Safety of temozolomide use in adult patients with renal dysfunction.

PURPOSE: Temozolomide (TMZ), a cytotoxic DNA alkylating agent, is the main chemotherapy used for the treatment of high grade astrocytomas. The active alkylator, methylhydrazine, is not recovered in urine and thus renal function is not expected to affect clearance. Prescribing information for TMZ states pharmacokinetics have not been studied in adults with poor renal function, eGFR < 36 mL/min/1.73 m2. We reviewed our clinical experience with TMZ in patients with impaired renal function to evaluate safety of administering full dose TMZ. METHODS: The primary endpoint was to characterize the incidence and severity of thrombocytopenia in patients with eGFR < 60 mL/min/1.73 m2 who received TMZ for treatment of high grade gliomas (HGG) or primary CNS lymphoma (PCNSL). Secondary endpoints included incidence and severity of neutropenia, lymphopenia hepatotoxicity, and number of TMZ cycles administered. Medical records of patients with HGG or PCNSL treated with TMZ from October 1, 2016-September 30, 2019 were accessed to identify cases for this study. RESULTS: Thirty-two patients were eligible for this study. Of the seven patients with eGFR < 36 mL/min/1.73m2, 38/39 cycles (97%) were completed without grade 3-4 thrombocytopenia. No patients experienced grade 3-4 neutropenia, and grade 3-4 lymphopenia occurred in 5 cycles (15%). One patient discontinued TMZ 7 days prior to completion of radiation due to thrombocytopenia. CONCLUSION: Hematologic toxicity in patients with severe renal dysfunction, eGFR < 36 mL/min/1.73m2, is similar to that of patients with normal renal function. Severe renal impairment does not preclude use of temozolomide, but cautious monitoring of blood counts is warranted.

Retrieval of Displaced Third Molar Into the Sublingual Space Using 3-Dimensional Navigation Assistance.

Surgical removal of third molars is a common procedure undertaken by both general dentists and oral and maxillofacial surgeons. Although rare, iatrogenic displacement of the tooth or root fragments into adjacent fascial spaces is a known complication. This case report details the retrieval of displaced root tips from a mandibular third molar into the sublingual space using intraoperative navigation to minimize surgical exploration. Oral-maxillofacial surgeons should consider using 3-dimensional navigation during scheduled retrieval of displaced teeth, fragments, or foreign objects to minimize the risk of surgical complications.

Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center.

OBJECTIVE: Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. METHODS: A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. RESULTS: Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. CONCLUSION: The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.