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Hi ,


Welcome back to the Oncology Insights Newsletter which fosters your continuous growth in oncology pharmacy practice


Last time you learned about the oncology battery, bendamustine renal dose adjustments, and taking of blinders


This week you'll learn about how decisions can surprise us, TIL therapy, and the 80,000 hour long career


Have a great week!


Kelley

🧠 IPS (Insight, Pearl, Sundry)


Insight


Sometimes our decisions may surprise us


A client in the ELO Collaborative reached out to me for coaching about a new opportunity - a clinical role in oncology. She has been working on the operations side for several years and was interested in expanding her skills. She found a newly created clinical position, got an interview, followed by the offer.


She listed out the pros and cons of making this change. The new position involved moving away from family but came with a bigger paycheck and the opportunity to do more clinical work throughout her day, including a lot of patient counseling.


There has long been a divide between clinical and operational roles, mostly at bigger centers that have both. Smaller centers have smaller staffs so they have to do all the work that comes their way, whether it’s verifying an order, getting a product out the door, or counseling a patient.


It makes sense to have a separation in larger practices, especially when our physician colleagues are specialized


This divide can easily trap us into thinking a clinical role has greener grass and is the best option when available


But that’s not always the case, and for my client, that’s how it turned out. She turned down the offer because, after weighing everything, it didn’t meet the mark she set for herself.


Professional development isn’t a cookie cutter path you just follow. It’s taking time to figure out what your values are, both personally and professionally, and using those as a lens to evaluate all new opportunities.


It actually makes decision making a lot easier if you know what’s in alignment with your goals and what is not.

Pearl


Tumor-infiltrating lymphocytes (TILs) have been studied for decades but their first FDA-approval came just earlier this year with the drug lifileucel (Amtagvi)


Similar to CAR-T cell therapies, TILs are complex cellular therapies but there are also a lot of differences between them


To undergo TIL therapy, T cells are collected from the patient’s tumor since those cells have already proven they can identify tumor cells and get to the tumor site 🎯 (vs CAR T that has to be modified to find the cells)


Despite knowing where home is, TILs still need some help to be effective which they get from their friend interleukin-2 (IL-2)


IL-2 is used ex vivo to rapidly increase the number of TILs and it’s also used after infusion of the product to enhance in vivo expansion


If you started in oncology <10 years ago, you likely won’t remember IL-2 being used to treat melanoma back in the day. We were hoping our days of managing high dose IL-2 were done when it was replaced by better therapies, but similar to fashion trends you didn’t particularly want to see again, it’s making a comeback.


Lifileucel is indicated in patients with unresectable or metastatic melanoma who have progressed on anti-PD-1 immunotherapy and a BRAF/MEK inhibitor combination (only if tumor is BRAF mutant). Unless you are working at a large center, you likely won’t see TILs for a while since you have to be an authorized center with adequate ICU care available and prior extensive experience with high dose IL-2 (because it’s a roller coaster ride).


Even if you’re not actively involved in administering TILs therapy, you might encounter these patients for follow up and should know that they will need long-term prophylactic medications similar to a patient who undergoes an autologous transplant.


Prophylaxis against PJP, herpes zoster, and fungal infections should be considered for up to 6 months. The NEJM article links to the study protocol so you can see what they did in the trial.

Sundry


Did you know that the average career is 80,000 hours long?


James Clear has talked about this math - 40 hours a week, 50 weeks a year, for 40 years


How does that make you react? The first thing that caught my eye was the 2 weeks of vacation, which is average. And probably how much I take but not how much I dream of taking 😅


Early retirement dreams aside, most of us will work for 40 years. And that is a REALLY long time to be working in a job you don’t like or that isn’t in alignment with your values.


If that’s the position you’re in, what is one step you can take this week that will start you on a journey to a job that won’t make you cringe?


💡 Have a topic you want to see discussed in the newsletter? Hit reply and share it! 💡


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