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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.
Upon completion of the chapter, the reader will be able to:
Describe the etiology of cancer.
Define the tumor, nodes, metastases (TNM) system of cancer staging.
Classify each drug used in the treatment of cancer and compare and contrast the mechanisms of action, uses, and adverse effects.
Outline actions for all health professionals to prevent medication errors with cancer treatments.
Discuss the impact that increased use of oral chemotherapy agents may have on oncology practice.
Describe what cancer survivorship means and how this impacts future health care needs of an individual.
Describe the role of health professionals in the care of cancer patients.
The word cancer covers a diverse array of tumor types that affect a significant number of Americans and individuals worldwide and are a major cause of mortality. The term cancer actually refers to more than 100 different diseases. What is common to all cancers is that the cancerous cell is uncontrollably growing and has the potential for invading local tissue and spreading to other parts of the body, a process called metastases. Cancer is the second leading cause of death behind heart disease.1 In 2018, it was projected that nearly 1.8 million Americans will be diagnosed with cancer, and that an estimated 609,640 Americans will die from the cancer.1 Figure 88–1 describes cancers by gender, new cases, and deaths.
Cancer incidences (top) and deaths (bottom) in the United States for males and females—2018 estimates. (Reproduced, with permission, from American Cancer Society. Cancer Facts and Figures 2018. Atlanta, GA: American Cancer Society, Inc.)
Once diagnosed, a cancer patient may encounter many different health professionals. All health professionals need to collaborate to ensure safe and appropriate prescribing, preparation, administration, and monitoring of anticancer agents; management of toxicities; resolution of reimbursement issues; and participation in clinical trials. The pharmacist is a pivotal member of the care team because of their medication expertise.2,...