Talimogene Laherparepvec (T-VEC): A Review of the Recent Advances in Cancer Therapy.

The landscape of melanoma treatment has undergone a dramatic revolution in the past decade. The use of oncolytic viruses (OVs) represents a novel therapeutic approach that can selectively infect and lyse tumor cells and induce local and systemic antitumor immune responses. As the first OV approved by the Food and Drug Administration (FDA) for melanoma treatment, talimogene laherparepvec (T-VEC), a genetically modified herpes simplex virus (HSV), has shown promising therapeutic effects in the treatment of advanced melanoma, both as a monotherapy or in combination with other immunotherapies, such as the immune checkpoint inhibitors (ICIs). With proven efficacy, T-VEC has been evaluated against a variety of other cancer types in a clinical trial setting. In this article, we will provide a review on OVs and the application of T-VEC in melanoma monotherapy and combination therapy. In addition, we will review the recent progress of T-VEC application in other cutaneous cancer types. Moreover, we will briefly describe our experience of T-VEC therapy at City of Hope, aiming to provide more insight for expanding its future application.

Implementing total-dose ferumoxytol in lieu of split-dose ferumoxytol.

BACKGROUND: Ferumoxytol is Food and Drug Administration-approved as two 510 mg infusions. Retrospective and prospective reviews have established that a single 1020 mg infusion is as efficacious and safe as two 510 mg infusions. OBJECTIVES: To transition our preferred intravenous iron infusion practice from two 510 mg infusions to a single 1020 mg ferumoxytol infusion. PRACTICE DESCRIPTION: This is a prospective process improvement study conducted at Tripler Army Medical Center, a large academic medical center. PRACTICE INNOVATION: We set up an evidence-based project to transition and monitor our preferred iron treatment of ferumoxytol from 2 doses to 1 dose. EVALUATION METHODS: We collected efficacy and safety data for 188 unique patients receiving 228 infusions, of which 62 were single 1020 mg doses, and 166 were two 510 mg doses. RESULTS: Comparing the 1020 mg dose in 62 patients with 166 patients treated with two 510 mg infusions, we found no increase in the rate of infusion reactions (4.8 % vs. 4.8 %) and comparable improvement in ferritin and hemoglobin (144 ng/mL vs. 140 ng/mL; P value = 0.874, and 1.8 g/dL vs. 1.9 g/dL; P value = 0.721, respectively). CONCLUSION: Thus, we were able to successfully transition to total-dose ferumoxytol for iron-deficient anemia, effectively reducing patient treatment visits without any difference in safety or efficacy. Ferumoxytol 1020 mg infused intravenously over 30 minutes in 250 mL normal saline single dose is a viable, safe, and effective treatment for iron-deficiency anemia.

Tubing determination in an hematology oncology clinic.

United States Pharmacopeia (USP) Chapter <800> for hazardous drug (HD) handling in healthcare settings requires HD be primed intravenously with a non-HD solution prior to dispensing. This review details our clinic's algorithm for determining tubing needs for medications used in an hematology oncology clinic. Factors to consider are volume, irritant and vesicant properties, and compatibility with hydration solution.

Training, education, and experience of active duty army pharmacy officers.

OBJECTIVE: To create a summary of training, education, and experience by pharmacy officer rank (colonel, lieutenant colonel, major, and captain) to produce information for senior pharmacy leaders to describe active duty army pharmacy officers and for junior army pharmacy officers to use for individual career planning. METHODS: A 32-question, anonymous, and voluntary survey was developed. Active duty army pharmacy officers were able to complete the survey via the government website, Intelink. The survey was open for 6 weeks during the summer of 2017. RESULTS: The survey was completed by 62% of active duty army pharmacy officers. The responses were used to create a summary of training, education, and experience by pharmacy officer rank. CONCLUSION: The survey was successful in capturing information relating to training, education, and experience by rank, thereby providing useful quantifiable information to describe army pharmacy officer careers. These results may prove valuable to those interested in pharmacy careers in the military, and they create an opportunity to illustrate the distinct profession of army pharmacy officers.

New oral anticoagulants for atrial fibrillation: a review of clinical trials.

BACKGROUND: Warfarin had been the only oral anticoagulant for stroke prevention in patients with atrial fibrillation (AF) for decades. Direct thrombin inhibitors and factor Xa inhibitors are new anticoagulants recently approved for prevention of stroke or systemic embolism in patients with AF. OBJECTIVE: The aim of this article was to provide a systematic review of recently published clinical data on the direct thrombin inhibitors and factor Xa inhibitors in the management of AF. METHODS: A search of the ClinicalTrials.gov registry was conducted using the subject terms dabigatran, rivaroxaban, and apixaban. Each search was limited to clinical trials that included patients with AF. Completed studies with warfarin as the main comparator were identified. From the yielded results, the national clinical trial identifier was inputted in PubMed (1966-November 2011) for a search of published literature. RESULTS: Three Phase III clinical trials reported the efficacy of each agent in patients who have AF and risk factors for stroke or embolic complications. The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study reported dabigatran 150 mg was associated with a lower rate of stroke and systemic embolism, whereas dabigatran 110 mg was associated with a similar rate for such events when compared with warfarin (relative risk = 0.66; 95% confidence interval [CI], 0.53-0.82; P < 0.001; and relative risk = 0.91; 95% CI, 0.74-1.11; P = 0.34, respectively). From the intention-to-treat analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, rivaroxaban was reported to be noninferior to warfarin in reducing stroke or systemic embolism (2.1% vs 2.4% per year; hazard ratio = 0.88; 95% CI, 0.75-1.03; P < 0.001). The Apixaban for Reduction in Stroke and Other Thrombotic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban reduced stroke or systemic embolic events by 21% when compared with warfarin (1.27% vs 1.60% per year, respectively; hazard ratio = 0.79; 95% CI, 0.66-0.95; P < 0.001). All 3 agents were associated with similar bleeding when compared with warfarin. CONCLUSIONS: Published data suggest that all 3 agents are at least as efficacious as dose-adjusted warfarin, with similar major bleeding profiles. For patients who are unwilling to adhere to regular coagulation monitoring or whose therapeutic effect using warfarin is not optimal despite adequate monitoring and management, the inhibitors of direct thrombin or factor Xa may provide alternative choices in anticoagulation.