#CAPhOCon15 Review

TBCC Pharmacist Forum - July 2015

Chris’s Collection of Tweets A Tweet-cap of #CAPhOCon15

#GoHardLearning

Opening RemarksRick Abbott and Scott Edwards, our co-chairs start our program

Theme: change, challengeand opportunity

Disclaimer● The communications team and other CAPhO

members tweeted the following information.● I have not verified all the information

contained herewithin.o @CAPhOACPhO o @OncoPrno @SohasRxo @PShaheen75

#CAPhOCon15 Twitter Contest

Link to video

The Numbers (Twitter)

1,832,528 Impressions1,696 Tweets79 Participants2 Avg Tweets/Hour21 Avg Tweets/Participant

Rethinking Our management of Anticoagulation in Cancer Patients

● Clinical pearl: vte risk increases 6x with chemotherapy

Survey says: lmwh is TOC for cancer associated DVT - warfarin is the alternative● The scoop on NOACs in cancer- very few pts in trials,

and studies are noninferiority trials ● Avoid NOACs! There's too many drug interactions

with chemo that you can't dose adjust for

● Always keep platelets above 50 in #cancer pts on LMWH #caphocon15 - either reduce lmwh dose by 50% or transfuse

● Clinical pearl: If pts have plt 20-50 with acute clot best to do LMWH at 50% of dose and escalate as plt counts go up

● Pt with CrCL=28 - need to reduce dose of LMWH or admit and start IV UFH

● Enoxaparin accumulates in poor kidney function <30ml/min so increases bleed risk

● Clinical pearl: Prefer dalteparin or tinzaparin in kidney dysfx #caphocon15

● Clinical pearl: should treat vte for min 6months - if underlying cancer is gone then you can stop therapy

● Clinical pearl: check antiXa levels for accumulation over time in dialysis pts on LMWH periodically

● Reminder- tinzaparin and dalteparin have larger molecular weights than enoxaparin.that's why they don't accumulate as much

#RandomAwesomeness700 new cancer drugs coming? Even if 10% come to market...better get ready to study!

BiosimilarsSubsequent Entry Biologics

SEBs account for 14% of the pharmaceutical market, will increase to 20% by 2020in Canada.

More on the Way!

● Rituximab biosimilars are coming - phase 3 studies ongoing in many disease states

● Rituximab is the "big dog" for biosimilar potentials

● Shail Verma: "We don't have the answers on these biologics...yet."

● Dr Verma shows data that oncologists are more conservative and want to avoid biosimilars when the stakes of survival are higher

● Suspect it will be difficult to reach consensus on "biosimilars" when we can't even agree on terminology used to describe them

● Generic drugs are exact copies, SEBs are not - protein folding is complicated #biosimilars

● There can be 10^8 antibody variants - its hard to get #biosimilars accurate

● Producing quality biologics is like producing a good wine. It's an art form.

In general, the poorer the nation the greater the adoption, but England proactive in implementing.

Lots of $$ at stake here. One hopes that hunger for access to SEBs does not end up trumping safety and efficacy.

Can we apply the clinical trial results to practice? Process may have to be retooled for #biosimilars.#Rethink #Reinvent #caphocon15

And in this corner: The challenger vs the innovator #biosimilars vs #biologics More $$ involved than Mayweather vs Pacquiao!

Another analogy - if it looks like a duck, walks like a duck, etc, is it a duck? Maybe not, if you're an SEB. Endpoints critical.

Whatever happens with SEBs, pharmacovigilance is going to be critical. That's where onc pharmacists are going to have a big role

Art on display: Chemo Rollercoaster

Smoking Cessation40 000 Canadians have premature deaths due to cigarette smoking

Smoking rates vary: BC is lowest at 16% but Nunavut has 60% prevalence #smoking

29% of smoking deaths are due to #lungcancer.

Quitting smoking after a cancer diagnosis; is it closing the barn door after the horses escaped? #foodforthought

Its never too late to quit smoking #caphocon15 - reduces risk of cancer recurrence.

When you quit #smoking your cardiac risk goes down within days, but your cancer risk declines very slowly

"decreased treatment efficacy...decreased survival..." These FACTS are significant for the patient.

Cancer pts need to quit smoking before surgery - reduces risk of mortality and morbidity post-surgery

Head and neck cancer patients that smoke are twice as likely to die within 2 years of treatment#smokingcessation #ebm #caphocon15

There's value in cessation of smoking in patients even if still smoking when arrive at your center. Tx RR can improve.

PK effects on drug metabolism from hydrocarbons in cigarette smoke.smoking impact on chemotherapy- changes cyp metabolism in the liver and prevents tumor death from some therapies like cisplatinThe AUC of irinotecan is decreased with continued #smoking . Neutropenia from irinotecan less in smokers,likely from effects on drug clearance from body. Efficacy changes with reduced AUC?PK and PD effects from smoking - need to double the dose of erlotonib to get therapeutic levels

Quitting smoking increases survival by 15 months - we would pay so much to get a drug that can do that!

Smoking cessation can offer benefits we can on dream of in some cancer treatments. - Dr. Bill Evans#NeverTooLate

"Smoking isnt a bad habit, it's an addiction" - Dr Bill Evans #paradigmshift #caphocon15

Dr Evans wants #hcp to be more firm and direct with our patients to get them to quit #smoking.

"#smokingcessation may be one of the best ways to improve treatment outcomes for #cancerpatients." Per Dr. Evans The diagnosis of cancer is a powerful teaching moment; patient is most willing to learn, change, and comply with your guidance.

What does a drone, medical "tricorder", #wearables, social media have in common? Find out at #caphocon15 #pharmacoinnovation table talk

What does a super bowl commercial, sailing picture, & nunchucks have in common? All are featured in my cancer pain management talk. #caphocon15

#BreakingBad is a necessary part of any drug talk #caphocon15 #superbowlcommercial

Congrats #CAPhOCon15 Poster award winners! Pharmacy Practice: Chris Ralph "Impact of Clinical Pharmacist F/U Service in Outpt Pain Clinic"

(Plus: Dean, Frances, Yvonne!!!)

Putting my poster to bed!(Actually just packing it up in my Hunger Games style poster tube)

AGMAwkward Pics

"Every Cdn with cancer should have interaction(s) with an oncology pharmacist" - @PianogirlTara talking re: capho2020 #caphocon15 #inspired

Initiatives● Pat did 1st one!

Congrats @MelanieDanilak on winning the Volunteer Recognition Award this year from @CAPhO_ACPhO #caphocon15

What a great #CAPhOCon15 at @DestinationSJ - don't want to leave the Rock.

#CAPhOCon15 closing remarks. Mixed emotions. Great conference, tough to say goodbye to NFLD. Next up: Niagara Fall, site of #CAPhOCon16!

"You can't do nar t'ing if ya got nar t'ing to do anyt'ing wid." = "You can't do anything if have nothing to do anything with" #caphocon15

Home from #caphocon1. Good friends seen, good work done.

Link to some photos