 31949040 PMCID: PMC7057483 DOI: 10.1136/jitc-2019-000112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Quality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges. METHODS Thus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to, first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to, second, advance priority concepts surrounding quality measures that could be developed and broadly adopted by the field. RESULTS After reviewing the existing quality measure landscape employed for immunotherapeutic-based cancer care, the expert panel identified four relevant National Quality Strategy domains (patient safety, person and family-centered care, care coordination and communication, appropriate treatment selection) with significant gaps in immunotherapy-based quality cancer care delivery. Furthermore, these domains offer opportunities for the development of quality measures as they relate to cancer immunotherapy. These four quality measure concepts are presented in this consensus statement. CONCLUSIONS This work represents a first step toward defining and standardizing quality delivery of cancer immunotherapy in order to realize its optimal application and benefit for patients.
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Affiliation(s)
- Sara Pai
- Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rachel Brodie
- Performance Information, Pacific Business Group on Health, San Francisco, California, USA
| | - Robert Carlson
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - Heidi Finnes
- Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Michele Galioto
- Center for Innovation, Oncology Nursing Society, Pittsburgh, Pennsylvania, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Tom Valuck
- Discern Health, Baltimore, Maryland, USA
| | | | - Howard L Kaufman
- Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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O'Donoghue D, Truong H, Finnes H, McDonald J, Leung N. P0008CASE REPORT: METABOLIC ALKALOSIS RESULTING IN RESPIRATORY COMPROMISE IN A PATIENT UNDERGOING HIGH DOSE METHOTREXATE THERAPY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
High dose Methotrexate (HDMTX) is an important component of several modern oncological/haematological treatment protocols due to its central nervous system penetrance. Nephrotoxicity represents a significant adverse effect and can limit therapeutic options. Therefore, strategies to prevent this are paramount. Urinary alkalinisation and large volume resuscitation to maintain adequate hydration and urine output are the typical strategies. Urinary alkalinisation prevents tubular precipitation of methotrexate and therefore, a strict urinary pH target of 7 is maintained via a continuous bicarbonate infusion.
Method
We describe a case report, of Iatrogenic metabolic alkalosis leading to respiratory compromise in a patient receiving HDMTX from Mayo Clinic, Rochester.
Results
We present the case of a 76-year-old woman with a Diffuse Large B-Cell Lymphoma with CNS involvement who presented for elective admission for her 1st cycle of HDMTX. She received 7g of Methotrexate at dosing of 8 g/m2. She received the standard urinary alkalinisation with pre- and post-hydration. Her baseline HCO3- was 28 mEq/L. Her 48 hour MTX level was elevated at 1.2 so the urinary alkalinisation protocol was continued until <0.1 mcmol/L. On day 4, she developed frequent episodes of apnoea. Her ABG demonstrated a metabolic alkalaemia pH 7.54, pCO 53, pO2 91, HCO3 45. She was transferred to the ICU for close monitoring. Her bicarbonate infusion was discontinued and she received acetazolamide. Her bicarbonate improved to 31 after 12 hours. She had a significant improvement in her respiratory status with no further episodes of apnoea. Her bicarbonate infusion was restarted due to elevated MTX levels. She was discharged home with no further complications.
Conclusion
Iatrogenic Metabolic alkalosis leading to respiratory compromise represents a rare but important complication of urinary alkalinsation protocols for High-dose Methotrexate therapy.
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Affiliation(s)
| | - Heather Truong
- Mayo Clinic, Nephrology, Rochester, United States of America
| | - Heidi Finnes
- Mayo Clinic, Nephrology, Rochester, United States of America
| | | | - Nelson Leung
- Mayo Clinic, Nephrology, Rochester, United States of America
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Manohar S, Ghamrawi R, Chengappa M, Goksu BNB, Kottschade L, Finnes H, Dronca R, Leventakos K, Herrmann J, Herrmann SM. Acute Interstitial Nephritis and Checkpoint Inhibitor Therapy. ACTA ACUST UNITED AC 2020; 1:16-24. [DOI: 10.34067/kid.0000152019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Abstract
BackgroundThe objective of this case cohort study was to describe our experience in the care of patients with immune checkpoint inhibitor–related acute interstitial nephritis (ICI-AIN) including rechallenge.MethodsA descriptive case series of patients that received an ICI and had an AKI (defined as a ≥1.5-fold increase in serum creatinine) as an immune-related adverse event (irAE), with biopsy-proven or clinically suspected ICI-AIN from January 1, 2014 to December 1, 2018 at Mayo Clinic, Rochester. We studied details regarding diagnosis, clinical course, management, and outcomes of rechallenge of immunotherapy. Complete response (CR) was defined as return of kidney function back to baseline or <0.3 mg/dl above baseline creatinine; partial response (PR) was defined as creatinine >0.3 mg/dl from baseline, but less than twofold above the baseline by the end of steroid course.ResultsA total of 14 cases of biopsy-proven (35%) or clinically suspected (65%) ICI-AIN was identified. All patients had their ICI withheld and 12 patients received steroids. Steroid regimens were highly variable. The starting equivalent dose of prednisone was higher in those that had a CR versus a PR (median 0.77 mg/kg versus 0.66 mg/kg). Proton pump inhibitors (PPIs) were used in 11 patients and were stopped in eight (73%) patients at the time of the AKI event. A CR was seen in five (63%) of the eight patients who discontinued PPIs. Rechallenge was attempted in four of the 14 patients: three were successful with no recurrence of AKI, but one patient had recurrent AKI and fatal pneumonitis.ConclusionsCareful review, withholding ICI and concomitant known AIN-inducing medications, along with prompt initial steroid management were the key in complete renal kidney recovery. A kidney biopsy should be strongly considered. Rechallenge of immunotherapy after a kidney irAE, although challenging, is possible and would need careful evaluation on an individual basis.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_01_30_KID0000152019.mp3
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Yan Y, Kumar AB, Finnes H, Markovic SN, Park S, Dronca RS, Dong H. Combining Immune Checkpoint Inhibitors With Conventional Cancer Therapy. Front Immunol 2018; 9:1739. [PMID: 30100909 PMCID: PMC6072836 DOI: 10.3389/fimmu.2018.01739] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/13/2018] [Indexed: 12/29/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have recently revolutionized cancer treatment, providing unprecedented clinical benefits. However, primary or acquired therapy resistance can affect up to two-thirds of patients receiving ICIs, underscoring the urgency to elucidate the mechanisms of treatment resistance and to design more effective therapeutic strategies. Conventional cancer treatments, including cytotoxic chemotherapy, radiation therapy, and targeted therapy, have immunomodulatory effects in addition to direct cancer cell-killing activities. Their clinical utilities in combination with ICIs have been explored, aiming to achieve synergetic effects with improved and durable clinical response. Here, we will review the immunomodulatory effects of chemotherapy, targeted therapy, and radiation therapy, in the setting of ICI, and their clinical implications in reshaping modern cancer immunotherapy.
