Patients and Methods. A pragmatic, retrospective review identified BCCA patients with advanced GIST who received imatinib or historical treatment during successive, pre-specified time periods. Primary outcome was the cost-effectiveness (CE) of imatinib based on median overall survival (MOS). Secondary outcomes were cost-effectiveness based on median progression-free survival (PFS) and comparison to literature efficacy. This study took the BCCA perspective. Sensitivity analyses varying effectiveness over the 95% confidence interval (CI), cost to its extremes, discounting level at 0, 3, and 5%, and substituting life expectancy for MOS were performed.

Results. Forty-six and 47 patients in the imatinib and historical groups respectively showed MOS with imatinib to be 66.7 months (95%CI 61.7— infinity) compared to 7.7 (95%CI 6.0—12.6) in the historical group. Median-PFS were 45.3 months (95%CI 24.4—infinity) and 5.6 (95%CI 3.5—8.5) respectively. Imatinib effectiveness was similar to literature reports. The annual incremental CE ratio for imatinib was $15,882 CDN per median life year gained and $23,603 CDN per median year of PFS.

Conclusions. Imatinib for advanced GIST seems cost-effective in BC. Results were robust across a range of sensitivity analyses. J Oncol Pharm Practice (2008) 14: 105—112.

Methods. The study developed and validated a self-administered questionnaire on the use of concomitant medications by patients undergoing treatment with chemotherapy. The questionnaire listed 510 prescription medications, OTCs, and supplements (including vitamins, minerals, and herbs). Fifty-two subjects completed the questionnaire while visiting the infusion clinic to receive chemotherapy. On a subsequent visit the subjects brought their medications to the clinic and a pharmacist reviewed their completed questionnaire.

Results. Ninety-six percent of the subjects reported taking prescription medications within 3 days prior to chemotherapy, 71% reported taking OTCs and 69% reported use of supplements. The subjects took an average of 5.5 (range 0—13) prescription drugs, 2.2 (0—20) OTCs, and 1.9 (0—11) supplements. Twenty-one drugs were each taken by at least 10% of the subjects. Acetaminophen was taken by 59.6% of the subjects. One subject reported taking five acetaminophen-containing drugs. The questionnaire's sensitivity was 92.0%, specificity 99.9%.

Conclusion. Within 3 days prior to chemotherapy, subjects took an average of 9.6 concomitant medications, many of which alter drug metabolism and or disposition. In clinical trials, multivariate analysis of all concomitant medications could add to clinically relevant data to identify drug interactions that negate or potentiate the efficacy of cancer treatment regimens. In some instances, apparent resistance of tumors to chemotherapy may be the result of drug interactions. J Oncol Pharm Practice (2008) 14: 123—130.

Methods. Outpatients to whom G-CSF was dispensed were identified and their actual medical records were reviewed to verify patients who received G-CSF for primary prophylaxis. Literature was reviewed to determine the expected incidence and risk of FN for chemotherapy regimens used, and the compliance of prescribers with the institutional guidelines was evaluated. After that, the proportion of patients who developed FN was identified and compared to the expected incidence from literature. Data analysis was performed on the outcome of patient-cycle.

Results. Of the 99 patient-cycles, 53 (53%) were compliant with guidelines whereas 46 (47%) were not. FN developed in 12 (12.1%, 95% CI = 5.7, 18.5) while the expected average incidence of FN was 32.7%. Eleven (21%, 95% CI = 10.1, 32.2) of the 53 patient-cycles that were compliant with guidelines developed FN, whereas one patient among the non-compliant group developed FN (2%, 95% CI = 0.0, 6.2). The expected incidence of FN was 42.9 and 21.5%, in the compliant group, and noncompliant group, respectively. Based on expected FN rates, the respective reduction in the incidence of FN was 51, and 90%.

Conclusions. Lack of adherence to institutional guidelines was noticed in G-CSF prescribing. Reasons behind poor compliance with the guidelines must be verified and resolved. Prophylactic G-CSF is effective in reducing the incidence of FN; however, further research in a larger population is warranted to confirm these findings. J Oncol Pharm Practice (2008) 14: 131—138.

Design. University of Colorado Cancer Center breast cancer patients treated with aromatase inhibitor therapy during July 2005 through July 2006 were studied. Data was collected for each patient from the time of breast cancer diagnosis up to April 2007. The study endpoints included (1) appropriate screening for osteoporosis, (2) incidence of osteoporosis diagnosis, and (3) initiation of appropriate drug therapy for bone loss. Appropriate management was defined as adherence to the 2003 American Society of Clinical Oncology guidelines for bone health issues in women with breast cancer.

