Current Guidelines, Appropriate Monitoring Recommendations for Therapies Used in Adult Sarcomas

Pharmacy Times 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 Hematology/Oncology Association conference addressing the treatment of adults 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 oncology pharmacy practice?

Christy S. Harris: So, we do have current guidelines that are usually comprehensive of the National Comprehensive Cancer Network, or NCCN—are the guidelines that we usually use for all cancers. It tends to be a little bit broad in sarcoma because there are so many sarcoma subtypes that they basically must break it down to what do we know has therapy for it and then what it is we don't. And then it just becomes more of a, here's the data on doxorubicin and here's data on [ifosfamide (IFOS)], because those are the 2 most common drugs that we still use in sarcomas.

Question: How does treatment location and volume of cases affect patient outcomes based on your analysis of the literature?

Christy S. Harris: So, we found in the literature, that if you're looking at a patient who is treated locally versus a patient that is treated who travels, either travels a long distance or is going to a larger center where there's a sarcoma specialty area, that they actually have better outcomes. It's been shown regardless [of grade] that the patients who were staying closer to home that they were usually lower grade, they usually didn't have as complex tumors, but they still had a lower overall survival or outcome compared to those patients that were able to go into a large institution.

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

Question: How can oncology pharmacists best recognize the appropriate therapy for an adult sarcoma based on the tumor markers exhibited?

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

Question: What can oncology pharmacists 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 do not see adult sarcomas very often. So, for a certain type of sarcoma, there may be only 300 a year, and that’s spread out throughout the entire United States. There's just not enough of this type of sarcomas that they actually see. So, this tends to be the hardest thing for pharmacists is to know there's all these therapies, but if you don't use them, then you might struggle with exactly what to use. We can look at the package insert, we can look at the studies that tell us, but sometimes you do need to understand a little bit more about that.

In those cases, this is what we try and do is provide presentations from some of the pharmacists that were involved 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 that didn't really bother the patient,’ as opposed to a sterile, where it's just the words sometimes you need that kind of personalized understanding of it. So that's what we try and do is to create information to create CDs for pharmacists to learn more about these.