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Cancer Chemotherapy and Treatment

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy: Pharmacotherapy Principles and Practice. Email User Services (userservices@mhprofessional.com) for more information.

Content Update

August 28, 2019

Erdafitnib Approved for FGFR Mutated Bladder Cancers: Erdafitnib (Balversa®) is the first FGFR inhibitor approved by the FDA and is indicated for adults with FGFR3 or FGFR2 mutations in locally advanced and unresectable or metastatic bladder cancer who have progressed on prior therapy. FGFR mutations are common, occurring in up to 60% of bladder cancers. In an open-label, multicenter, Phase II trial, the median progression free survival was 5.5 months (95% CI, 4.2-6.0). The overall response rate to erdafitnib was 40%. The most common adverse effects were hyperphosphatemia, stomatitis and diarrhea.

Content Update

May 7, 2019

ASCO Practice Guidelines on Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitors: In February 2018, the American Society of Clinical Oncology (ASCO) published a new guideline regarding the management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy. Recommendations are outlined by organ-specific toxicities with diagnosis and management criteria presented. Differences in treatment approaches exist, but most patients with Grade 1 toxicities may continue immune checkpoint inhibitor therapy. Corticosteroids may be initiated for Grade 3 toxicities and higher and must be tapered over at least 4 to 6 weeks. In severe and refractory cases, other immunosuppressive therapies may be required to control immune-related adverse events. In most cases, immune checkpoint inhibitor therapy is permanently discontinued with Grade 4 toxicities.

Content Update

March 4, 2019

Larotrectinib Approved for NTRK Fusion Cancers: Larotrectinib (Vitrakvi®) is the first disease agnostic small molecule inhibitor approved by the FDA and is indicated for adult and pediatric patients with NTRK fusion cancers. While NTRK fusions are rare, occurring in ~ 1% of all cancers, they are common in some rare cancers such as secretory carcinoma of the breast. Overall response rate in NTRK fusion cancers is 75%. The most common adverse effects are elevations in LFTs and anemia, with serious neuropathies in about 1% of patients. Larotrectinib is first line therapy in metastatic disease if no standard therapies are available or after initial disease progression.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the etiology of cancer.

  2. Define the tumor, nodes, metastases (TNM) system of cancer staging.

  3. Classify each drug used in the treatment of cancer and compare and contrast the mechanisms of action, uses, and adverse effects.

  4. Outline actions for all health professionals to prevent medication errors with cancer treatments.

  5. Discuss the impact that increased use of oral chemotherapy agents may have on oncology practice.

  6. Describe what cancer survivorship means and how this impacts future health care needs of an individual.

  7. Describe the role of health professionals in the care of cancer patients.

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