Oncopharmpod

Reviewing the data to support use of dexamethasone solution mouthwash for PIK3/AKT/mTOR inhibitor-induced stomatitis, caused by drugs like everolimus, alpelisib, capivasertib, & inavolisib. SWISH: https://doi.org/10.1016/s1470-2045(17)30109-2 Alliance MIST Trial: https://doi.org/10.1053/j.seminoncol.2023.01.001

The first Cldn 18.2 targeting monoclonal antibody has been improved. Let's talk about it!

Discussing two excellent articles from earlier this month. S1826: N-AVD vs. Bv-AVD (DOI: 10.1056/NEJMoa2405888) & INTERLACE: induction chemo prior to concurrent cisplatin/RT in locally advanced cervical cancer (DOI: https://doi.org/10.1016/S0140-6736(24)01438-7)

A new PIK3Ca inhibitor is approved for breast cancer.

Reviewing 3 recent AML publications Double-Dauno (90 mg/m2 vs. 60 mg/m2): https://doi.org/10.1200/JCO.24.00235 AML60+ Risk Stratification: https://doi.org/10.1200/JCO.23.02631 Decitabine-Ven as bridge to Allo HSCT: https://doi.org/10.1016/S2352-3026(24)00241-2

MSI-high/MMRd rectal cancer treatment guidelines are being re-written. A brief synopsis of why treatment guidelines are changing so quickly in this space. Also, listeners helped out in explaining the ribociclib storage & stability change. Hint: https://www.novartis.com/news/novartis-implements-manufacturing-adjustments-ribociclib-ensure-alignment-latest-regulatory-standards-ebc-end-q2

FDA has been busy the last week approving: -ribociclib x 3 years in high risk stage II & III breast cancer based on the NATALEE trial as well as a new storage requirement -osimertinib indefinitely following chemoradiation in stage III EGFR-mutated NSCLC -amivantamab + chemotherapy following progression on osimertinib (Mariposa-2) -a subcutaneous formulation of atezolizumab -isatuximab + VRD for multiple myeloma -pembrolizumab + chemotherapy for metastatic pleural mesothelioma

Recapping just some of the notable data coming out of ESMO 2024: -Final OS results from Keynote-522 (perioperative pembrolizumab in TNBC) -AMBASSADOR (adjuvant pembrolizumab in bladder cancer) -NIAGRA (perioperative durvalumab in bladder cancer) -ADRIATIC (discussed on ASCO recap Pod, but publication now available) -LEANOX (impact of lean body mass adjustment on oxaliplatin dose)

LMS04 final OS results are published for doxorubicin + trabectedin in Leiomyosarcoma. Plus, a natural experiment of what happens in small cell lung cancer during an IV etoposide shortage. Finally, a nice paper provides some examples of how oncology pharmacists can bridge the care gap between oncology and primary care. LMS04: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2403394 IV etoposide shortage: https://doi.org/10.1200/OP.24.00394 Primary care - oncology pharmacy collaboration: https://doi.org/10.1177/10781552241279303

This is chapter 1 of a keynote address from summer 2024 on putting together the pieces of oncology pharmacy - with an emphasis on how our knowledge of drug dosing changes with time. Video/slides available at YouTube: https://youtu.be/1Oae8AV5Af4

We all know we aren't supposed to make cross-trial comparisons, but it happens anyway. So, let's compare FLARUA2 (osimertinb + chemo) and the newly FDA-approved MARIPOSA regimen (lazertinib + amivantamab) to see what we can (and can't) take away from such a dangerous cross-trial comparison.

A mixed bag of Phase III results for using olanzapine with moderately emegotenic chemotherapy (MEC). Inui, et al: https://doi.org/10.1200/JCO.24.00278 Ostwal, et al: doi:10.1001/jamanetworkopen.2024.26076

A new cellular therapy is approved for synovial sarcoma and the anticipated approval has occurred for the dual IDH1/IDH2 inhibitor, vorasidenib.

FDA appears to change its stance on evaluating perioperative (adjuvant followed by neoadjuvant) ICI study designs in NSCLC. Also, a simple blood test is approved to detect colorectal cancer, but there are several limitations compared to colonoscopy.

Did you know high-dose chemotherapy with autologous stem cel rescue was a "standard" breast cancer treatment ~30 years ago? This story involves changing practices based on Phase II data and outright clinical trial fraud, and retractions of publications. On-site review of Bezwoda study: https://doi.org/10.1016/S0140-6736(00)90024-2 Oral History: https://cancerhistoryproject.com/institutions/nccns-bob-carlson-talks-about-the-day-he-stormed-out-of-a-meeting-with-transplanters/

Reflections from vacation on 1) How similar the chef training experience on The Bear mirrors some pharmacy residency training and 2) being a resource to family/friends with oncology questions.

Running through recent updates on epcoritamab, adagrasib + cetuximab for colorectal cancer, endometrial cancer, adjuvant dabrafenib/trametinib melanoma follow-up data, and topical capsaicin for delayed CINV. Also, a brief travelogue on my inaugural trip to ATOPP (advanced topics for oncology pharmacy professionals) Summit.

The MARIPOSA study suggests there may be a new preferred first line regimen (amivantamab + lazertinib) for metastatic EGFR-mutated NSCLC, as this regimen improved PFS compared to osimertinib.

An experimental regimen for DLBCL piques my interest. Venetoclax ibrutinib Prednisone Obinutuzumab Revlimid (lenalidomide) Link: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2401532

A new drug is approved for MDS. While some will likely benefit from this new agent, the more enticing news is that inhibiting telomerase may be an attractive target for many malignancies.