PHARMACY NEWS FOR MAY 2011 Transdermal Patches with Metallic Components Require Removal before MRI
BRAND NAME METAL COMPONENT?
** Double-asterisk denotes that generic transdermal products containing this agent are
New Therapies for Treatment of Advanced Melanoma Melanoma is the third most common type of skin cancer with an estimated 68,000 new cases diagnosed annual y in the US. Patients diagnosed with Melanoma present with advanced stage (Stage III and IV) disease. The 5 year survival rate for advance stage disease can vary from 20-70% for Stage III and 10% for Stage IV disease. Treatments for advance stage disease other than a surgical modality (if the lesion(s) could be excised with adequate margins) include: Interleukin-2, Interferon alpha, dacarbazine and temozolomide. The response rate to these agents is <20% with a duration of response of less than 1 year in the metastatic setting. Ipilimumab (YERVOY®) was approved by the FDA in March of 2011 for the treatment of unresectable or metastatic melanoma. Ipilimumab an inhibitor of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) stimulates the T-cel s to
fight the melanoma cel s. In a clinical trial, ipilimumab was compared to an investigational tumor vaccine for the second line treatment of advanced melanoma. The overal survival was 10 months for the ipilimumab arm versus 6 months for the vaccine arm. The overal response rate was 10.9% for the Ipilimumab arm versus 1.5% for the vaccine arm. Ipilimumab has been associated with significant toxicities including: enterocolitis (12%), immune mediated hepatitis (5%), dermatitis (14%), endocrinopathies (4%) and neuropathies (<1%). Peginterferon alfa-2b (SYLATRON®) received FDA approval for the adjuvant treatment of melanoma with lymph node involvement (Stage III). Peginterferon alfa-2b is the long acting formulation of interferon which can be administered weekly by subcutaneous injection as opposed to daily injections required for interferon alfa-2b. In a clinical trial peginterferon alfa-2b was compared to observation for a 5 year period fol owing surgical resection. The relapse-free survival was 34.8 months in the peginterferon arm versus 25.5 months in the observation arm. There was no difference in overal survival between the groups. The most common side effects observed with peginterferon alfa-2b were: fatigue (94%), elevation of liver enzymes (77%), fever (75%), headache (70%) and anorexia (69%). There is a black box warning for serious risk of depression and suicides. 1/3 of patients discontinued treatment due to toxicities. Despite the advent of these agents which are associated with significant toxicities, advance melanoma remains a difficult disease to cure. Probiotics for Prevention of Clostridium Difficile Associated Diarrhea Clostridium difficile associated diarrhea (CDAD) has become a recognized major nosocomial problem nationwide. The Pharmacy & Therapeutics Committee (P&T) has approved the use of the probiotic Saccharomyces boulardi (250mg PO BID) for prophylaxis of CDAD in high risk patients. Possible mechanisms of action of probiotics include: 1) To reestablish the normal gastrointestinal microflora, 2) To provide a layer of intestinal protection so that Toxin A and Toxin B cannot attach to the intestine wal , 3) To provide direct antimicrobial action against C. difficile, and 4) To stimulate immune modulators to increase IgA production and stimulate monocyte function. Risk factors for developing CDAD include administration of broad spectrum antibiotics (mainly beta-lactams, clindamycin, erythromycin, and fluoroquinolones), history of CDAD, age 65 years or older, patients with an NG tube, patients in ICU, and hospital stay longer than 14 days. Probiotics are contraindicated in immunocompromised patients and should be used with caution in any situation where bowel integrity is in question. To assist with this hospital-wide initiative, the pharmacists wil help identify patients receiving systemic antibiotics that have risk factors for developing CDAD and recommend the use of probiotics for prevention of CDAD in high risk
patients. Pharmacists are present on rounds and available for each patient care area to review and recommend therapy when appropriate. Additional y preprinted order forms for saccharomyces boulardi (Florastor) are being developed to be placed on patient’s charts to alert the medical staff that the patient is at risk for developing CDAD, which should be signed by the prescriber if deemed appropriate to initiate probiotic therapy. For more information, contact Karen Michaels: 301-896-3577.
C L I N I C A L I N V E S T I G A T I O NBland Embolization in Patients with Unresectable HepatocellularCarcinoma Using Precise, Tightly Size-Calibrated,Anti-Inﬂammatory Microparticles: First Clinical Experienceand One-Year Follow-UpGuido Bonomo • Vittorio Pedicini • Lorenzo Monfardini •Paolo Della Vigna • Dario Poretti • Gianluigi Orgera •Franco OrsiReceived: 30 April 2009 / Acce
Advance Access Publication 29 October 2007eCAM 2009;6(3)365–373doi:10.1093/ecam/nem136Evaluating Complementary Therapies for Canine OsteoarthritisPart I: Green-lipped Mussel (Perna canaliculus)Anna Hielm-Bjo¨rkman1, Riitta-Mari Tulamo1, Hanna Salonen2 and Marja Raekallio11Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki,PO Box 57, Fi-000