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Session descriptions and speaker information for Friday's sessions at HOPA's Annual Conference.

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8–9 am

Ambulatory Practice (301) 0.1 CEUs blue K

Breast Cancer, Bone Health, and Bisphosphonates: Breaking Down the Role of Bone-Modifying Agents in Adjuvant Breast Cancer

Kelly Gaertner, PharmD BCOP BCPS

This presentation will discuss currently available or pending literature surrounding the rationale for and use of bone-modifying agents in the adjuvant treatment of breast cancer, including the literature supporting recommendations set forth in the 2017 guidelines published by Cancer Care Ontario and the American Society of Clinical Oncology. The discussion will include background for the use of bone-modifying agents in the adjuvant treatment of early-stage breast cancer, dissection of key trials on use in the adjuvant setting, areas of controversy, and current gaps in the literature, such as use of specific bone-modifying agents, timing, and duration of therapy. Key trials discussed will include ABCSG-12, AZURE/BIG 1-04, and the EBCTCG meta-analyses. The presentation will also briefly identify additional roles of bone-modifying agents in the adjuvant breast cancer treatment setting. The goal is for the audience to understand the available data and key literature behind the guideline recommendations to assist with implementing them in clinical practice. This session is directed toward beginning or advanced practitioner pharmacists practicing in an adult oncology setting that includes breast cancer patients.

 

STAMPEDE into CHAARTED Territory: Updates on the Treatment of Castrate-Sensitive Prostate Cancer

Catherine Lee, PharmD BCOP BCPS

The treatment landscape for hormone-sensitive prostate cancer has been transformed recently by new research using additional systemic therapies combined with androgen deprivation therapy. This session will discuss the recent advancements in castrate-sensitive prostate cancer with agents such as abiraterone acetate and docetaxel. Use of systemic agents earlier in the treatment continuum of prostate cancer is not without consequences, and the long-term clinical effects of combination therapy will be reviewed.

 

Practical Issues for Clinicians (302) 0.1 CEUs blue K

The Treatment of Hepatitis C with Direct-Acting Antivirals in Patients with Cancer

Jill Comeau, PharmD BCOP

The session will cover the current American Association for the Study of Liver Disease (AASLD) hepatitis C (HCV) treatment guidelines specific to direct-acting antivirals (DAAs) and discuss the evidence related to HCV treatment in patients with cancer. I will review the first-line treatment recommendations for HCV in the AASLD guidelines, including schedule, cost, drug interactions, and other relevant clinical pharmacy information. I will then discuss the literature related to the treatment of HCV with two specific malignancies: B-cell lymphoma and hepatocellular carcinoma. For B-cell non-Hodgkin lymphoma, I will review the evidence as well as the National Comprehensive Cancer Network guidelines discussing the role of DAAs for HCV treatment based on the type of B-cell lymphoma and its place in therapy. For hepatocellular carcinoma, I will discuss the data concerning the risk for relapse in patients who are receiving DAAs for HCV. The audience is those involved in direct care for patients who have hepatitis C and a malignancy. The material is more applicable for outpatient clinicians but will offer a good overview for all practitioners of the treatment of hepatitis C, which has evolved drastically in the past 5 years and continues to evolve.

The Clot Thickens: Direct Oral Anticoagulants in the Cancer Patient and Their Reversal

Prakirthi Yerram, PharmD BCOP BCPS

Venous thromboembolism risk is increased by 4–7 times in cancer patients and is the second leading cause of death in these patients, after death from cancer itself. Though data for the use of the direct oral anticoagulants (DOACs) in cancer patients are lacking, many providers are using these agents because of their advantages in convenience and patients’ quality of life when compared to low-molecular-weight heparins. However, there is significant concern regarding the efficacy and safety of the DOACs in cancer patients. Pharmacists play an important role in patient and provider education, so the oncology pharmacist must be knowledgeable about new advances in anticoagulation. This presentation will address the gap in education regarding the existing data on the use of DOACs in cancer patients as well as the new DOAC reversal agents currently available and in the pipeline.

 

Pediatrics (303) 0.1 CEUs blue K

Beating the Odds When Fighting the Fungi

Joshua Elder, PharmD BCOP BCPS; Abby Kim, PharmD BCOP

Fungal infections contribute to significant morbidity and mortality in the pediatric oncology setting. Clinical pharmacists can optimize outcomes for patients with these infections if they have appropriate knowledge of therapeutic drug monitoring and optimization of certain azole antifungals. Unfortunately, the treatment of choice for many fungal infections involves azole antifungals, which often directly interact with commonly used chemotherapy in pediatric oncology protocols and present intra- and interpatient variability with respect to dosing and therapeutic drug monitoring. Although this session does not present a one-size- fits-all solution, we will use case-based examples to discuss strategies for overcoming drug interactions in order to optimize patient outcomes. We will also discuss the utility of therapeutic drug monitoring for optimal treatment while limiting toxicities.

