Journal of Oncology Pharmacy Practice http://opp.sagepub.com/

Selected Abstracts presented at the 10th Annual Meeting of the Hematology/Oncology Pharmacy Association, 26−29 March 2014, New Orleans, Louisiana, USA J Oncol Pharm Pract 2014 20: 5 DOI: 10.1177/1078155213520288

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Journal of

Volume 20 Number 2(Supplement) April 2014

Oncology Pharmacy Practice

Contents

Selected Abstracts presented at the 10th Annual Meeting of the Hematology/Oncology Pharmacy Association, 26–29 March 2014, New Orleans, Louisiana, USA

Abstracts Platform Presentations

5

Pharmacy Practice

6

Author Index

17

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SELECTED ABSTRACTS Presented at the 10th Annual Meeting of the Hematology/Oncology Pharmacy Association 26–29 March 2014 New Orleans, Louisiana, USA

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Journal of

Oncology Pharmacy Practice J Oncol Pharm Practice 2014, Vol. 20 2(Supplement) 5–17 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1078155213520288 opp.sagepub.com

Abstracts

Platform Presentations P1 The Prevalence of Polypharmacy (PP) and Potentially Inappropriate Medication (PIM) Use in Senior Adult Oncology (SAO) Patients at an Urban Academic Medical Center Ginah Nightingale1, Emily Hajjar1, Kristine Swartz2, Jocelyn Andrel-Sendecki3, Lauren Hersh3, Andrew Chapman4 1

Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, 2Department of Family Medicine, Thomas Jefferson University, Philadelphia, PA, 3Hospital Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, 4 Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA

Background/Rationale: Excessive and inappropriate medication use in seniors is a significant public health problem and cancer treatment escalates its prevalence and complexity. NCCN SAO Guidelines recommend medication evaluations as part of geriatric oncology assessments. Existing (PP/PIM) studies have been limited by inherent pitfalls of patient-report and chart extraction compared to a pharmacist-led comprehensive medication assessment. Objective: To: 1) Identify the prevalence of PP, excessive polypharmacy (EP) and PIM use; 2) Identify characteristics associated with PP use; 3) Determine the most inclusive PIM screening criteria. Methods: This retrospective study (data collected from physician(s)/pharmacist(s) electronic notes) involved patients aged  60 years with cancer (all types/stages) and a geriatric oncology assessment between January 2011 and June 2013. Patients brought in all medications (prescription, nonprescription, herbals) for the assessment. PP and EP was defined by  5 and  10 concurrent medications. PIM was defined by 2012 Beers, STOPP and HEDIS criteria.

Results: Our cohort included 248 patients (mean age, 79.9 years; 64% women, 74% Caucasian and 87% solid tumors, mean comorbidity count, 7.69). Mean number of medications used were 9.23 (range 1–30). The prevalence of PP, EP and PIM use was 41%, 43% and 51%, respectively. PP use was associated with increased comorbidity count (P < 0.001) and declined ECOG score (P ¼ 0.0005). STOPP and Beers were most inclusive. Conclusions: A pharmacist-led comprehensive SAO medication assessment demonstrated a high prevalence of PP, EP and PIM use versus previously reported methodologies. Next steps include a pharmacist-led intervention to identify and reduce medication related problems during SAO care transitions.

P2 Drug-Drug Interaction Profile of Components of a Fixed-Dose Combination of Netupitant and Palonosetron (NEPA) James J. Natale1, Tulla Spinelli2, Selma Calcagnile2, Corinna Lanzarotti2, Giorgia Rossi2, Norman G. Nagl3 1

UPMC Cancer Center, Pittsburgh, PA, 2Helsinn Healthcare, SA, Lugano, Switzerland, 3Eisai Inc., Woodcliff Lake, NJ

Background/Rationale: Neurokinin-1 receptor antagonists (NK1 RAs) are commonly coadministered with 5-HT3 RAs (e.g., palonosetron [PALO]) to prevent chemotherapy-induced nausea/vomiting. In vitro data suggest that netupitant (NETU) inhibits CYP3A4 and is a substrate for and a weak inhibitor of P-glycoprotein (Pgp). Objective: To evaluate potential drug-drug interactions (DDI) between NETU and CYP3A4 substrates/inducers/inhibitors or Pgp substrates in healthy subjects. Methods: Pharmacokinetic (PK) parameters were evaluated for each drug when NETU was coadministered with PALO and when NETU or a

