Nathalie Letarte

An evaluation of pharmacists’ expectations towards pharmacogenomics

BACKGROUND Given their expertise in pharmacotherapy, pharmacists are well positioned to play a leading role in the implementation of pharmacogenomics in clinical practice. However, little is known about the opinions of pharmacists towards pharmacogenomics or their willingness to integrate this new field in their practice. METHODS We conducted a survey of 284 pharmacists practicing in the province of Québec (Canada) to describe the opinions, expectations and concerns of pharmacists toward pharmacogenomics. RESULTS Pharmacists were very hopeful regarding the potential role of pharmacogenomics. Moreover, more than 95% of responders would be willing to recommend pharmacogenomic testing. Nevertheless, only 7.7% of pharmacists currently felt comfortable advising patients based on pharmacogenomic test results. Accordingly, the majority of responders (96.6%) indicated that they would like to undertake continuing education related to pharmacogenomics. CONCLUSION Pharmacists are extremely hopeful towards pharmacogenomic testing. Furthermore, a vast majority is willing to integrate these tests as part of their clinical practice. Proper education will be required if the integration of pharmacogenomics in patient care is to be optimal.

Adjuvant treatment for endometrial cancer: Literature review and recommendations by the Comité de l'évolution des pratiques en oncologie (CEPO)

OBJECTIVE Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this review is to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patients with resectable endometrial cancer and to develop evidence-based recommendations. METHODS A review of the scientific literature published between January 1990 and June 2012 was performed. The search was limited to published phase III clinical trials and meta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified. RESULTS The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beam radiotherapy, chemotherapy, or a combination of these. CONCLUSIONS Considering the evidence available to date, the CEPO recommends the following: (1)post-surgical observation for most patients with a low recurrence risk; (2)adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk; (3)adjuvant pelvic radiotherapy with or without vaginal brachytherapy for patients with a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors); (4)adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease;

Going past the data for temozolomide.

The benefit of six cycles of adjuvant temozolomide was documented in a randomized phase III (EORTC-NCIC CE.3) trial, and this therapy, following combined temozolomide and radiation, is the standard of care for patients with newly diagnosed glioblastoma. We comment on the differences in the length of adjuvant therapy in both clinical practice and national studies (e.g. RTOG 0825), usually doubling the length in the EORTC/NCIC study, and relate to historic adjuvant trials for solid tumors.

Safe administration of docetaxel after weekly paclitaxel-induced acute pancreatitis.

Acute pancreatitis is an inflammatory process of the pancreas that can be mild to severe. It requires biochemical or radiologic evidence to establish the diagnosis. Only few chemotherapy agents are directly linked to acute pancreatitis. In this case report, we describe a patient who developed a mild acute pancreatitis on weekly paclitaxel with a positive dechallenge and rechallenge. A 57-year-old woman with advanced ovarian cancer started chemotherapy with carboplatin (AUC 5 every three weeks) and weekly paclitaxel (80 mg/m2 on days 1, 8, and 15). On day 13 of cycle 1, the patient presented with elevated lipase and mild epigastric pain with a suspicion of acute pancreatitis. Because the patient was asymptomatic and pancreatic enzymes decreased on day 16, the third paclitaxel dose was given on day 17 and was followed by another increase of these enzymes. She later received carboplatin and docetaxel without any perturbation of the amylase and lipase. Applying the Naranjo adverse drug reaction probability scale, a score of nine was obtained, indicating a definite association between the administration of paclitaxel and acute pancreatitis. This adverse event could be explained by paclitaxel itself or one of two diluents: cremophor or ethanol. Because paclitaxel is use in many chemotherapy protocols, pharmacists and physicians should be aware of this rare adverse event. Docetaxel administration proved to be safe in this patient without any appearance of pancreatitis signs or symptoms.