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JHOP - December 2019 Vol 9, No 4

Multidrug regimens have become a staple in oncology, thanks to their ability to overcome multiple areas of treatment resistance by the tumor. The use of multidrug regimens facilitates different mechanisms of attack against the tumor.1 This multidrug regimen method frequently leads to the question of how to sequence chemotherapies or monoclonal antibodies. This is an important question that is asked of oncology pharmacists, because of findings that demonstrate greater toxicity and/or efficacy, depending on the sequencing of the agents.1-5 A common misconception in oncology pharmacy is that these agents have been tested as part of a chemotherapy regimen and are therefore safe and effective, but this belief has been disproved by several studies.2-4
The National Comprehensive Cancer Network (NCCN) is comprised of 27 leading cancer centers in the United States that focus on creating patient and prescriber guidelines for the diagnosis of, treatment of, and supportive care for patients affected by cancer. Since 1995, the NCCN has aimed to aid oncology prescribers by providing evidence-based clinical recommendations. Although those guidelines often focus on treatment, they also provide a large amount of supportive care recommendations, including guidelines for antiemesis. The NCCN antiemesis guidelines are based on the following criteria—emetic risk of the chemotherapy agents administered, previous use of antiemetic medications, and the patient’s risk factors.1
The oncology patient population is at an elevated risk for severe infections associated with increased mortality. The early recognition of fever is critical in patients with febrile neutropenia, because a fever may be the only sign of infection.1 According to the 2010 Infectious Diseases Society of America (IDSA) guidelines, febrile neutropenia is defined as an absolute neutrophil count (ANC) of ≤500 cells/mm3, with a single oral temperature of ≥101°F or a temperature of ≥100.4°F sustained over a 1-hour period.2
Many chemotherapy agents have the potential to impair fertility.1,2 Infertility resulting from cancer treatments can affect the quality of life for young cancer survivors.3 In 2017, an estimated 852,630 female patients were diagnosed with cancer in the United States, of whom 10.5% were aged <45 years.4
Paclitaxel is a taxane-derived antineoplastic agent that is often used for US Food and Drug Administration (FDA)-approved indications such as breast cancer, AIDS-related Kaposi sarcoma, ovarian cancer, and non–small-cell lung cancer (NSCLC).1 It is also widely used for a number of off-label indications, and it works by promoting the assembly of microtubules, further enhancing the inhibition of cellular replication. It is administered as an intravenous (IV) solution, and its dosage and duration of treatment vary based on the indication.1 Patients with high-risk breast cancer in the preoperative or the adjuvant setting can receive either dose-dense paclitaxel (ie, 175 mg/m2 every 2 weeks for 4 cycles) or weekly paclitaxel (ie, 80 mg/m2 weekly for 12 weeks). In breast cancer, paclitaxel can be administered after the use of an anthracycline, in combination with cyclophosphamide.2
Keeping up with the many treatment advances in relapsed or refractory multiple myeloma can be a challenge for even the most informed providers, according to Jorge J. Castillo, MD, Clinical Director, Bing Center for Waldenström’s Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.
An increasing number of biosimilars have been approved in the United States, but many clinicians are still poorly informed about what constitutes a biosimilar, and what is involved in their unique pathway to approval, said Andrew D. Zelenetz, MD, PhD, Medical Oncologist, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York City. He discussed this topic at the NCCN 2019 Hematologic Malignancies meeting.
We are in a “golden age” in chronic lymphocytic leukemia (CLL), according to Andrew D. Zelenetz, MD, PhD, Medical Oncologist,

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