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As pharmacists, we play an integral role in anticipating and managing adverse events associated with conventional and novel cancer treatments. From alkylating agents to programmed cell death-1 receptor antagonists, the sheer number of agents, spectrum of toxicities, and rapidly evolving combination data make it difficult to maintain an up-to-date approach to treating patients who are at risk for adverse events.
With advances in technique and supportive care, bone marrow transplant (BMT) patients have a longer life expectancy now than when BMT was first performed more than 40 years ago. Despite much higher mortality rates than the general population, up to 80% of BMT patients who survive 5 years posttransplantation will be alive 20 years posttransplantation. However, patients who live longer can be at higher risk for complications, in part because of changes in their body’s immune system. One of these concerns is the loss of immunity that was previously achieved through vaccination. To regain immunity to vaccine-preventable diseases, including measles, mumps, hepatitis, and diphtheria, patients need to be revaccinated following BMT.
Corneal toxicity with high-dose cytarabine is a well-established risk of therapy. Routine prophylaxis with eye drops, usually topical corticosteroid drops, is an established part of high-dose cytarabine treatment protocols. Without topical corticosteroid prophylaxis, incidences of keratoconjunctivitis have been reported in 85% to 100% of cases; the occurrence of clinically significant symptoms with the use of prophylaxis is reported in 8% to 16% of cases.
Recent statistics from the National Cancer Institute estimate that 25% of adults with acute myeloid leukemia (AML) are expected to survive for ≥3 years. Depending on other prognostic factors, such as duration of first remission, age, performance status, cytogenetics, and prior hematopoietic stem cell transplant, the overall survival of patients with relapsed/refractory disease at 5 years was
Although the BRAF inhibitor vemurafenib (Zelboraf) improves progression-free survival (PFS) and overall survival (OS) in patients with advanced melanoma, 25% of patients using it as monotherapy end up with a second cancer. Combining BRAF and MEK inhibitors has been shown to prevent or delay the onset of resistance with BRAF inhibitors alone. A new study investigated the use of combining vemurafenib with the experimental MEK inhibitor cobimetinib.

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