New and Evolving Drugs in Cancer Care:  Investigational Agents in Oncology
Rowena Schwartz, Associate Professor of Pharmacy Practice, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, USA

Drug development for cancer continues to provide new drugs and strategies for the management of individuals with cancer. During this presentation, we will discuss some of the drugs currently in clinical trials around the world, and how the application of these agents may change our approach to care in select solid tumors. The discussion will focus on targets for new drug therapies and the care issues of the agents in clinical practice.
Learning Objectives

1. Describe the pharmacology of the cancer agents discussed during the session;
2. Discuss potential applications of the noted cancer agents, and describe the impact these agents may have on the current standard of care; and
3. Outline patient and caregiver counselling for agents discussed during the session.

Hematologic Malignancies and the Role of the Study Pharmacist
Ida Homoki, Budapest, Hungary

Hematologic malignancies manipulate the immune suppressive pathways involving CTLA-4, PD-1 and others to promote immune tolerance of cancer. New monoclonal antibodies targeting immune checkpoints are showing meaningful responses in the treatment of relapsed and refractory Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma and chronic lymphocytic leukemia. The utilization of immune checkpoint targeting agents to boost the innate and acquired immune systems to eradicate human malignancies represents a unique opportunity to develop novel therapies with increased clinical efficacy.

During this session, the role and responsibilities of the study pharmacist, the problems to be solved, the local practices at the Hungarian National Institute of Oncology and major trials of hematologic cancer drugs will be covered.

Learning Objectives

1. Identify the main roles and tasks of the study pharmacist;
2. Outline immune checkpoints as targets of new drugs;
3. Differentiate between single drugs regimens and combinations; and
4. Find out about clinical trials in the field of hematologic malignancies.

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Friday, April 28

Round Table Discussions

10:30-11:30

Participants will have the opportunity to discuss two of the 10 available topics, each led by a different facilitator. Read below for details on the topics and facilitators for this session. Pre-registration was required.  If you did not pre-register and would like to attend, please go to the session room to see if space is available.

Round Table 1: Implementing Patient Care Programs in Your Practice and Pharmacist Expanded Scope of Practice
Lisa Holle, Associate Clinical Professor, University of Connecticut, Storrs, USA

This round table is aimed at discussing strategies for implementing patient care programs into your practice and how we can continue to expand the scope of pharmacists throughout the world.

Round Table 2: Hydration Protocols for Cisplatin
Rosalyn Sims, Clinical Pharmacy Specialist, Children’s Hospital of Michigan, Michigan, USA

Cisplatin is used in many treatment protocols for adult and pediatric malignancies. Nephrotoxicity is a dose-limiting adverse effect. Hydration and/or mannitol are commonly used in an attempt to avoid this complication of cisplatin therapy.

In this round table discussion, we will discuss hydration methods for cisplatin administration. Is there one that is more effective? Come prepared to share how cisplatin is administered at your institution!

Round Table 3: Prevention of Burnout in Oncology Pharmacists
Peter Gilbar, Pharmacist Consultant, Toowoomba Hospital, Toowoomba, Australia

Oncology pharmacists are at significant risk of burnout. Discussion topics will include what constitutes burnout, potential causes of burnout and strategies for prevention.

Round Table 4: New Cardiotoxicities for Oncology Drugs (A.Fib, QT Prolongation, etc.)
Bruce Burnett, Senior Lecturer in Pharmacy Practice, University of Central Lancashire, Preston, United Kingdom

As survival improves, the long-term toxicities associated with cancer treatments, including newer targeted and immunotherapies, necessitate strategies in place to maintain quality of life. Cardiotoxicity is associated with a range of cancer-related therapies and identifying at-risk patients, providing effective monitoring and appropriate medical management strategies to prevent cardiotoxicity will be required, as well as managing emergent cardiotoxic effects.

Round Table 5: Pharmacy Technician Expanded Scope of Practice
Carole Chambers, Pharmacy Director, Alberta Health and Services Cancer Care, Calgary, Canada

Pharmacy technicians are seeing expanded scope of practice, whether they are non-regulated or moving to a regulated health profession. Please come ready to discuss some expanded scopes of practice you are seeing in your practice so that we all may find one or two things we can take back to our practices. 