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Affiliation(s)
- Yiyi Yan
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Heidi Finnes
- Department of Pharmacy, Mayo Clinic, Rochester, MN, United States
| | | | - Sean Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Roxana S Dronca
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Haidong Dong
- Department of Immunology, Mayo Clinic, Rochester, MN, United States.,Department of Urology, Mayo Clinic, Rochester, MN, United States
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Kao JC, Liao B, Markovic SN, Klein CJ, Naddaf E, Staff NP, Liewluck T, Hammack JE, Sandroni P, Finnes H, Mauermann ML. Neurological Complications Associated With Anti-Programmed Death 1 (PD-1) Antibodies. JAMA Neurol 2017; 74:1216-1222. [PMID: 28873125 DOI: 10.1001/jamaneurol.2017.1912] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Neurological complications are an increasingly recognized consequence of the use of anti-programmed death 1 (PD-1) antibodies in the treatment of solid-organ tumors, with an estimated frequency of 4.2%. To date, the clinical spectrum and optimum treatment approach are not established. Objective To investigate the frequency, clinical spectrum, and optimum treatment approach to neurological complications associated with anti-PD-1 therapy. Design, Setting, and Participants This single-center, retrospective cohort study was conducted from either September or December 2014 (the approval dates of the study drugs by the US Food and Drug Administration) to May 19, 2016. All patients receiving anti-PD-1 monoclonal antibodies were identified using the Mayo Cancer Pharmacy Database. Patients with development of neurological symptoms within 12 months of anti-PD-1 therapy were included. Patients with neurological complications directly attributable to metastatic disease or other concurrent cancer-related treatments were excluded. Main Outcomes and Measures Clinical and pathological characteristics, time to development of neurological symptoms, and modified Rankin Scale (mRS) score. Results Among 347 patients treated with anti-PD1 monoclonal antibodies (pembrolizumab or nivolumab), 10 (2.9%) developed subacute onset of neurological complications. Seven patients were receiving pembrolizumab, and 3 patients were receiving nivolumab. The patients included 8 men and 2 women. Their median age was 71 years (age range, 31-78 years). Neurological complications occurred after a median of 5.5 (range, 1-20) cycles of anti-PD-1 inhibitors. Complications included myopathy (n = 2), varied neuropathies (n = 4), cerebellar ataxia (n = 1), autoimmune retinopathy (n = 1), bilateral internuclear ophthalmoplegia (n = 1), and headache (n = 1). Peripheral neuropathies included axonal and demyelinating polyradiculoneuropathies (n = 2), length-dependent neuropathies (n = 1), and asymmetric vasculitic neuropathy (n = 1). The time to maximum symptom severity varied from 1 day to more than 3 months. The median mRS score was 2.5 (range, 1-5), indicating mild to moderate disability. Five patients experienced other systemic immune-mediated complications, including hypothyroidism (n = 3), colitis (n = 2), and hepatitis (n = 1). Treatment with anti-PD-1 antibodies was discontinued in 7 patients. Treatment included corticosteroids (n = 7), intravenous immunoglobulin (n = 3), and plasma exchange (n = 1). Nine patients improved, with a median mRS score of 2 (range, 0-6). One patient with severe necrotizing myopathy died. Conclusions and Relevance Neurological adverse events associated with anti-PD-1 therapy have a diverse phenotype, with more frequent neuromuscular complications. Although rare, they will likely be encountered with increasing frequency as anti-PD-1 therapy expands to other cancers. The time of onset is unpredictable, and evolution may be rapid and life-threatening. Prompt recognition and discontinuation of anti-PD-1 therapy is recommended. In some cases, immune rescue treatment may be required.
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Affiliation(s)
- Justin C Kao
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Bing Liao
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Heidi Finnes
- Pharmacy Services, Mayo Clinic, Rochester, Minnesota
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Sonbol MB, Rana V, Kenderian SS, Finnes H, Witzig TE. Therapeutic options for patients with lymphoma and liver dysfunction or failure during mechlorethamine shortage. Leuk Lymphoma 2013; 55:1815-21. [DOI: 10.3109/10428194.2013.828349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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