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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 15 mistakes oncology pharmacists make, interpreting the CheckMate 649 study in upper GI cancers, and how time unfolds us


This week you'll learn about raising your floor, biomarker-directed therapy in metastatic colon cancer, and a renovation update


Have a great week!


Kelley

🧠 IPS (Insight, Pearl, Sundry)


Insight


Do you have one of those friends that you used to be super close with but your relationship has grown apart as time goes on?


This happens when our growth becomes out of sync. When one person starts raising their floor and the other doesn’t, or does it at a different pace (it happens with romantic relationships too).


It’s not inherently bad, only a function of every human doing their own thing - following their own interests and priorities


Education is one way this can happen. When we’re in school, especially graduate programs, we are consumed by the curriculum and rapidly raise our floor to accommodate new information, new ways of thinking, new dreams and ideas for the future.


If those around you aren’t in a similar learning phase, you can become out of sync if effort isn’t put in to reconnect


[perhaps this is also why so many pharmacists are in relationships with other pharmacists - we’re all working on raising our floor together πŸ€”]


Connection is really what it’s all about. Can you connect in the same way if your floors are at different levels? Potentially, but it will likely take more effort than it used to.


Maybe this is why we get stuck in the β€œsameness” - that comfortableness of life


It take a lot of effort to move out of it, to overcome the inertia that wants to keep you there. It’s even harder to get 2 people to do it at the same time.


So when you’re working towards something challenging, like learning oncology, and others around you don’t seem to understand, know that it’s normal


Your elevator is on a different floor than theirs and you’re looking at a different view. Not necessarily a better or worse view, but something different. So you’ll need to put in the effort to relate to their experiences and reality moving forward.

Pearl


For patients with metastatic colon cancer with disease progression on oxaliplatin or irinotecan based therapies, we look to biomarker directed therapy


This is why it’s critical tumors are being tested for all the different biomarkers that can impact treatment - here is a great summary of them


For example, in order to select treatment for HER2+ tumors, we also have to know the status of RAS and BRAF.


Take a look at biomarker-directed treatment options in these patients:


HER2+ and RAS/BRAF wild type (wild type = normal):

  • Trastuzumab + pertuzumab
  • Trastuzumab + tucatinib
  • Trastuzumab + lapatinib
  • Fam-trastuzumab deruxtecan - this is often reserved after they’ve failed another HER2 agent since it’s shown to have activity after previous HER2 therapy


HER2+ and RAS/BRAF mutant:

  • Fam-trastuzumab deruxtecan


BRAF V600E+

  • Encorafenib + cetuximab
  • Encorafenib + panitumumab


KRAS G12C mutant

  • Sotorasib + cetuximab
  • Adagrasib + cetuximab
  • Sotorasib + panitumumab
  • Adagrasib + panitumumab


NTRK fusion positive

  • Larotrectinib
  • Entrectinib
  • Repotrectinib


RET gene fusion positive

  • Selpercatinib


Choosing a regimen when multiple are available comes down to accessibility and convenience


Here are some questions to discuss with the team:

  • Are you concerned about pill burden?
  • Is there a preferred treatment schedule?
  • Is there a patient out of pocket difference?
  • Is the patient a good candidate for an oral therapy?
  • Are there overlapping toxicities or drug interactions to manage?

Sundry


I mentioned in a previous newsletter that I am buying a fixer upper and got a lot of requests about sharing the journey. So we’ll start today!


I closed on the house last Wednesday afternoon (after some last minute kerfuffle about the house not being empty) and had a contractor there on Thursday morning for demo as I boarded a plane for the HOPCON conference.


The timing worked out perfect. I met with my contractor (a referral from my realtor) during the buying process. He was at my inspection and one other visit to give me estimates on all the work needed and our schedules just happened to align so he was able to start right after close.


This 3br/1ba house is almost a full gut. Here are the things to be completely renovated:

  • Kitchen
  • Bathroom
  • Deck
  • Roof
  • Front porch
  • Windows
  • and seemingly a million other little things...

Take a peek at the deck and kitchen before the demo!


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


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