PGY2 Oncology Pharmacy Residency

Immunotherapy vs Chemoimmunotherapy in Advanced Non-Small Cell Lung Cancer

Blake Buzzard, PharmD; Hanna Zaghloul, PharmD; Monica Chintapenta, PharmD; Godsfavour Umoru, PharmD, Eric Bernicker, MD

PURPOSE

The purpose of this study is to compare front-line treatment of advanced NSCLC utilizing immunotherapy alone versus chemoimmunotherapy, particularly according to PD-L1 expression.

METHODS

This is a retrospective cohort study of oncology patients newly diagnosed with advanced NSCLC and received treatment at Houston Methodist Hospital between November 2016 and December 2019. Patients received either pembrolizumab or atezolizumab monotherapy or pembrolizumab combined with platinum-based chemotherapy. The study is approved by the hospital’s institutional review board. The primary objective is to determine the number of completed treatment cycles of immunotherapy monotherapy compared to immunotherapy with platinum-based chemotherapy. Secondary endpoints will include PD-L1 expression, adverse effects, dose reduction and rationale, type of second-line therapy, and number of completed cycles of second-line therapy.

RESULTS

A total of 164 patients were evaluated and 59 patients met inclusion criteria, 31 in the immunotherapy group and 28 in the chemoimmunotherapy group. The mean number of cycles completed were 11 vs 7 in the immunotherapy compared to chemoimmunotherapy groups respectively. For patients with PD-L1 expression at 1-49%, the mean cycles in the two groups were 7 vs 7. In patients with PD-L1 expression greater than or equal to 50%, the mean cycles completed were 12 vs 9. The number of patients discontinuing therapy due to progression was 18 (58%) vs 9 (32%) respectively. The number of patients discontinuing therapy due to adverse events was 7 (23%) vs 15 (54%).

CONCLUSION

Immunotherapy provided a similar time-to-treatment discontinuation compared to immunochemotherapy, even within the patients with PD-L1 expression 1-49% and demonstrated less incidence of treatment discontinuation due to side effects.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Blake A Buzard, PharmD

Blake Buzard earned his BS in Pharmaceutical Sciences and PharmD from University of Kansas in 2019. He completed his PGY1 residency at Ascension Via Christi in Wichita, Kansas Following completion of his PGY2, Blake will move into an oncology clinical specialist role at St. Luke’s Hospital in Kansas City. Primary project preceptor: Hanna Zaghloul, PharmD, BCOP

Presented at: 2020 Virtual Vizient Pharmacy Network, HOPA 2021, 2021 Virtual Midwest Pharmacy Residents Conference 2021.

Cytomegalovirus (CMV) reactivation rate in allogeneic hematopoietic stem cell transplant (HSCT) patients

Ashka Patel, PharmD; Godsfavour Umoru, PharmD; William Musick, PharmD; Hanna Zaghloul, PharmD; James Cox, PharmD

PURPOSE Cytomegalovirus (CMV) infection is a clinically significant infection in patients post allogeneic hematopoietic stem cell transplant (HSCT). Prophylactic letermovir use after allogeneic HCST reduces risk of CMV reactivation. The objective of this study is to quantify CMV reactivation rates pre- and post- the initiation of letermovir prophylaxis at our institution.

METHODS

A single-center, retrospective chart review was performed to identify eligible patients that received allogeneic HSCT between May 1, 2016 and June 30, 2020. Eligible patients were evaluated from admission through day +100 post-transplant. The primary outcome of this study is to evaluate the rate of CMV reactivation between the pre-letermovir arm and post-letermovir arm. Secondary outcomes included evaluating timing of letermovir initiation, CMV reactivation rates in relation to donor serologic status, provider prescribing practices, and concurrent immunosuppression. Patient demographic information were also be collected.

RESULTS

A total of 129 patients were identified, 78 in the preletermovir arm and 51 in the post letermovir arm. 51.3% of patients in the pre-letermovir arm experienced CMV reactivation; 41.3% of patients in the post letermovir arm experienced CMV reactivation. 50% of the patients receiving letermovir 28 days or more post-transplant experienced CMV reactivation; whereas, 39.5% of the patients receiving letermovir within 28 days of transplant experienced CMV reactivation.

CONCLUSION

Although not statistically significant the patients in the post letermovir arm had less incidence of CMV reactivation compared to patients in the pre-letermovir arm.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Ashka Patel, PharmD

Ashka earned her PharmD from MCPHS University in 2019. She completed his/her PGY1 residency at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Following completion of his/her PGY2, Ashka will be an Oncology Pharmacy Clinical Specialist at Boston Medical Center.

Primary project preceptor: James Cox PharmD BCOP

Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference; 2021 HOPA