Current guidelines, appropriate monitoring recommendations for therapies used in adult sarcomas

Pharmacy hours interviewed Christy S. Harris, PharmD, BCOP, FHOPA, Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy & Health Sciences and Clinical Pharmacy Specialist, Dana-Farber Cancer Institute, discusses her presentation at the Association of hematology/oncology on the treatment of adult sarcomas, including guidelines for common therapies and appropriate monitoring recommendations for selected therapies used in the treatment of adult sarcomas.

Question: What are the current guidelines for common therapies used in the treatment of adult sarcomas, and how do these guidelines influence the practice of oncology pharmacy?

Christy S. Harris: So we have current guidelines that are generally comprehensive from the National Comprehensive Cancer Network, or NCCN – these are the guidelines that we usually use for all cancers. It tends to be a bit broad in the case of sarcoma because there are so many subtypes of sarcoma that they basically have to break it down into what we know have therapy for it and then what we don’t have not. And then it just becomes plus one, here’s the data on doxorubicin and here’s the data on [ifosfamide (IFOS)]because these are the 2 most common drugs that we still use in sarcomas.

Question: How do treatment location and case volume affect patient outcomes based on your literature review?

Christy S. Harris: So we found in the literature, if you look at a patient who is treated locally versus a patient who is treated who travels, either travels a long distance or goes to a larger center where there is a specialty of sarcoma, that they actually have better results. It was shown anyway [of grade] that the patients who stayed closer to home that they were usually lower grade, they usually didn’t have tumors that complex, but they still had lower overall survival or outcomes than the patients who could enter a large establishment.

So this data is really trying to support the comments and, of course, the NCCN guidelines that recommend that patients be referred to a large, multidisciplinary sarcoma center, if possible, because of the results that come out of that.

Question: How can oncology pharmacists best recognize the appropriate treatment for adult sarcoma based on exposed tumor markers?

Christy S. Harris: So we have some sarcomas that have tumor markers for which we can have specific therapies. It’s very frustrating because sarcomas – there are about 100 of them, and only certain subtypes have these markers. So those are included in the NCCN guidelines to separate them and to know very specifically if that tumor has a marker, and of course in the literature, pharmacists can often investigate the literature and see what’s at. But it’s still a good start.

Question: What can pharmacist oncologists do to develop and follow appropriate monitoring recommendations for selected therapies used in the treatment of adult sarcomas?

Christy S. Harris: So for most pharmacists, they don’t see adult sarcomas very often. So for a certain type of sarcoma, there may only be 300 a year, and that’s spread across the entire United States. There just aren’t enough of these types of sarcomas that they actually see. So, that tends to be the hardest thing for pharmacists to know is that there are all of these therapies out there, but if you’re not using them, you might have a hard time knowing exactly what to use. We can look at the package insert, we can look at the studies that tell us that, but sometimes you need to know a little bit more about it.

In these cases, that’s what we try to do, is to provide presentations from some of the pharmacists who participated in the studies that can kind of give you a more personalized view of ‘Yes we started this but it was more of a grade 1 rash which didn’t really bother the patient‘, as opposed to a sterile one, where it’s just the words, sometimes you need that kind of personalized understanding. So that’s what we’re trying to do is create information to create CDs for pharmacists to learn more about.

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