Round Table 6: Strategies to Integrate Pharmacy Students to Enhance Patient Care and Mobilize Projects
Tara Leslie, Clinical Pharmacist, Alberta Health Services / University of Alberta, Calgary, Canada

Precepting pharmacy students or residents in your oncology practice has many benefits.  Not only does oncology practice provide a rich learning opportunity for learners, but precepting can allow for enhancement of patient care services, additional manpower to mobilize projects, and recruitment of new staff.  In this round table session, we will share experiences and new ideas to better integrate students to optimize their learning while adding value to the practice site.

Round Table 7: Cytotoxic Preparation in Developing Countries: Challenges and Way Forward
Harbans Dhillon, ISOPP President, Kuala Lumpur, Malaysia

Cytotoxic preparation in developing countries can be very challenging. Proper facilities, equipment, control of the working environment, use of personal protective equipment, training and education of personnel involved, amongst others, need to be setup to create a safe working environment. Special attention has to be paid towards administration of hazardous drugs, spill and waste management.

Round Table 8: Strategies for Managing Refractory Nausea and Vomiting

Alexandre Chan, Deputy Head and tenured Associate Professor, Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore

In this round table discussion, we will focus on effective strategies for managing refractory nausea and vomiting in patients receiving chemotherapy.

Round Table 9: Chemo Dosing in Special Populations - Obesity and Organ Dysfunction
Rowena Schwartz, Vice President, Associate Professor of Pharmacy Practice, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, USA

The field of clinical oncology is rapidly evolving, and the therapeutic options for treatment of individuals with cancer are growing.  In clinical practice, the use of drug therapy is individualized based on patient specific factors including organ function and weight.  We will discuss strategies for individualization of dosing of anticancer agents in practice.

Round Table 10: How to Avoid Pitfalls when Submitting Research to the Ethics Committee
John Wiernikowski, Clinical Pharmacist, Paediatric Haematology/Oncology, McMaster Children’s Hospital, Hamilton, Canada

If you have a project that will need to be submitted to an Ethics Review Board; come and participate in this round table to get important tips on key elements of your submission that will make the review and approval process as smooth as possible.

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Concurrent Session 4
Clinical 4: Cancer Associated Thrombosis - Clinical Considerations and Tools for the Oncology Pharmacist

11:30-12:30

Marliese Alexander, Pharmacist, Peter MacCallum Cancer Centre, Melbourne, Australia

Patients with cancer are at high risk of preventable and potentially life-threatening thromboembolic events. However, there is substantial heterogeneity in risk, reflected in the lack of comprehensive guidelines and variability in practice, most notably in the ambulatory care setting. This presentation will cover a broad range of topics from pathophysiology to risk profiling and prevention and treatment strategies. Particular focus will be given to implications of drug choice considering on and off target effects, duration, interactions, monitoring, reversibility, convenience and compliance. Various international approaches will be discussed, with conflicting practices and knowledge gaps highlighted.

Learning Objectives

1. Incidence and burden – healthcare utilisation, morbidity, mortality and treatment deliverability;
2. Pathophysiology;
3. Longitudinal risk profile;
4. Cancer-, treatment- and patient-related risk factors;
5. Risk assessment tools – clinical and biomarker models;
6. Drug choice – prevention and treatment, on and off target effects, duration, interactions, monitoring, reversibility, convenience and compliance; 
7. Major guidelines – consistent and conflicting recommendations; and
8. Evidence gaps.

Fundamentals 4: The Role of the Pharmacist in the Management of Oral Chemotherapy: From Theory to Practice

11:30-12:30

Fabrizio Festinese, Pharmacist, ASST Lodi, Lodi, Italy 

Communication is an important tool when giving information, especially when it comes to cancer therapies. This session will describe where to start to ensure a good counselling session, how to understand the difficulties that may occur and how to best motivate each patient in the care process.

Learning Objectives

1. Understand the sources of information from which to have a good theoretical basis;
2. Identify the critical phases within the working reality, being able to understand how to improve the process; and
3. Be able to adapt the information to create an ideal project and study the feasibility.