Keeping Up the TACE! Transarterial Chemoembolization in Pediatric Patients

Julie Gegg, PharmD BCOP

Transarterial chemoembolization (TACE) is a treatment technique commonly used in the management of liver tumors in adult patients. TACE involves the intra-arterial injection of chemotherapeutic agents along with embolic materials to achieve high concentrations of chemotherapy in areas of disease with minimal effect on the normal liver. This presentation will focus on the indications for TACE in pediatric patients, and specifically on the use of TACE for pediatric hepatoblastoma and hepatocellular carcinoma. The unique considerations for TACE in pediatric patients—including drug formulations, dosing, administration techniques, supportive care, and monitoring—will also be discussed.

 

Practice Management (304) 0.1 CEUs blue K

Innovative Use of Students in Ambulatory Oncology

Shannon Hough, PharmD BCOP; Shawna Kraft, PharmD BCOP

Pharmacists are being asked to perform more and more tasks associated with assisting in patient care. Using strategies from a layered learning model, we can optimize our use of students even beyond advanced pharmacy practice experience rotations to help perform some of our patient care duties in the ambulatory oncology setting. This session will cover a variety of ways that students can be used, including an on-call program to assist with access and complementary and alternative medicine reviews. Training for these activities will also be covered.

 

Hematopoietic Cell Transplant (305) 0.1 CEUs blue K

Updates in the Treatment of Graft-Versus-Host Disease: A Focus on Novel Therapies

Katie Gatwood, PharmD BCOP

This session will cover updates in the diagnosis and treatment of graft-versus-host disease (GVHD) following hematopoietic cell transplantation, with a focus on novel therapies. Ibrutinib and ruxolitinib will be highlighted because these therapies have recently received either U.S. Food and Drug Administration approval or breakthrough therapy designation for GVHD treatment. An overview of key clinical data will be provided, as well as information on application to practice, such as toxicities, drug interactions, access issues, and considerations in patient selection.

The Gut Microbiome: Nature's Defense in Stem Cell Transplant

Stephanie Willenbring, PharmD MPH BCOP

The involvement of the gastrointestinal microbiome is emerging as an important player in the prevention of bacterial infection and graft-versus-host disease (GVHD) in hematopoietic stem cell transplant patients. Infection and GVHD account for approximately 25% of deaths that occur within 100 days of allogeneic stem cell transplant. Preservation of the microbiome and specific organisms within the natural floral may be able to reduce or prevent the incidence of some of these transplant-related complications. This presentation will discuss current information on the involvement of gut microflora in infections and gastrointestinal GVHD, examine available studies for gut microbiome modification in transplant, and summarize how a stem cell transplant pharmacist may intervene to try to take advantage of natural gastrointestinal flora.

9:15–10:15 am

The Role of PARP Inhibitors in Oncology and Combination Therapy (306) 0.1 CEUs blue K

Laura Alwan, PharmD BCOP

This session will review the use of poly (ADP-ribose) polymerase (PARP) inhibitors in oncology therapy. Key topics include the mechanism of action of PARP inhibitors, clinical trial data that have led to the current U.S. Food and Drug Administration–approved indications, common and important toxicities of this drug class with recommended dose adjustments, and the rationale for choosing a particular PARP inhibitor for a specific patient. Combination therapy with PARP inhibitors will be discussed, as well as suggestions for toxicity management and future directions of PARP inhibitor use.

 

Outpatient Transplant: From the Inside Out (307) 0.1 CEUs blue K

Jeanne McCarthy-Kaiser, PharmD BCOP

The Centers for Medicare and Medicaid Services and other insurers are continually reevaluating their position on the coverage and reimbursement of hematopoietic cell transplant. These decisions may decrease reimbursement for services performed in the inpatient setting and force transplant centers to treat patients in the outpatient setting. Transplant centers across the country differ in their approach to outpatient transplant care. This session will present an overview of one center's allogeneic and autologous transplant practices, with a focus on outpatient transplant, and opportunities for pharmacists’ involvement.

 

Advocacy Updates (HP/ADV) 0.1 CEUs blue K

Jerrica Mathis, MSEd; Jeremy Scott, MA

This session will provide an overview of the current political landscape affecting hematology/oncology pharmacists, an update on HOPA’s health policy agenda, and a discussion of ways that you can advocate on behalf of hematology/oncology pharmacists.

