The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.

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Does therapeutic drug monitoring of hydroxychloroquine improve treatment outcome in intensive care unit patients with COVID-19?To The Editor, COVID-19 is a newly emerging human infectious disease of SARS-CoV-2 origin that has spread from China. The global COVID-19 situation was described as a pandemic by the WHO on 11 March 2020. Several treatment strategies are being considered and evaluated in numerous clinical trials. Among several treatment strategies, hydroxychloroquine (HCQ) has been suggested as potential treatment option for COVID-19. However, it has very long half-life(5-40 days) and large volume of distribution into blood and tissues which causes variability in treatment response. It is known that, the steady-state concentration is reached within weeks and differs according to individual factors (eg, obesity, sepsis, burn, ascites, pregnancy, critical illness) even at the same dose regime especially in the treatment of rheumatic diseases. 1 In contrast, the usage of HCQ is limited to 5 days and the mean time to reach the minimum therapeutic drug concentration (1 mg/L) is 3-4 days in patients with Patients in intensive care unit (ICU) present certain characteris-LETTER

To the Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus strain that typically causes acute respiratory distress in patients, and its associated disease was named CoV Disease-19 (COVID-19). Presence of comorbid diseases and suppressed immune systems, especially in advanced age (>60 years), have been shown to be risk factors for COVID-19. 1 Both cancer and its treatment can weaken the immune system of patients which leads cancer patients become more vulnerable to infections. Cytopenias such as neutropenia, anemia, and thrombocytopenia, which are seen as a result of myelosuppression, are particularly important problems that can affect the treatment process. Depending on the chemotherapy regimen used, patients may present different myelosuppressive side effects. The National Comprehensive Cancer Network (NCCN) guideline classified chemotherapy regimens according to the risk of neutropenia as: high (>20%), intermediate (10-20%), and low (<10%). 2 In the view of this guideline, topotecan used in the treatment of small cell lung cancer is at high risk, cisplatin-paclitaxel, cisplatinvinorelbine, cisplatin-docetaxel, cisplatin-etoposide, carboplatin-paclitaxel, and docetaxel regimens used in the treatment of non-small cell lung cancer are considered to be at intermediate risk. 2 Prophylactic use of granulocyte colony stimulating factor is recommended to prevent complications of neutropenia in patients using high-risk treatment regimens, and patients using medium-risk treatment regimens if more than one risk factor exists. 2 Immunotherapeutic agents (such as anti-PD-1/PD-L1 drugs) may have myelosuppressive side effects similar to cytotoxic agents, but data are limited. 3 The myelosuppressive effect of cytotoxic agents is cumulative and the risk is further increased in the later stages of treatment. 3 The most important fatal adverse effects of anti-PD-1/PD-L1 drugs are known as pneumonitis (35%). 3 Therefore, determining the risk status of cancer patients and re-evaluation of treatment during COVID-19 is important. Assessment of cancer as a risk factor for COVID-19 has not yet been fully defined. However, the study of Liang et al. described the COVID-19 and cancer relationship with limited data. 4 According to the study, the prognosis of COVID-19 was shown to be worse in cancer patients compared to the others and the most common type is lung cancer seen in patients with COVID-19, which also has the high mortality rate. 5 There is currently no approved treatment for COVID-19, but hydroxychloroquine, azithromycin, lopinavir-ribonavir, remdesivir, tocilizumab, favipiravir, and plasma antibody therapy are considered potential treatment option worldwide. Cancer often requires a long-term treatment in cycles, and drug treatment may have cumulative and/ or immediate effects. Cumulative effects of drug treatment can cause a risk for potential drug interactions with drugs used in COVID-19 treatment. The drugs used in the treatment of COVID-19, such as hydroxychloroquine and tocilizumab, have a long...

Oncology pharmacists, pharmacy technicians and assistants are key members of the multidisciplinary health care team (MHT) caring for patients receiving immunotherapy with immune checkpoint inhibitors. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on the role of oncology pharmacy practitioners in caring for patients receiving immune checkpoint inhibitors. Four key recommendations were identified: 1) participation as an integrated, collaborative member of the MHT; 2) provision of education and training for patients, students, residents, fellows and other members of the MHT; 3) involvement in clinical governance to optimise the use of immune checkpoint inhibitors and 4) involvement in research and development in the field of immunotherapy. In summary, oncology pharmacy practitioners play essential roles within the MHT in caring for patients receiving immune checkpoint inhibitors.