Results. Of the 54 patients included in this study, 12 (22.2%) had no DEXA scans documented, 22 (40.7%) patients received a baseline DEXA scan and 8 (14.8%) patients received baseline and yearly DEXA scans. During the study timeline, 26 (48%) patients were diagnosed with osteopenia and 4 (7%) patients were diagnosed with osteoporosis. Forty-one (75.9%) patients received calcium and vitamin D therapy. Bisphosphonate therapy was received by less than one-third of the osteopenic patients and three-fourths of the osteoporotic patients.

Conclusions. The majority of patients were not adequately screened which may have falsely lowered the diagnosis of osteoporosis resulting in omission of drug therapy. All high-risk patients should receive calcium and vitamin D therapy and be evaluated for bisphosphonate therapy. Screening and medical management for osteoporosis in breast cancer patients on aromatase inhibitors is an important area for clinical intervention. J Oncol Pharm Practice (2008) 14: 139—145.

Methods and Patients. The Hematopoietic Stem Cell Transplant Unit of the Centre Hospitalier Universitaire Sainte-Justine performs around 50 hematopoietic stem cell transplants per year. During a pharmaceutical care specialized residency program, a French pharmacist participated in certain clinical activities. Drug-related problems and clinical interventions were compiled over 31 nonconsecutive days using a tool developed by the Société Française de Pharmacie Clinique. Data concerning patients, drugs, intervention, documentation, approval (if needed), and estimated impact were compiled.

Results. During the 31-day period, 525 interventions were collected (16.9 ± 3.7 per day), targeting 29 patients. The main drug-related problems were adverse drug reactions (N = 125, 23.8%), untreated indication (N = 92, 17.5%) and failure to receive drug (N = 89, 17.0%). The pharmacist's interventions concerned mainly dose adjustment (N = 174, 33.1%) and drug monitoring (N = 132, 25.1%). Among the 324 (61.7%) interventions requiring a physician's approval, 302 (93.2%) were accepted without any change.

Conclusion. A pharmacist is able to perform clinically relevant interventions in a hematopoietic stem cell transplant unit, given the complexity of the pharmacotherapy. Our description of drug-related problems and interventions may help other pharmacists already working or developing pharmaceutical care in a hematopoietic stem cell transplant unit to compare their practice and it is one of the few reported in the literature. J Oncol Pharm Practice (2008) 14: 147—152.

Methods. A retrospective study of inpatients with sarcoma who received a two or four-day regimen of MAI (mesna, doxorubicin, and ifosfamide) between January 1, 2004 and December 31, 2006 was conducted. Data collection focused on characterizing neurotoxicity of patients receiving ifosfamide with or without aprepitant. Correlation between serum creatinine, albumin, liver function tests, age, gender, and total doses of ifosfamide was examined.

Results. A total of 45 patients received ifosfamide of which 23 (51%) were male and 24 (53%) received aprepitant. All baseline characteristics were similar for those who received aprepitant versus those who did not. No significant differences were noted between patients with or without neurotoxicity for age, gender, or liver enzymes. Eight patients (18%) of 45 developed neurotoxicity of which six (75%) of those patients also received aprepitant. A trend of increased occurrence of neurotoxicity was noted with aprepitant administration (6 vs. 2 patients respectively, p = 0.176), although a statistical difference was not observed. A relative risk of 2.6 (95% CI, 0.47—26.6) was associated with the addition of aprepitant.

Conclusions. An increased risk was identified for ifosfamide-induced neurotoxicity associated with aprepitant use; however, the observed difference was not statistically significant. The necessity of aprepitant given in association with ifosfamide may need to be reconsidered due to this risk. J Oncol Pharm Practice (2008) 14: 157—162.

Data sources. Studies published from January 1995 to August 2007 were identified by computer searches of Medline and hand searching of bibliographies of the articles identified via the computer searches. The current clinical practice guidelines were identified by computer searches of the web sites for national professional organizations that represent health care professionals who treat patients with cancer.

Results of data analysis. Hematopoietic responses demonstrate that epoetin alfa and darbepoetin alfa provide similar outcomes for patients with chemotherapy-induced anemia (CIA); however, up to 50% of patients receiving these agents fail to adequately respond. Functional iron deficiency defined as a state of iron-restricted erythropoiesis is likely the primary contributor to the lack of response. Hematopoietic responses following ESA therapy with parenteral iron are substantially higher compared to response with no or oral iron.

