OncoPharm is a podcast dedicated to all things oncology pharmacy. Most episodes cover updates and recent publications concerning the use of medications in caring for patients with cancer. Periodically, episodes drop devoted to Landmark Clinical Trials in oncology and Fundamentals of Oncology Pharmacy.
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Doxorubicin + Trabectedin
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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…
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Chapter 1. Doses Matter
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22:48
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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/1Oae8AV5Af4Von John Bossaer
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Cross-Trial Comparison Don'ts
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19:31
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.Von John Bossaer
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A mixed bag of Phase III results for using olanzapine with moderately emegotenic chemotherapy (MEC).Inui, et al: https://doi.org/10.1200/JCO.24.00278Ostwal, et al: doi:10.1001/jamanetworkopen.2024.26076Von John Bossaer
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Afamitresgene Autoleucel & Vorasidenib
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12:29
A new cellular therapy is approved for synovial sarcoma and the anticipated approval has occurred for the dual IDH1/IDH2 inhibitor, vorasidenib.Von John Bossaer
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Perioperative ICI Trial Design & Blood Test Screening For Colorectal Cancer
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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.Von John Bossaer
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The Auto Transplant Breast Cancer Scandal
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15:28
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)90024-2Oral History: https…
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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.Von John Bossaer
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June '24 Updates & ATOPP Travelogue
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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.…
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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.Von John Bossaer
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An experimental regimen for DLBCL piques my interest.VenetoclaxibrutinibPrednisoneObinutuzumabRevlimid (lenalidomide)Link: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2401532Von John Bossaer
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Imetelstat, Targeting Telomerase
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12:11
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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.Von John Bossaer
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Lots and lots of updates from the past weekend's ASCO annual meeting.1. ADRIATIC (consolidation durvalumab in limited stage SCLC)2. NADINA (neoadjuvant Nivo/Ipi in stage III melanoma)3. *NICHE-2 (neoadjuvant Nivo/Ipi in dMMR colon cancer)4. CheckMate 8HW (Nivo/Ipi in dMMR metastatic colon cancer)5. TRANSMET (liver transplantation in colon cancer wi…
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Updated ASCO-ONS Antineoplastic Safety Standards
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ASCO & ONS (along with pharmacist representation) released updated safety standards for preparing, administering, and monitoring chemotherapy. Look for a calendar invitation to review your site's policies soon.Link: https://doi.org/10.1200/OP.24.00216Von John Bossaer
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A new drug for small-cell lung cancer, a bispecific, targeting DLL3 on small-cell lung cancer and CD3 on T-cells is FDA approved. But, infigratinib's FDA approval for cholangiocarcinoma is withdrawn.Von John Bossaer
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QT Prolongation In Oncology
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QT interval prolongation is a common hurdle to taking care of cancer patients. We dive into what QT interval prolongation is, why it matters, risk factors, and prevention/management strategies.Von John Bossaer
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The non-Award Winning series of Landmarks in OncoPharm returns to discuss a Next Big Thing in NHL that wasn't any better than plain old CHOP.From April 1993, it's Pro-MACE-CytaBOMLink: https://www.nejm.org/doi/full/10.1056/NEJM199304083281404Von John Bossaer
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Tisotumab vedotin garners a regular FDA approval for metastatic cervical cancer with OS benefit data.A lingering question that demands a focused RCT: What is the optimal dose of methotrexate in primary CNS lymphoma? I'm glad I'm not the only one with this question: https://doi.org/10.1177/10781552231176754What, some BRAF mutations in colorectal can…
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Lots of recent updates to cover this week...1. Adjuvant pembrolizumab of RCC demonstrates OS improvement in NEJM publication (DOI: 10.1056/NEJMoa2312695)2. Yet adjuvant nivolumab did not demonstrate OS improvement in the adjuvant setting. There may be a few reasons for this (https://doi.org/10.1200/JCO.2024.42.4_suppl.LBA358)3. A cytokine-fusion pr…
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Arguably, the most anticipated release of 4/19/24Von John Bossaer
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HOPA '24, Site Agnositc T-DXd, & ALINA
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What I learned (or relearned?) at HOPA's 2024 Annual Conference: updates in Neuro Oncology, fedratinib toxicity, and bispecific antibodies in multiple myeloma.Also, fam-trastuzumab deruxtecan (T-DXd) garnered a site-agnostic approval for HER2 amplified solid tumors.Finally, the ALINA study, adjuvant alectinib in ALK+ NSCLC, was published in this we…