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Journal of Oncology Pharmacy Practice 20 2(Supplement)

NETU-PALO fixed-dose combination (NEPA) was coadministered with CYP3A4 substrates (oral contraceptives [OCs], erythromycin [ERY], midazolam [MID], and dexamethasone [DEX]), inhibitors (ketoconazole [KETO]), or inducers (rifampicin [RIF]), or a Pgp substrate (digoxin [DIG]). Results: No relevant PK interactions between NETU and PALO were reported. NEPA coadministration had no clinically significant effect on OC metabolism, although levonorgestrel exposure increased. NETU exposure increased after coadministration of NEPA with KETO, and decreased after coadministration with RIF; PALO exposure was unaffected. Coadministration of NETU increased MID and ERY exposure, and significantly increased DEX exposure in a dose-dependent manner; NETU exposure was unaffected. NETU coadministration did not influence DIG exposure. Conclusions: There were no clinically relevant interactions between NETU and PALO, or NEPA and OCs. Coadministration of NETU and/or NEPA with CYP3A4 inducers/inhibitors/substrates should be done with caution. Dose reduction is recommended for DEX. Dose adjustments are not needed for NETU coadministration with Pgp substrates.

P3 Improving Oncology Quality Through the Implementation of Evidence-Based Clinical Pathways in a Payer’s Oncology Network Cecilia L. Tran, Daniel McCrone, Gill Dudley, Michael Sturgill New Century Health, Brea, CA

recommendations before and after the initiation of the prior authorization system. Methods: Oncology practices used an online prior authorization system to submit chemotherapy treatment plans to NCH for approval. The system: 1) captured detailed patient clinical information and 2) measured compendium adherence rates. Patients with the tumor types: breast, colon, lung, lymphoma, multiple myeloma and prostate were included in the study for two time periods: baseline (Q1 2011) and review (Q4 2012). Average compendium recommendation adherence rates were calculated for both time periods. Results: A comparison of the results showed an increase in adherence rates to compendia-based chemotherapy treatment plans with a baseline target metric (Q1 2011) of 82.6% (76/92), review period target metric mean of 91.8%, and an end period mean (Q4 2012) of 97.5% (115/118). Conclusions: Implementation of an oncology prior authorization system that measures compendiabased adherence rates is associated with increased levels of evidence-based chemotherapy treatment plans by participating providers.

Pharmacy Practice PP4 A Descriptive Analysis of the Utilization of Kinase and mTOR inhibitors for Patients with Renal Cell Carcinoma in Maine Edward Li1, Jacob A. Barker1, Gary Cattabriga2 1

Background/Rationale: Physicians and health plans are collaboratively exploring clinical pathway strategies to improve patient outcomes, reduce treatment variation, and reduce oncology cost. Studies demonstrate that pathway use can lower the cost of care and oncologist participation is critical for success. New Century Health (NCH), partnered with a leading health plan and a Midwestern oncology network to implement a chemotherapy prior authorization system to review chemotherapy regimens for all patients, with the goal of improving adherence to evidence-based clinical pathways and compendia recommendations. Objective: The purpose of this study is to measure and compare the adherence to compendium

University of New England College of Pharmacy, Portland, ME, University of New England School of Community and Population Health, Portland, ME 2

Background/Rationale: Many kinase/mTOR inhibitors were recently FDA-approved to treat metastatic renal cell carcinoma (RCC), offering better options over previous cytoxic- or immunotherapies. Not much is known about these agents’ real-world use patterns (i.e., sequencing) and resultant impact on outcomes. Thus, realworld, population-based analyses of this lowincidence cancer should be conducted using large databases. Objective: The objectives of this study are to: 1) describe the cohort receiving kinase/mTOR

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HOPA 2014 abstracts

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inhibitors for RCC, and 2) identify the most common agents and sequences of these therapies. Methods: We conducted a cross-sectional, descriptive analysis of mRCC patients in the Maine All-Payer Claims Database from 2007–2010. Billing codes were used to identify RCC and kinase/mTOR inhibitors. Exclusions were: enrollment

Oncology Pharmacy Association, 26-29 March 2014, New Orleans, Louisiana, USA.

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