Conclusions. Iron stores should be assessed in all patients with cancer- or treatment-related anemia and parenteral iron should be administered to patients receiving ESA therapy to improve hematopoietic response. A unique algorithm that summarizes our institutional guidelines to assess iron stores and administer parenteral iron with ESA therapy in patients with CIA is included. J Oncol Pharm Practice (2008) 14: 5—22.

Objectives. ves. The primary aim of this study was to describe medical oncologists' perceptions of factors that can influence prescribing of antiemetics for acute and delayed nausea and vomiting associated with chemotherapy. A secondary aim was to assess medical oncologists' perception of antiemetic counseling by oncology pharmacists.

Methods. This was a single-centered, non-randomized survey conducted at NCC in Singapore. Twenty-seven oncologists in the Department of Medical Oncology (DMO) were invited to participate in this survey. Survey forms were distributed to the medical oncologists at weekly DMO and tumor board meetings in November 2006.

Results. Twenty oncologists returned surveys during the study period. Most oncologists closely adhered to the institution guideline on antiemetics utilization; however, results showed a trend of overprescribing acute antiemetics for low emetogenic chemotherapy regimens. Oncologists have identified anxiety, age and gender as the top three patient risk factors taken into consideration when they prescribe antiemetics. Majority of oncologists found pharmacists' counseling on antiemetics to be effective.

Conclusions. Through this survey, oncology pharmacists at NCC were able to identify areas of antiemetics utilization that needed refinement. Results from this survey provide opportunities for oncology pharmacists to collaborate with medical oncologists to further improve the management of chemotherapy induced nausea and vomiting. J Oncol Pharm Practice (2008) 14: 23—29.

Methods. Results from a 13-question questionnaire about the chemotherapy education preferences of patients in three community gynecology oncology clinics were compared to the results from a similar study previously conducted in an academic gynecology oncology clinic.

Results. A total of 57% of the 203 communityclinic respondents (116) and 67% of the 282 academic-institution respondents (189) who completed questionnaires had previously received chemotherapy. Of the patients treated in community clinics, almost 60% preferred chemotherapy education to be provided in written form and directly by a health care professional compared to 87% of the patients in academic clinics. Overall, 88% of the patients in the community clinics believed they received adequate information, compared to 63% of the patients in the academic setting. Patients in the community clinics wanted to get more in-depth answers to questions such as `What is chemotherapy?' (54%) and `How it is given?' (55%). In addition, community patients also wanted to know more about `Why chemotherapy stops working?' (72%) and `What to do and who to call about side effects?' (60%). In the academic setting, patients were less likely to want to know more about these chemotherapy related questions (42, 35, 57, and 49, respectively).

Conclusions. Patients preferred to receive written chemotherapy education that was reviewed with a healthcare professional and that gave more detailed information about the chemotherapeutic drugs themselves and how to prevent and manage side effects. As a result of this questionnaire, the patient education materials used at our institution will be revised to better address patients' preferences in both treatment settings. J Oncol Pharm Practice (2008) 14: 31—36.

Methods. Patients visiting the pharmacy of a comprehensive cancer centre for the first time were recruited before (control) and after (intervention) the introduction of routine structured counselling on NHP by pharmacists. The primary endpoint was patient satisfaction. Overall cost and cost per improvement in satisfaction were estimated.

Results. 265 patients completed the questionnaires. The average age was about 60 years old, with roughly equal number of men and women. Breast and genitor-urinary cancers made up about 80% of the patients. Nearly 45% of patients had some college or university education. The scores for overall satisfaction and each subscale were all increased in the intervention group. This was statistically significant regarding information on NHP. Counselling was associated with an increase of about 9 minutes of counselling time and a mean additional cost of CDN$7.49 per patient.

Conclusion. We found increased patient satisfaction with routine counselling on NHP. There was only minimal increase in workload and cost for each counselling section. J oncol pharm practice (2008) 14: 37—43.

Design. Retrospective chart review. The primary outcome measured was survival. Survival data was analyzed through the Kaplan—Meier methodology. A multivariate analysis of prognostic variables was also conducted.

Setting. Public cancer centers within the Canadian province of Alberta.

Patients. Hormone refractory, metastatic prostate cancer patients initiated on docetaxel chemotherapy between September 2004 and February 2007 within the Alberta Cancer Board.

Main Outcome Measured. The primary outcome measured was median survival.

Results. Among 161 patients eligible for review, median survival was 17.22 months. Chemotherapy received after docetaxel was determined to be a significant favorable prognostic factor for survival ( p<0.0001).