10:30–11:45 am

New Oncology Drugs in 2017 (308) 0.125 CEUs blue K

Amy Seung, PharmD BCOP

This session will review all medications approved by the U.S. Food and Drug Administration for oncologic indications in 2017. The discussion of each medication will include its pharmacology, evidence to support its approval, its place in therapy, and significant adverse effects.

 

BCOP Session 4 (BC4) 0.125 CEUs red A

Death with Dignity: Implications for Pharmacists

Rabia Atayee, PharmD BCPS; Joseph Bubalo, PharmD BCOP BCPS

Physician-assisted suicide, also known as physician-assisted death or death with dignity, is a controversial topic for healthcare providers and patients alike. This session will discuss the origins of this practice and current experiences and will explore issues from the point of view of both patients and providers. Because pharmacists prepare the final prescription used by patients, their involvement will be a focus. For both palliative care practitioners and oncology pharmacists, multiple approaches to physician aid in dying (PAD) exist. This session will provide insights into and provide a method for exploring care for the patient seeking aid in dying. Are the patient’s symptoms well managed or not, and how can the practitioner address these symptoms in a time-limited fashion? If a patient’s suffering or perception of suffering at the end of life does not improve, then we consider their nonmodifiable reasons for requesting physician assistance, and their request progresses as defined within the laws of that state. We will discuss patients’ cases, reviewing modifiable and nonmodifiable reasons for a PAD request and including pharmacists’ involvement and the use of medications in both types.

1:15–2:15 pm

Summiting the Biosimilar Landscape: Practical Considerations for Biosimilar Evaluation (309) 0.1 CEUs blue K

Lisa DiGrazia, PharmD BCOP BCPS

The development of biosimilars is advancing rapidly, and the first biosimilar used to treat cancer in the United States has been approved. With more oncology biosimilar candidates in a robust pipeline, clinical pharmacists must have a comprehensive understanding of biosimilar development and stay abreast of biosimilar approvals for implementation in real-world clinical practice. This session will discuss the U.S. Food and Drug Administration’s framework for biosimilar development, with a focus on analytical testing; review currently approved biosimilars and biosimilar candidates in hematology and oncology in the United States; and identify barriers to biosimilar uptake. After completion of this session, clinical pharmacists should have the tools to facilitate proper discussions at pharmacy and therapeutic meetings and provide education to patients and healthcare providers in order to increase access to these lifesaving medications.

 

Updates on the Treatment of Neuroendocrine Cancers (310) 0.1 CEUs blue K

Carolyn Oxencis, PharmD BCOP BCPS

Neuroendocrine cancer is steadily increasing in incidence and represents a unique subset of malignancies not frequently focused on. This session will help beginning and advanced pharmacy practitioners understand newly approved neuroendocrine cancer therapies and apply them in practice. The discussion will use clinical trials, highlighting design, efficacy, and safety. In addition, clinically important pharmacy pearls will be reviewed, along with new literature on current areas of study and future directions in the paradigm of neuroendocrine cancer treatment.

 

BCOP Session 5 (BC5) 0.1 CEUs red A

Overview of Interesting and Novel Therapies for the Treatment of Neuroblastoma in Pediatric Patients

Nicole Kaiser, RPh BCOP

An overview of interesting and novel therapies for the treatment of neuroblastoma will be presented. The target audiences are providers who encounter pediatric oncology patients and those interested in learning novel approaches to solid tumor therapy. Therapies to be discussed include tandem autologous stem cell transplantation, targeted antibodies, radionucleotide therapy, and differentiating agents, as well as monoclonal antibody therapy, which has been developed and approved specifically for the treatment of neuroblastoma.

3:45–5 pm

2018 Investigational Drug Updates (311) 0.125 CEUs blue K

Pam Pawloski, PharmD

This presentation will discuss the pharmacology, mechanism of action, and biologic targets of a number of investigational anticancer drugs currently in clinical trials. Existing and novel drug classes and recent clinical findings will be covered. The session’s content is applicable for most attendees.

 

BCOP Session 6 (BC6) 0.125 CEUs red A

Update on Head and Neck Cancer: Molecular Features and Emerging Novel Therapies

Eve Segal, PharmD BCOP

Each year, an estimated 55,000 adults in the United States develop head and neck cancer. Recent advances in molecular biology, genetics, and sequencing technologies now provide a basis for the practice of precision medicine in the management of head and neck cancer. This session will focus on novel therapies for head and neck cancer, including anti–programmed death ligand-1 and anti–programmed cell death-1 agents, antitumor vaccines, and targeted therapies. It will also cover pertinent screening and prevention guidelines for these patients.

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