Hi ,

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

Last time you learned about hand-foot syndrome, treatment in the 4 clinical stages of pancreatic cancer, and why language matters

This week you'll learn about how learning oncology is like the Chinese bamboo tree, the newly approved zenocutuzumab, and a reminder that we can't control everything

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

Oncology pharmacists are just like the Chinese bamboo tree

This unique tree is known for it’s slow growth

When it’s planted it stays in the ground for a ridiculous amount of time - 5 years 🤯

It has to be tended to for 5 years while it germinates before there is any evidence of success

And then in year 5 it explodes out of the ground and grows rapidly

During those 5 years, it’s building its root system - the foundation that will support the rapid growth in year 5. Without that, it couldn’t be successful when it finally breaks through the soil.

This is the same process to learn oncology

You’re tending to your education and learning, giving it water and nutrients, and often seeing very little results in the beginning

This can be disconcerting - you are putting in a ton of effort, you want to see results!

If you stopped watering the bamboo tree, it would die and you never see the end result

If you stop nurturing your education, your growth will also be stunted

I think 5 years is probably the right timeframe comparison. And that probably sounds daunting.

You will absolutely make progress before 5 years, but it does take a long time to not only build the foundation but develop the critical thinking and analytical skills that are equally important in oncology.

That comes with time and experience, which you can’t speed up any more than you can speed up the bamboo tree’s growth. It takes what it takes.

Curate your patience and be amazing when you do finally break ground 🌱

Pearl

Another new kid is on the oncology block!

Zenocutuzumab-zbco (Bizengri) is a first-in-class bispecific antibody with a catchy mechanism trademarked as Dock & Block™ (pretty sure it’s the first mechanism that is trademarked). This clever branding not only highlights its mechanism but also helps us remember it.

Here’s what you need to know about this new therapy approved on 12/4/24 for advanced, unresectable, or metastatic non-small cell lung cancer (NSCLC) or pancreatic adenocarcinoma with a neuregulin 1 (NRG1) gene fusion and disease progression on or after prior systemic therapy

Mechanism of Action

This IgG monoclonal antibody has a unique dual-binding strategy:

• One arm docks to HER2 and the other docks to HER3
• This docking triggers a conformational change to block the binding of neuregulin-1 (NRG1), a growth factor critical for HER3-mediated cell survival (hence the Dock & Block)
• It’s also thought to induce antibody-dependent cellular cytotoxicity (ADCC), rallying immune cells to the tumor microenvironment for an added punch

Clinical Context

• Target: NRG1 fusions, which are found in fewer than 1% of solid tumors. Rates slightly climb in non-small cell lung cancer (NSCLC) and pancreatic adenocarcinoma but are still low.
• Diagnostic Challenge: No standalone test exists yet for NRG1 fusions, but they can be detected via next-generation sequencing (NGS).
  
• Evaluated in the eNRGy study (there are some great marketing brains behind study names 🤩)
  
  • Enrolled 94 patients (small study, but remember, this is a rare fusion) with advanced or metastatic NRG1 fusion positive NSCLC (64) or pancreatic adenocarcinoma (30). Primary outcome was overall response rate (ORR) and duration of response (DOR).
    
  • Results showed an ORR of 33% (NSCLC) and 40% (pancreatic), but the vast majority were partial responses

Dosing and Administration

• Dose: 750 mg IV every two weeks
• Infusion Protocol: Prepare for extended infusion days due to a 4-hour initial infusion followed by a 1-hour observation
• Premedication is recommended with dexamethasone, acetaminophen, and an H1 antihistamine to mitigate the 13% incidence of grade 1-2 infusion reactions
• Stability: Watch the admin times with this - a bag at room temperature is only good for 6 hours. If delays happen for infusion reactions, you might get close to the expiration time.

Safety Profile - it has 3 warnings and precautions

• Infusion Reactions: Mild-to-moderate (grade 1-2) and manageable with premedications
• Pulmonary Toxicities including interstitial lung disease and pneumonitis
• Cardiotoxicity: Monitor for decreased left ventricular ejection fraction (LVEF) at baseline and throughout treatment at “regular intervals" (could the PI be any more vague?!)
  
• Other Common Adverse Effects (>10%):
  • Musculoskeletal pain
  • Rash and dry skin
  • Fatigue
  • Nausea/vomiting/constipation/diarrhea
  • Edema
  • Decreased hemoglobin, sodium, and platelets
  • Altered liver function tests

This therapy is an exciting new tool in bispecific antibody development, joining a growing class of agents but with a unique, T-cell-independent twist!

Sundry

In case you need this reminder, we can’t control everything. And in reality, we can’t control all that much.

As someone that likes control in most scenarios, this is a constant lesson to be learned for me 😅

Number one thing to remember - you cannot control other people. They will do what they want, behave how they want, and make decisions they want to make.

Sometimes it doesn’t affect you much and sometimes it really sucks

The faster we can figure out what is in our control, and do something about it, the faster we’ll feel better about the situation

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