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Tumor Lysis Syndrome (TLS) is a foundational topic for all oncology clinicians. We discuss the what, the why, prevention, and treatment.Von John Bossaer
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Updates In RCC, Pancreatic Cancer, And Skin Cancer In SOT
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Discussing four papers that caught our eyes from the last few weeks:Pazopanib vs. placebo following metastatectomy. Always concerning when placebo has an OS advantage.ECOG-ACRIN E2810: https://doi.org/10.1200/JCO.23.01544Gemcitabine vs. Gem + Paclitaxel (Taxol) in pancreatic cancer patients after FOLFIRINOX: https://doi.org/10.1200/JCO.23.00795An R…
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Colon Cancer Screening Wars
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Two recent publications suggest more people may be choosing non-colonoscopy screening practices in the future. One is a new stool DNA test, while the other is a blood test.How do they compare to the gold standard of colonoscopy?Cell-free DNA blood test: DOI: 10.1056/NEJMoa2304714Next generation stool DNA test: DOI: 10.1056/NEJMoa2310336…
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EV-302 is finally published, and you have to squint to find any major critiques. Enfortumab bedouin + pembrolizumab fully arrives as a standard 1st-line regimen of advanced urothelial cancer.Also, nivolumab gets a 1st-line FDA approval for urothelial carcinoma in conjunction with cisplatin + gemcitabine based on CHECKMATE-901.…
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Two nice studies have been recently published in the supportive care realm.SPARED asks if we can omit dexamethasone on days 2-4 following cisplatin-based chemotherapy.D-TORCH asks if topical diclofenac can prevent capecitabine-induced hand-foot syndrome.SPARED: https://doi.org/10.1038/s41416-023-02493-7 D-TORCH: https://doi.org/10.1200/JCO.23.01730…
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Lifileucel & FLAURA2 Updates
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17:27
An exciting new cellular therapy, lifileucel, is approved for metastatic melanoma. The FLAURA2 trial of osimertinib + chemotherapy has led to an FDA approval, but questions remain about a possible new standard of care. And a few minor updates on tepotinib.Von John Bossaer
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NAPOLI 3, POUT, & Ivosidenib - Azole DDIs
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New updates on metastatic pancreatic cancer (NAPOLI-3), upper tract urothelial cancer (POUT), and the drug-drug interaction between ivosidenib and azole antifungals.NAPOLI 3: https://doi.org/10.1016/S0140-6736(23)01366-1POUT (final OS): https://doi.org/10.1200/JCO.23.01659Ivosidenib Azole Antifungal DDIs: https://doi.org/10.1002/cncr.35251…
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You know about small cell lung cancer, but let's talk about small cell carcinoma of the prostate.Von John Bossaer
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Rethinking Some Fundamental Considerations
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15:41
In oncology we are always asking questions about which treatment option is best. And that focus on the next best treatment may prevent us from rethinking some fundamentals of current practice. Three recent studies illustrate this and made me ask:Do we need a Port or PICC for every testicular cancer patient?Study: https://doi.org/10.1200/OP.23.00580…
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...on FDA approvals for belzutifan for RCC, pembrolizumab + cisplatin/RT for cervical cancer, erdafitinib (FGFR3 alterations only) for bladder cancer.Plus, early morning ICIs (https://doi.org/10.1016/j.ejca.2024.113571)&FLAG-Ida-GO in AML from NCRI AML 19 (https://doi.org/10.1200/JCO.23.00943)Von John Bossaer
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Development Of Generic Lenalidomide with Dr. Ryan Beechinor
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Special guest Ryan Beechinor joins the pod to discuss his recent paper on the obstacles in the development of generic lenalidomide. It's a fantastic read, and this episode will be a fantastic listen!Link: https://doi.org/10.1016/j.jcpo.2023.100446Von John Bossaer
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Foundations of OncoPharm episode on lenalidomide (Revlimid) and its MOA, use, dosing, & toxicity.Von John Bossaer
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A Holiday Tradition returns as we review 14 new OncoPharm drugs approved this past year and ask Keep, Re-Gift, or Return.Von John Bossaer
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Small bites of updates coming out of ASH's 2023 annual meeting on CLL, multiple myeloma, and lymphoma.Von John Bossaer
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Our Landmarks of OncoPharm series returns to talk about 2008's VISTA study, which ushered bortezomib into the front line setting, albeit with a now outdated alkylating agent-based backbone.VISTA (VMP vs. MP): https://www.nejm.org/doi/full/10.1056/nejmoa0801479Von John Bossaer
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Gamma Secretase Inhibition et al
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The recent approval of nirogacestat, the first gamma secretase inhibitor on the market, provides a great opportunity to discuss desmoid tumors and Notch signaling.Review article: https://doi.org/10.1002/onco.13627Also, a new T-cell malignancy warning for most CAR-T products. And, is belantamab mafodotin coming back based on the DREAMM-7 results?…
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Repotrectinib & Capivasertib
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FDA has approved two new kinase inhibitors: one for ROS1 (+) NSCLC and one for PIK3CA/AKT/PTEN altered breast cancer.Von John Bossaer
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Fruquintinib And Osimertinib-Chemo in Combo?
