Web Exclusives

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.”


Imatinib (Gleevec) revolutionized the treatment of Philadelphia chromosome– positive chronic myeloid leukemia (CML) and established targeting and inhibiting BCR-ABL as the standard of care.1 In 2009, 8-year follow- up data from the landmark phase 3 IRIS (International Randomized Study of Interferon Versus STI571) trial were presented for the 553 patients with newly diagnosed chronic-phase (CP) CML randomized to imatinib.

Maintenance therapy has begun to emerge as a treatment standard for patients with non–small cell lung cancer (NSCLC) whose disease has not progressed after 4 to 6 cycles of frontline chemo therapy. But some caveats still apply. Although it may be suitable for fit, motivated patients who are highly symptomatic at the time of presentation, it is not yet clear if maintenance therapy should be routine.

The National Cancer Institute set out to answer this question last year and published results of their investigation in the January 2011 issue of the Journal of the National Cancer Institute. The study’s authors point to flaws in previous cancer cost estimates, many of which did little more than take figures from 15 years ago and adjust them for inflation.

The following is a list of drugs commonly used for patients with cancer that the American Society of Health-System Pharmacists (ASHP) classified as being in short supply in March. For some drugs, only certain doses or preparations are unavailable. Most shortages are attributable to manufacturing delays and/or increased demand. In some cases, the manufacturer discontinued the drug or offered no explanation for the short supply. A couple (ie, capecitabine [Xeloda] tablets and dexamethasone sodium phosphate) have been voluntarily recalled because of contamination concerns.

APP Pharmaceuticals has issued a voluntary recall of 5 lots of irinotecan hydrochloride injection (Camptosar) as a precautionary measure. No adverse events related to the recalled products have been reported. The following lots have been recalled:

ANAHEIM—Pharmacist assessment of palonosetron use for the prevention of emesis associated with chemotherapy has the potential to capture inappropriate use and result in cost savings, said John P. Jezak, PharmD.

ANAHEIM—Overweight as well as obese chemo therapy recipients who are dosed according to total body weight do not experience more adverse drug events or cycle delays than normal weight recipients.

The finding, which comes from a 10-year retrospective analysis of patients with gastrointestinal (GI) cancers, should allay concerns about overdosing and the potential for increased toxicities when calculating the chemotherapy dose using total body weight, said lead investigator Tiffany Dea, PharmD.

ANAHEIM—A new process for handling oral chemotherapy medications that delineates prescriber privileges may help to avert errors or drug–drug interactions, said Brian L’Heureux, PharmD.

On August 1, 2010, at Suburban Hospital in Bethesda, Maryland, a new procedure for processing oncology orders was implemented, said L’Heureux, an oncology pharmacy resident.

Under the new system, oncologyspecific medications have to be ordered by prescribers with delineated privileges using a specific chemotherapy order form.

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