Blood pressure control in patients receiving bevacizumab in an outpatient cancer center.

PURPOSE: Hypertension is a common adverse effect of vascular endothelial growth factor (VEGF) signaling inhibitors, such as bevacizumab, with an incidence upwards of 35%. The management of bevacizumab-induced hypertension is important in order to avoid dose interruption/discontinuation and/or end organ damage. The efficacy of antihypertensive medications for this cause of hypertension has not been demonstrated. This study seeks to determine if antihypertensives are effective in treating anti-VEGF-induced hypertension from bevacizumab and determine which classes of antihypertensive agents are effective. METHODS: A retrospective review of all patients who received bevacizumab between January 2007 and September 2009 at two medical centers was conducted. Patients were included if they experienced new onset or exacerbation of preexisting hypertension, during bevacizumab treatment. Efficacy of antihypertensives was determined by recording a 28-day change in systolic blood pressure from the initiation or dose increase of individual antihypertensive medications. Secondary endpoints included an efficacy analysis of antihypertensive classes. RESULTS: Five-hundred thirteen patients were identified as receiving bevacizumab during the indicated time period. Fifty-seven patients met the full inclusion/exclusion criteria for analysis. The average systolic blood pressure declined by 23 mm Hg with 4 weeks of treatment (p < 0.0001). Each class had a statistically significant decline in systolic blood pressure of 15.5-57 mm Hg with the exception of diuretics and a group of miscellaneous antihypertensives. CONCLUSIONS: This is the first data that demonstrates individual classes of antihypertensives are effective in bevacizumab-induced hypertension. Most antihypertensives were effective in reducing blood pressure, with the exception of diuretics and miscellaneous antihypertensives, which may be due to a limited sample size.

Incidence and risk factors of clinically significant chemotherapy-induced thrombocytopenia in patients with solid tumors.

UNLABELLED: PURPOSE AND RELEVANCE: Chemotherapy-induced thrombocytopenia (CIT) can be a significant problem in patients with cancer, leading to numerous clinical complications. Understanding the types of patients at risk for these complications is essential to improve monitoring, counseling, and provide future targeted prophylaxis measures. Previous studies have limited prospective utility since they do not examine risk factors associated with complications from multi-agent regimens. This evaluation aims to identify the incidence and risk factors associated with clinical complications of CIT in patients receiving common chemotherapy regimens. METHODS: Retrospective evaluation of adult patients receiving first or second line regimens for the most common solid tumors associated with high rates (≥5%) of laboratory diagnosed thrombocytopenia. Patients were examined for clinically significant CIT (defined as platelet count <75,000 cells/µL as well as the presence of one of the following: bleeding, dose reduction/delay, platelet transfusion, or therapy cessation) and associated risk factors. RESULTS: About 254 patients receiving a total of 278 regimens were evaluated. The incidence of clinically significant CIT=10.1%; complications were most common in patients receiving cisplatin/gemcitabine for bladder cancer (57%), or carboplatin/gemcitabine (29%) or cisplatin/etoposide (18%) for lung cancer. Bladder cancer (OR=13.7 (2.89-64.7); p=0.001) and concurrent or recent infection (OR=3.8 (1.45-10.1); p=0.007) was found to increase the risk of clinical complications while smoking was found to have a protective effect (OR=0.17 (0.04-0.71)). CONCLUSIONS: The incidence of clinically significant CIT is most commonly seen in patients using cisplatin/gemcitabine for bladder cancer, or carboplatin/gemcitabine or cisplatin/etoposide for lung cancer. Further evaluation of these patients is warranted.

Description of current practices of empiric chemotherapy dose adjustment in obese adult patients.

PURPOSE: The literature is not clear on the best method to empirically dose chemotherapy in obese adult patients. The purpose of our study was to determine whether a standard of practice existed, characterize current practices of empiric dose adjustment (EDA) in obese adult patients, and identify factors affecting this decision. METHODS: An electronic survey was distributed to oncologists and board-certified oncology pharmacists via the Association of Community Cancer Centers and Board of Pharmaceutical Specialties e-mail distribution lists. The survey contained patient scenarios assessing the impact of various factors on EDA of chemotherapy, demographic information, and details of institutional policies. RESULTS: Responses were collected from 174 professionals. Pharmacists comprised 95% of respondents. Of these, 50% practiced in academic medical centers, and 19% practiced in institutions with a standard of practice regarding EDA for obesity. The most common methods of EDA were use of an adjusted body weight in the body-surface area (BSA) equation and capping BSA. Factors with the most impact on EDA were curative intent, degree of obesity, type of chemotherapy, and performance status. CONCLUSION: There is no standard of practice regarding EDA of chemotherapy in obese adult patients. Although many factors affect this decision, intent of treatment, degree of obesity, performance status, age, and type of medication seem to carry the most weight.

Pharmacogenomics-Potential applications to orthopedic practice.

Pharmacogenomics is developing at a rapid pace. Though ethical and financial considerations still exist, physicians should familiarize themselves with this evolving science.