|
Pearl
One question often asked, usually by those outside pharmacy, is what an oncology pharmacist does
There are many different roles we can have in oncology, the most common ones involving direct patient care
In these patient care roles, most of us are not involved in the treatment selection process, but something we all should be doing is helping to manage the toxicities from these treatments
And there is usually a lot to manage 😅
For example, patients taking alpelisib for PI3K-mutated breast cancer often experience hyperglycemia, rash, and diarrhea (more than half of patients in the SOLAR-1 study) in addition to N/V, anorexia, rash, weight loss, stomatitis, fatigue/asthenia, and a slew of others
We hear a lot about “off target” effects of drugs, which describes a side effect that happens when the drug binds to a non-intended target (we call these “dirty drugs”)
Hyperglycemia with alpelisib is an “on target” side effect, meaning it’s an expected result of its alpha-specific PI3K inhibition
Regardless if it’s an on or off target effect, we need to monitor for it. In the study, the median time to first occurrence was about 2 weeks, so it needs to be on your radar for all new starts
And you are very likely to see it because any grade hyperglycemia occurred in ~64% of patients in the trial, with grade 3 at 33% 😳
Because of the high incidence and severity, you can consider adding metformin up front to help mitigate this toxicity
Another on target toxicity we can try to prevent are severe skin reactions, which were also seen early, in the first few weeks of treatment. These occurred in ~54% of patients in SOLAR-1, with grade 3 in ~20% (look at the footnote for table 3 because the table is a little misleading).
The study protocol was amended to allow cetirizine or another non-sedating antihistamine to be given prophylactically so consider starting this in your patients also
Want to dive in a little more? Listen to this OncoPharm podcast. |
