Hi ,

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

Last time you learned about seizing opportunity, QTc prolongation with arsenic, and a community conversation about paclitaxel titration

This week you'll learn about vaccination and hepatitis B with anti-CD20 therapies and how to use community to make progress

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

Vaccination plays a critical role in cancer treatment, as many patients face a heightened risk of infection due to the cancer itself, the treatment they receive, or both

Immunosuppressive therapies, such as anti-CD20 monoclonal antibodies (e.g., rituximab), can compromise the body's defense mechanisms, leaving patients more susceptible to infections. While vaccines help reduce this risk, their effectiveness can depend on the timing of administration relative to cancer treatment.

Ideally, both live and inactivated vaccines should be administered at least two weeks before starting rituximab to maximize the immune response. If this is not feasible, waiting at least six months after completing therapy is recommended to enhance the likelihood of an adequate immune response.

For patients that do receive an inactivated vaccine during or shortly after anti-CD20 therapy, the vaccine may have limited effectiveness but is unlikely to cause harm

Pearl

When considering anti-CD20 therapies, it’s essential to assess a patient's risk for hepatitis B virus (HBV) reactivation, as these therapies are known to increase this risk

Testing for hepatitis B exposure should include both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) and is recommended for all patients starting anti-CD20 monoclonal antibody therapy

A positive HBsAg indicates an active infection as this antigen typically disappears within a few months for those who recover from the infection. The appearance of hepatitis B surface antibodies signals recovery and future immunity to HBV.

On the other hand, a positive HBcAb suggests the presence of the virus's core protein, indicating either a past or current infection

If either HBsAg or HBcAb is positive, it’s necessary to check a quantitative hepatitis B viral load by PCR - not for diagnosis, but to monitor chronic infections and treatment response

For patients with a positive HBsAg, antiviral therapy with entecavir is recommended specifically over lamivudine due to lower resistance rates. Additionally, consulting infectious disease or hepatology specialists for ongoing monitoring is recommended, allowing the oncology team to focus on cancer care.

Fun fact: patients who receive IV immunoglobulin (IVIG) may test HBcAb-positive due to passive transfer. IVIG is made by pooling plasma from multiple donors, which can introduce HBcAb in patients who weren’t previously exposed. If you’re interested, this retrospective review dives deeper into this phenomenon.

Sundry

Community has become a central part of my life, both in the ELO Collaborative program I lead and in the professional development communities where I’m a member

Communities hold a unique power: they connect us with others on similar journeys and help us make progress on our personal and professional goals - often both at once

Last week, I had the opportunity to experience this firsthand at a community event in England. The other nine attendees, also small business owners, were similarly dedicated to helping others master a challenging subject, such as learning Chinese (I’m not sure which is harder to learn, oncology or Chinese 🤔). It was a shared commitment to education and growth that made this event worthwhile, and the diverse methods and perspectives made it truly stand out.

Reflecting on this experience, I’m reminded of the most immediate benefit of joining new communities: they provide access to fresh perspectives. This might surprise you, but I’m not naturally an “outside-the-box” thinker. I can fall into routines, sticking with “what’s always been done” because it often feels easier or safer.

But innovation requires us to step out of our comfort zones. Engaging with others who approach their work differently can help shake us out of those routines and reveal new possibilities. For me, this group did just that - through lively conversations and direct feedback that encouraged me to consider other ways of approaching my work.

So, I encourage you to think about how you might connect with people who have different perspectives. How can you learn from those who approach things differently? Often, it’s through these interactions that we find new ways forward.

Here are a few images from the experience 👇

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

When you're ready, here are ways to get help

Learn with others in the ELO program

The ELO Collaborative is my signature oncology pharmacy membership community that was created for pharmacists working in oncology and trying to learn on the job. It combines a curated curriculum with access to expert oncology pharmacists to walk through case studies and answer questions.

Learn on your own with digital products

Prepare for BCOP with over 400 questions in the Oncology Pharmacy Question Bank (you can also add on example patient cases!)

Learn about breast, lung, prostate, and other cancers with our individual disease courses