Research 4: Collaborating with the Pharmaceutical Industry to Help Reduce the Cost of Cancer Drugs

11:30-12:30

Carole Chambers, Pharmacy Director, Alberta Health and Services Cancer Care, Calgary, Canada

Peter Gilbar, Pharmacist Consultant, Toowoomba Hospital, Toowoomba, Australia

Cancer drug expenditure is of growing concern, with pharmaceutical companies criticized for not doing enough to contain drug pricing. The pharmaceutical industry, in collaboration with oncology pharmacists, has the ability to introduce a number of simple inexpensive strategies that have the potential to give better value for little financial outlay. This can make a substantive difference to how drugs are used in the clinical setting, contribute to patient and staff safety, and avoid unnecessary wastage. Several strategies, involving parenteral administration of cancer drugs, have been identified and include: increasing the available range of drug vial strengths, ensuring vials contain sufficient overage, providing reliable extended stability data for products prepared for administration, and providing products in the most suitable form for administration.

To further elucidate the problem, we identified drugs (65) which may be amenable to these strategies. Cytotoxic agents (29), MABs with cancer indications (16) and MABs without cancer indications (20) were evaluated. Twenty countries were selected to provide a global perspective, with Europe (6), Asia (6), North (2) and South America (2), Africa (2), and Australasia (2) represented. Information was obtained, by ISOPP members, only from the approved Product Information (PI) of individual drugs available in their country. Data was collected on a range of vial sizes available, overage/underage provided in vials, stability data on final product prepared for administration to the patient, and availability in a pre-filled, ready-to-administer syringe for suitable products.

Drugs were not available in all countries. Limited vial size availability meant many drugs were subject to wastage on preparation or increases in manufacturing time. Short stability allowed wastage as products could not be reused if patients treatments were cancelled or delayed. Overage data was lacking. Pre-filled syringes were available in 10 non-cancer monoclonal antibodies (MABs) but in none of the three suitable cancer MABs.

Many drugs were identified that are amenable to the above strategies. Oncology pharmacists should work with government agencies and the pharmaceutical industry to implement these measures.

Learning Objectives

1. Recognize the reasons behind the increasing expenditure associated with cancer care, particularly in relation to cancer drugs;
2. Understand the inexpensive strategies that can potentially be used to avoid wastage and give better value for money spent on cancer drugs;
3. Identify which antineoplastic agents and monoclonal antibodies in which these strategies are suitable for implementing based on the research conducted; and
4. Appreciate how oncology pharmacists can work with the pharmaceutical industry to help introduce these strategies.

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Concurrent Session 5
Clinical 5: Hematology Updates

14:00-15:30

Novel Targets and Combinations for Myeloma Therapy
Donald Harvey, Associate Professor, Director, Phase 1 Clinical Trails Section, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA

Innovations in molecular biology, pharmacology and formulations have led to a number of new agents approved for the treatment of myeloma across various populations. Improvement in patient outcomes in the relapsed/refractory, as well as initial induction treatment settings have been shown recently. Pharmacists need to be aware of appropriate patient selection, treatment sequencing, and adverse event prevention and management with these novel regimens. This presentation will summarize data relevant to single agent and combination monoclonal antibody therapy, multiple drug induction regimens, and emerging pathways and promising combinations for myeloma patients.

Learning Objectives

1. Distinguish between the indicated uses, mechanisms of action, depth and duration of clinical responses, and safety of current and emerging immunotherapeutic targeted agents;
2. Outline a treatment plan for newly diagnosed patients to achieve the deepest and most durable response while balancing the risk for adverse events; and
3. Outline a treatment plan for patients who have relapsed from, or are refractory to, their treatment.
   

What's New in MDS?
Tara Leslie, Clinical Pharmacist, Alberta Health Services / University of Alberta, Calgary, Canada

Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid clonal disorders characterized by various peripheral blood cytopenias. Patients are vulnerable to morbidities associated with these cytopenias and are also at risk of their disease evolving to an acute myeloid leukemia. MDS is more common in elderly patients and advanced age can limit treatment options. In this session, we will discuss new pharmacotherapy evidence in MDS and supportive care.

Learning Objectives

1. Provide a brief update of the new WHO Diagnostic Criteria and Revised IPSS;
2. Explore the evolving role of lenalidomide for lower risk MDS patients; and
3. Discuss supportive care issues (such as iron overload and thrombocytopenia) and associated pharmacotherapy.

