Oncopharmpod

Topics on this week's Pod include: -Lurbinectedin in SCLC -Nivolumab is esophageal cancer -Pembrolizumab for TMB-high cancers -Gemtuzumab ozogamicin for pediatric AML -Venetoclax + HMA for adult (unfit) AML -Gardasil for prevention of SCCHN -Perhaps the biggest non-oncopharm news of the year?

LD Vs Ld by John Bossaer

Recapping lots of updates from ASCO 2020. Then (20:00) we chat with Shannon Hough, oncology pharmacy specialist, to talk about her ASCO abstract (https://meetinglibrary.asco.org/record/185996/abstract) on pharmacist interventions in managing CINV.

Another week, another two new approved indications in NSCLC. We cover Checkmate-9La (Nivo/Ipi + 2 cycles of chemo) and ALTA-1L (1st Line brigatinib in ALK-rearranged NSCLC). Finally, we cover an interesting case report highlighting the need to determine CNS penetration of kinase inhibitors. (Lots of ASCO talk *next* week!)

There are 2 new Immunotherapy (without chemo) options for untreated metastatic NSCLC. We try to make sense of this evolving landscape. Then, we run through the latest TKI, ripretinib. Finally, we discuss a new approval for Kaposi sarcoma and our obligatory PARP inhibitors update of the week.

We now have a RET inhibitor, selpercatinib. This new drug for NSCLC and thyroid cancer is discussed as well as RET in general as a target. Then, we cover olaparib's latest approval for use in conjunction WITH bevacizumab for maintenance in HRD ovarian cancer based on PAOLA-1 (19:30). Finally, we run through IMBrave 150 (atezolizumab + bevacizumab) which may establish a new standard of care in HCC (22:20) and briefly discuss olanzapine for cancer-associated N/V and Ivosidenib for IDH1-mutated cholangiocarcninoma. RET fusions: https://doi.org/10.1016/j.ctrv.2019.101911 PAOLA-1: https://www.nejm.org/doi/full/10.1056/NEJMoa1911361 IMbrave150: https://www.nejm.org/doi/full/10.1056/NEJMoa1915745 Olanzapine: https://jamanetwork.com/journals/jamaoncology/article-abstract/2765323 Ivosidenib in cholangiocarcinoma: https://doi.org/10.1016/S1470-2045(20)30157-1

First, we discuss the FDA approval of daratumumab hyaluronidase for subcutaneous administration and compare its administration to SC administration of rituximab hyaluronidase and trastuzumab hyaluronidase. We end by discussing the 1st FDA-approved drug for MET exon 14 skipping mutations, capmatinib. We also discuss how a receptor tyrosine kinase could skip.

Topics of discussion: Q 6 week pembrolizumab dosing schedule FDA approved Updates on possible PARP inhibitor use. Niraparib for ovarian maintenance. Olaparib in prostate cancer (5:28) The monarcHER study of abemaciclib in HER+ MBC (12:20) The GRIFFIN study of Dara+VRD in myeloma (17:00)

Five (5!) new #oncopharm products to discuss. First, sacituzumab govitecan. Then, (9:30) tucatinib. Finally, (18:40) mitomycin gel, pemitgatinib, and selumetinib.

Our 1st Journal Club. 1. Read this: https://www.futuremedicine.com/doi/10.2217/fon-2018-0787 2. Ask how, or if, this would change practice. 3. Listen.

First, we run through 4 recent FDA-approved expanded indications for HCC, small cell lung cancer, MDS-related anemia, and BRAF-v600e-mutated colorectal cancer. Then, we review the evidence that warranted bevacizumab's FDA-approval for metastatic breast cancer way back in 2008 (E2100) and its subsequent labeled indication removal by the FDA (Avado & Ribbon-1). Why talk about old news? Perhaps there's a lesson here as we consider using untested drugs... E2100: https://www.nejm.org/doi/full/10.1056/nejmoa072113 Avado: https://www.ncbi.nlm.nih.gov/pubmed/20498403 Ribbon-1: https://www.ncbi.nlm.nih.gov/pubmed/21383283

Reviewing the lasted DOAC study in treating cancer-associated VTE: Caravaggio. We compare it the other major DOAC studies in this patient population. Caravaggio: https://www.nejm.org/doi/full/10.1056/NEJMoa1915103 Also, announcing our first journal club! This will be our 4/16 Pod. It is especially for an oncology APPE students missing out on an oncology experience, but all are welcome to participate. Journal Club link: https://www.futuremedicine.com/doi/pdf/10.2217/fon-2018-0787

The Foundations of OncoPharm series returns with a unique chemotherapy drug: bleomycin. Also, Covid Thoughs (14:00).

Recent updated survival analyses for CLEOPATRA and Keynote-189 (6:45) require some historical context to truly see their impact. Finally, #AskOncoPharm returns (15:05) with a listener question about infusion rates when restarting daratumumab.

We all should do what we can to "flatten the curve" and that includes our patients on treatment. While there is no such thing as elective chemo, there are some practical ways we can minimize patients needing to come into our facilities.

Looking back at a 2012 NYT op-ed (https://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html) that led to a 50% price decrease in a biologic cancer medication.

A plethora of #oncopharm updates! Isatuximab is approved and neratinib gets another breast cancer indication (2:00) Pembrolizumab with chemo for triple-negative breast cancer (8:50) New EPOC updated survival analysis on FOLFOX+cetuximab in isolated liver metastatic colon cancer (15:00) Precision medicine in pancreatic cancer (19:30) Cladribine + rituximab for hairy cell leukemia (23:30)

Two recent publications add to our knowledge concerning the utility of CYP2D6 genotyping and tamoxifen. TARGET-1: https://www.ncbi.nlm.nih.gov/pubmed/31821071 Tamoxifen D/C rates by 2D6 genotype: https://www.ncbi.nlm.nih.gov/pubmed/31800347

You've heard of CAR-T therapy, and now it's time to learn about CAR-NK cells. Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1910607

Drug-drug interactions are a key consideration when determining which NK-1 antagonist to use in patients receiving highly emetogenic chemotherapy. We discuss the issues for (fos)aprepitant, netupitant, & rolapitant. A nice aprepitant review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595939/) and the case for an aprepitant-vincristine interaction (https://doi.org/10.1177/1078155219870840).