Conclusion. In a clinical setting, docetaxel and prednisone did not perform as well in terms of median survival, as it was shown to in prior clinical trials (17.22 vs. 18.9 months). Further investigation into the impact of docetaxel and prednisone on quality of life in clinical practice, would complement the findings of this study. J Oncol Pharm Practice (2008) 14: 45—49.

Case summaries. The cases of 6 patients with advanced malignancies who experienced acute etoposide hypersensitivity are documented. There were 3 male and 3 female patients and their ages ranged from 16 to 68. Four patients had curable malignancies with trophoblast tumors or germ cell tumors and two were receiving palliative chemotherapy for other malignancies. All of the 6 patients who experienced etoposide hypersensitivity developed their symptoms in the first few minutes of the initial infusion. The most common symptoms were chest pain, facial flushing, and bronchospasm. All of the patients had emergency treatment with discontinuation of the infusion and usually the administration of hydrocortisone and chlorpheniramine, which lead to the rapid resolution of their symptoms.

For the next cycle of chemotherapy each patient was rechallenged with etoposide phosphate, with steroid cover given in only two of the cases. None of the 6 patients experienced any hypersensitivity symptoms on treatment with etoposide phosphate and in one the steroids were withdrawn for all the subsequent cycles. The 4 patients with curable malignancies all remain disease free, while the 2 palliative patients obtained significant control of their disease.

Discussion. Etoposide is one of the most important chemotherapy drugs in the treatment of many curable malignancies but an acute hypersensitivity reaction occurs in around 1% of patients. Retreatment with etoposide in these patients is difficult and generally alternative drugs/regimens have to be used. A small number of case reports have suggested that etoposide phosphate can be safely used in these patients and 6 cases have been found in the pharmacy records where this has been done. In all of the patients, treatment with etoposide phosphate proceeded without any symptoms or the use of repeated steroid cover in 5 of the 6 patients.

Conclusion. Etoposide hypersensitivity is a rare clinical problem and responds promptly to drug discontinuation, steroids, and chlorpheniramine. Patients with previous etoposide hypersensitivity can safely be treated with etoposide phosphate and do not need any additional hypersensitivity prophylaxis. J Oncol Pharm Practice (2008) 14: 51—55.

Data sources: A search of MEDLINE, PubMed, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, and Web of Science (1996—2006) databases was conducted using terms such as: chemotherapy, diarrhea, diarrhoea, and irinotecan. Appropriate references from selected articles were also used. The search engine, Google, provided further access to information.

Data extraction: The retrieved literature was reviewed to include all articles pertaining to the pathophysiology, assessment and management of CID.

Data synthesis: Diarrhea is a debilitating and potentially life-threatening side effect associated with many chemotherapeutic agents. Despite the high incidence and severity of CID, it is often under recognized and poorly managed. A multidisciplinary panel recently updated recommended practice guidelines for the assessment and management of CID. Prompt and aggressive intervention is important in order to minimize the negative consequences of CID, such as dehydration, which may cause interruptions in optimal clinical outcomes or may lead to life-threatening sequelae. Further investigation into the pathophysiology of CID may allow for more directed approaches in the prophylaxis and treatment of CID. J Oncol Pharm Practice (2007) 13: 181—198.

Objective: To describe the classifications and basic pharmacology of targeted therapies.

Methods: A literature search was performed for peer reviewed journal articles using Medline (1996—2007), Embase (1996—2007) and Google. The search was performed using keywords such as angiogenesis inhibitors, cancer vaccines, gene therapy, monoclonal antibodies, small molecules, proteasome inhibitors, targeted therapy and tyrosine kinase inhibitors.

Conclusions: A review of the basic pharmacology is described in this article, including the following major categories of targeted therapies: • Small molecule drugs • Monoclonal antibodies • Apoptosis-inducing drugs • Angiogenesis Inhibitors • Cancer vaccines • Gene therapy J Oncol Pharm Practice (2007) 13: 199—205.

Objective: The purpose of this article is to provide an updated review of the literature in this field.

Data Sources: A search of PubMed was performed using the key terms bisphosphonate, acute phase response, and cancer, and limited to publications in English. The published literature on acute phase response with bisphosphonate therapy was reviewed.

Results and Conclusions: Approximately 40% of patients receiving aminobisphosphonates experience an acute phase response, which generally occurs only on first exposure to the drug and typically last <72 h. Not all bisphosphonates induce acute phase responses to the same extent. This article reviews acute phase response in patients with metastatic bone disease treated with aminobisphosphonates. J Oncol Pharm Practice (2007) 13: 223—229.