Fundamentals 5: Basics of Best Practice

14:00-15:30

Best Practices of Oral Chemotherapy and Public Health / Advocacy
Lisa Holle, Associate Clinical Professor, University of Connecticut, Storrs, USA

This session is aimed at providing examples of best practices related to managing patients receiving oral chemotherapy, advocating for patients and professions at the government level, and incorporating policies into practice when new regulations and laws arise (e.g. use of medical marijuana).

Learning Objectives

1. Describe successful efficacy monitoring methods for patients receiving oral chemotherapy;
2. Discuss appropriate handling and disposal of oral chemotherapy;
3. Identify opportunities to advocate on behalf of patients with cancer; and
4. Illustrate approaches to practice policy development with new laws and regulations.

From Prescription to Administration: How to Handle Hazardous Drugs
Birgit Tans, Pharmacist, University Hospitals of Leuven, Leuven, Belgium

The lecture will give an overview of best practices in handling hazardous drugs according to the current guidelines.

Learning Objectives

1. Explain the need for a correct prescription;
2. Describe the guidelines for safe manipulation of hazardous drugs: preparation, packaging and transport, and administration; and
3. Discuss how to avoid and manage contamination.

Research 5: Platform Presentations

14:00-15:30

Towards the Safe Handling of Cytotoxic Drugs in Academic Research Settings; Recommendations from a Multidisciplinary Working Group
Racha Sabbagh Dit Hawasli, London, United Kingdom

Oral Anticancer Drugs: to Crush or Not to Crush 
Tine Van Nieuwenhuyse and Brigit Tans, Leuven, Belgium 

Differences Between Online Survey and Mailed Survey from the Nationwide Survey for Community Pharmacists in Japan
Shinya Suzuki, Kashiwa, Japan

Developing a Decision Support Tool to Assist Clinicians to Assess the Benefit of Palliative Chemotherapy in Stage 4 Breast Cancer Patients 
Phebe Si, Singapore, Singapore 

Challenge the Compatibility of Closed System Transfer Devices with Multiple Chemotherapy Drugs 
Chenchia Lin, Taipei City, Taiwan

Efficacy of Four Cleaning Solutions for the Decontamination of Cytotoxic Drugs on Different Surfaces of the Automated Compounding System APOTECAchemo 
Matteo Federici, Mainz, Germany

Poster and Exhibit Viewing Session

15:30-17:30

During the Poster and Exhibit Viewing Session, poster presenters will present their electronic posters (e-posters) in a casual atmosphere.  Participants also have the opportunity to visit the exhibit booths. 

View the poster presentation schedule.  

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Saturday, April 29

Plenary
Platform Presentations

09:45-10:45

Oncology Dose-Rounding Program
Lisa Holle, Storrs, USA 

Implementation of Camera Technology to Meet Traceability Standards for Compounded Sterile Products and Increase Efficiency in a Regional Cancer Centre 
Lauren Charbonneau, Toronto, Canada

Patient Adherence to Oral Anticancer Medications in an Asian Tertiary Cancer Care Centre
Eskinder Eshetu Ali, Singapore, Singapore
Lita Chew, Singapore, Singapore

Characteristics and Management of High Incidence of Grade 3, 4 Hypertension in Lenvatinib Oral Chemotherapy for Thyroid Cancer Patients
Shinya Suzuki, Kashiwa, Japan

Concurrent Session 6
Clinical 6: Supportive Care Update: Pain Management

11:30-12:30

Dezső Embey Isztin, Consultant Anaesthetist, Head of Pain Clinic, National Institute of Oncology, Budapest, Hungary

This session covers the types (nociceptive, neuropathic and visceral) and neuroanatomy of pain (lateral spinothalamic, spinoreticularis, spinoreticulothalamic, spino-hypothalamic, spino-mesencephalic and descending inhibitory pathways), the causes of chronic pain, neuropathic pain, principles of pain management, pain treatment methods (drugs, non-invasive techniques, nerve blocks, neuromodulation and neurosurgical interventions), scheduling and titration. A critical assessment of the WHO analgesic ladder is also discussed.

Learning Objectives

1. Define the various types of pain associated with cancer, review and understand the clinicopathological background of each;
2. Distinguish between the pain treatment methods, medications, sites of application and mechanism of action and identify the need of adjuvant analgesics; and
3. Understand the reasons why the WHO analgesic ladder might not be valid and outline a treatment plan for a cancer patient with pain.

