Hi ,

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

Last time you learned about vaccination and hepatitis B with anti-CD20 therapies and how to use community to make progress

This week you'll learn about comfy couches, ruxulitinib discontinuation syndrome, and the recent PACC event

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

Too much of a good thing can be a bad thing

Where do your dreams and goals go to die?

It’s that cozy place that we love hanging out - the “comfort zone”

We’ve all heard that we should step outside of comfort zone, but it can be pretty intimidating

Plus, sometimes it’s just really nice to feel comfortable. It’s completely okay to enjoy the fruits of your labor that got you to that comfortable position.

We all want to enjoy a cozy night on the couch and turning our brain off. And those days are absolutely needed to have a balanced life.

But leaning into that comfort for too long can throw you off course

Think about floating in the pool on a hot summer day. It feels relaxing, you might even take a nap.

And if you aren’t cognizant of how long you’ve been there, you will be fried by the sun ☀️

When we get trapped in the comfort of our current situation, we stop paying attention to opportunities; we stop striving. Because it takes so much more effort to leave the comfy couch after weeks there than if we were there a few hours.

Don’t let comfort consume you because that’s where your dreams and goals will die a slow death

They need energy and movement to come to life - energy that can only come from you

Get up, move, experiment

You don’t have to have all the answers but you do need to make the effort!

Pearl

We know that oncology drugs have a lot of toxicities to monitor for during active treatment

What’s less common are toxicities that come after a therapy is stopped

Ruxolitinib is one example of this - it can cause a constellation of symptoms in some patients after discontinuation, including:

🔥 A flare of the underlying disease

😳 Potentially life-threatening cytokine rebound

Ruxolitinib (Jakafi) is a kinase inhibitor (like so many of our oral therapies) that specifically inhibits JAK1 and JAK2 which are involved in cell cycle signaling of cytokines and growth factors for hematopoiesis and several types of immune cells

It’s used in myelofibrosis (MF), polycythemia vera (PV), and graft-versus-host disease (GVHD, a complication of a bone marrow transplant)

In an early study of the drug in MF, there were reports of systemic inflammatory response syndrome in those that abruptly stopped the drug

A review of 251 patients with MF found that ruxolitinib discontinuation syndrome (RDS) occurred in 13.5% of patients after a median of 7 days

Reported symptoms included fever, weight loss, night sweats, fatigue, itching, abdominal and/or bone pain, and a symptomatic increase in spleen size

These were mild in most patients (~62%) but there were severe cases including a splenic rupture and severe ARDS (thankfully no fatal events)

There are a few strategies to prevent RDS depending on the overall treatment strategy (do they need to stay on therapy, are the coming to transplant, etc)

👉 taper off slowly

👉 add steroids for prophylaxis of symptoms

👉 overlap two JAK inhibitors and slowly taper off the first one

👉 switch to another JAK inhibitor without overlap but consider adding steroids and using in patients on low doses

These patients will need some thoughtful planning for how to get them off therapy

Sundry

I traveled to Miami this past weekend (I’m pretty sure it was my first trip to the city) for the PACC event (Pharmacists Advancing Cancer Care). It was a fantastic event with a good mixture of clinical and operational topics.

One area of focus was on recruiting pipelines. Like many cancer centers around the country, hiring and retaining oncology pharmacists is a top priority.

The Miami area is particularly challenged with finding staff due to it’s geography - there isn’t a lot of land around to recruit from!

I was invited to speak about what I am seeing in the marketplace and how to help non-residency trained staff members be successful in oncology

I get lots of messages from pharmacists that say they can’t work in oncology without a PGY2 and it’s not true. Everyone I spoke with was very supportive of training up staff members without residency.

There will always be centers that have a hard line of residency training (a hard line is only as hard as the availability of candidates though so even those can soften in the right environment) but that’s not the majority of the centers I talk to

Most recognize the changing dynamics of oncology pharmacy and that they need to be willing to invest in the training of their staff members

I am going to start working with an institution soon that recognizes this and is not only enrolling their staff in my program but is giving them time in the schedule to go through the curriculum 🙌 💪

If you are looking for a new role, this is the best time to find one (and if you’re interested in Miami, I can put you in touch with someone!)

And thanks for the attendee that mentioned this very newsletter during my session! It’s so rewarding when I hear feedback that the content I produce is meaningful and helpful 🙏

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