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This week's Pod dives into a new VEGF-R inhibitor, fruquintinib. We also ask if FLAURA2, osimertinib + chemotherapy in combination, will become a new standard of care in EGFR-mutated metastatic NSCLC.Von John Bossaer
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Elderly AML & Burkitt Lymphoma Updates
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24:39
Aggressive hematologic malignancy publications can be challenging to interpret and translate to clinical practice.We look at two recent studies to illustrate this point. Elderly AML: 10-day decitabine vs. 7 + 3 (https://doi.org/10.1016/S2352-3026(23)00273-9)Burkitt Lymphoma: R-CODXO-M/R-IVAC vs. DA-R-EPOCH (https://doi.org/10.1016/S2352-3026(23)002…
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Landmarks Of Stage III NSCLC
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Out Landmarks of OncoPharm series returns to chronicle how treatment of stage III NSCLC has changed over time with an overview of three studies.1. Dillman (1990) NEJM (sequential chemo --> RT): https://doi.org/10.1056/nejm1990100432314032. Albain (1995) JCO (concurrent cisplatin/etoposide + RT): https://pubmed.ncbi.nlm.nih.gov/?term=76365303. Albai…
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Lots of practice changing new information came out of last week's ESMO conference.This Pod is packed with updates on NSCLC, bladder cancer, gastric cancer, medullary thyroid cancer, KRAS G12C colorectal cancer.....and even bendamustine (non-ESMO update).Von John Bossaer
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Enzalutamide monotherapy? Plus, nivolumab & pembrolizumab approval updates
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This week we discuss the continued push to introduce 2nd generation androgen inhibitors earlier into treatment with the EMBARK trial.Nivolumab and pembrolizumab, pemrolizumab and nivolumab. Again and again. Their role (and approvals) for adjuvant melanoma make sense. But what to think about their use for NSCLC in the neoadjuvant setting?West commen…
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Encorafenib + binimetinib gets FDA-approval for metastatic NSCLC, but how does it compare to dabrafenib/trametinib? Plus, a new pediatric approval for dabrafenib/trametinib means more dosage form options.Von John Bossaer
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Trying to make sense of the limited information put out via Press Release the last 2 weeks for mobocertinib, pembrolizumab + enfortumab vedotin, nivolumab, and more.Von John Bossaer
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From the Foundations of OncoPharm archives - the history and groundbreaking STI 571 (imatinib).Von John Bossaer
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Carboplatin Paclitaxel in Ovarian Cancer
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It's another Landmarks of OncoPharm episode looking at the carboplatin-paclitaxel regimen in ovarian cancer from 20 years ago.carboplatin/paclitaxel vs. cisplatin/paclitaxel: https://pubmed.ncbi.nlm.nih.gov/?term=37643542Von John Bossaer
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HER3-DXd & Motixafortide
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An experimental drug for EGFRm NSCLC, patritumab deruxtecan (HER3-DXd), raises some eyebrows and a new agent is FDA-approved for hematopoietic stem cell mobilization (motixafortide).Von John Bossaer
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You read it in every solid tumor paper - RECIST - criteria. This Pod discusses some of the details of the Response Evaluation in Solid Tumors (RECIST) criteria along with the pros and cons of its use - including a modification of the criteria for use with immunotherapy.Von John Bossaer
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DPYD Variant Dosing & ICIs In Pancreatic Cancer
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Empiric dose reductions for variant DPYD alleles isn't necessarily new, but the outcomes of patients treated with those dose reductions isn't well described. Dutch researchers provide some much needed evidence.Link: https://pubmed.ncbi.nlm.nih.gov/?term=37639651Is there a role for ICIs in dMMR/MSI-h pancreatic cancer? This retrospective says, uh ma…
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