Fundamentals 6: Appraisal and Funding of Cancer Drugs in England

11:30-12:30

David Thomson, Lead Chemotherapy Pharmacist, Chemotherapy CRG and National Cancer Drugs Fund, NHS England, West Yorkshire, United Kingdom

In a time of significant financial pressure on the NHS in England, a number of changes are being made that will increase the importance of affordability in the appraisal and funding of cancer drugs. The session will discuss the history of the appraisal and funding of cancer drugs in England and an overview of the current processes and proposed changes. Particular focus will be given to the cancer drugs fund and proposals for the setting of budget impact limits for cancer drugs. The session will also review work being led by cancer pharmacists in England to assist with the affordability problem such as the implementation of chemotherapy treatment algorithms and the introduction of biosimilars/generics. 

Learning Objectives
1.      Overview of the appraisal and funding of cancer drugs in England;
2.      Understand the mechanisms being put in place to limit the growth in expenditure of cancer drugs; and
3.      Discuss the lessons for and from other countries.

Research 6: Side Effect Management on Immune-Oncology Agents

11:30-12:30

Bruce Burnett, Senior Lecturer in Pharmacy Practice, University of Central Lancashire, Preston, United Kingdom

This session will cover the immune related toxicities of cancer therapy, with a focus on the newer checkpoint inhibitors, and its management. There will be consideration of both common and rarer side effects as well as considering their impact when combined with existing therapies, including chemotherapy and radiotherapy.

Learning Objectives

1. Describe the common toxicity profile associated with immunotherapy and their management;
2. Identify "at risk patients" and consider strategies to manage these patients; and 
3. Discuss the potential problems associated with combining these immunotherapies with other treatments.

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Concurrent Session 7
Clinical 7: BMT Updates

14:00-15:30

Role of the Pharmacist in the FACT-JACIE Process
Tiene Bauters, Clinical Pharmacist, Ghent University Hospital, Ghent, Belgium

The major objective of the FACT-JACIE International Standards for Hematopoietic Cellular Therapy Product Collection, Processing, and Administration (the "Standards”) is to promote quality practice in hematopoietic progenitor cell transplantation and other therapies using cellular products.

Since the 6^th Edition, new requirements were added for pharmacists who are involved in the care of hematopoietic stem cell patients.

Learning Objectives

1. Overview of the new requirements for pharmacists since the 6^th Edition of the FACT-JACIE Standards; and
2. Practical overview on how pharmacists can comply with the Standards.

Hiking the Haplo Path with Post-Transplant Cyclophosphamide
Jennifer Jupp, Pharmacy Clinical Practice Leader, Inpatient Hematology, Oncology, Blood and Marrow Transplant, Alberta Health Service - Calgary Zone, Calgary, Canada

When a patient doesn’t have a matched related/unrelated donor….an overview of alternative donors will take place at this session.  As #haplos are trending, we will also discuss the use of post-transplant cyclophosphamide as part of the GVHD prophylaxis platform in haploidentical BMT patients.  

Learning Objectives

1. Provide an overview of alternative donor sources for patients without a matched donor;
2. Discuss the use of post-transplant cyclophosphamide in the setting of haploidentical transplant; and
3. Summarize the differences between umbilical cord blood, haploidentical and matched related donor transplants. 

Fundamentals 7: Stability of Cancer Agents

14:00-15:30

Alain Astier, Head of the Department of Pharmacy, Henri Mondor University Hospital Group, Paris, France

The objective of this session, is to explain the main physico-chemical principles of the degradation of anticancer drugs. Alain will focus not only on the chemical instability of classical anticancer drugs but on the physical instability of complex formulations and therapeutic proteins. Including a special discussion on the stability of diluted bags of monoclonal antibodies sent by pneumatic network system.

What In-use Stability Data do Hospital Pharmacist Practically Need?
Johan Vandenbrouke, Senior Pharmacist Production, Ghent University Hospital, Ghent, Belgium

There are different kinds of stability, all with their own specificity and challenges. In this presentation, an overview will be given of the different types of stability along with a discussion what is already existent and what could be helpful and needed by the hospital pharmacist in his/her daily practice.

Learning Objectives

1. Understand what stability means;
2. Know what to look for in stability studies; and
3. Discuss what we need in the (near) future.