Content - ADCs in Solid Tumors Pharmacy Perspective

Introduction

In this module, Allison Butts, PharmD, BCOP, and Danielle Roman, PharmD, BCOP, provide an overview of the latest evidence on antibody–drug conjugates (ADCs) for solid tumors with a focus on the role of the oncology pharmacist in identifying and managing treatment-related adverse events (TRAEs).

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking on any of the slide thumbnails in the module alongside the expert commentary.

Please note that Clinical Care Options plans to measure the educational impact of this activity. Some questions are asked twice: once at the beginning of the activity, and once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your individual responses will not be shared. Thank you in advance for helping us assess the impact of this education.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with solid tumors do you provide care for in a typical month?

A.
1-5
B.
6-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

When discussing the unique characteristics of ADCs with patients, which of the following would you tell them about potential for a “bystander effect”?

A.
ADCs with a cleavable linker and high drug-to-antibody ratio (DAR) may allow membrane-permeable payloads to also affect adjacent cells
B.
The cytotoxic payload on ADCs only affects target cancer cells, preventing bystander effects on surrounding healthy cells
C.
ADCs with a noncleavable linker and low DAR are more likely to result in increased systemic exposure to the payload
D.
Lower specificity of the ADC to target antigens on cancer cells can prevent potential bystander effects

The patient is a 52-year-old woman with diagnosis of triple-negative breast cancer (TNBC) (HER2 immunohistochemistry [IHC] 0) status post right breast mastectomy followed by adjuvant chemotherapy and radiation. One year later, she developed pulmonary metastases that were biopsy confirmed TNBC (PD-L1 negative) with no actionable mutations. She received capecitabine for 8 months then had disease progression. She was then initiated on sacituzumab govitecan. The patient presents to clinic prior to cycle 2, Day 1 and complains of diarrhea for 7 days after cycle 1, Day 8.

Soon after her infusion on cycle 1, Day 8, she experiences abdominal cramping and has 5 stools over baseline in the next 24 hours (grade 2). Which of the following strategies would you recommend to reduce the risk of cholinergic diarrhea at her next infusion?

A.
Atropine prophylaxis; continue sacituzumab govitecan at same dose
B.
Loperamide prophylaxis; continue sacituzumab govitecan at same dose
C.
Octreotide prophylaxis; dose reduce sacituzumab govitecan
D.
Permanently discontinue sacituzumab govitecan

How confident are you in applying evidence-based communication and shared decision-making strategies when tailoring individuals’ treatment plans?

A.
Not at all confident
B.
Slightly confident
C.
Moderately confident
D.
Confident
E.
Very confident

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Insight on Safety and Efficacy of ADCs in Solid Tumors: Focus on the Role of Oncology Pharmacists in Adverse Event Management

Allison Butts, PharmD, BCOP

Danielle Roman, PharmD, BCOP

Activity

Introduction

How many people with solid tumors do you provide care for in a typical month?

When discussing the unique characteristics of ADCs with patients, which of the following would you tell them about potential for a “bystander effect”?

Soon after her infusion on cycle 1, Day 8, she experiences abdominal cramping and has 5 stools over baseline in the next 24 hours (grade 2). Which of the following strategies would you recommend to reduce the risk of cholinergic diarrhea at her next infusion?

How confident are you in applying evidence-based communication and shared decision-making strategies when tailoring individuals’ treatment plans?