In the cardio-oncology population, drug interactions are of particular importance given the complex pharmacological profile, narrow therapeutic index, and inherent risk of therapies used to manage cardiovascular disease and cancer. Drug interactions may be beneficial or detrimental to the desired therapeutic effect. Clinicians in both cardiology and oncology should be cognizant of these potential drug-drug interactions that may reduce the efficacy or safety of either cardiovascular or cancer therapies. These risks can be mitigated through increased recognition of potential drug-drug interaction, use of alternative medications when possible, and careful monitoring. This scientific statement provides clinicians with an overview of pharmacodynamic and pharmacokinetic drug-drug interactions in patients with cancer exposed to common cardiovascular and cancer medications.

No abstract

The shortage of dacarbazine (DTIC) has created an acute and unprecedented crisis in the management of patients with classical Hodgkin lymphoma, with DTIC being an essential component of doxorubicin, bleomycin, vinblastine, and DTIC (ABVD) and prior attempts at omitting DTIC from ABVD leading to substantial loss of efficacy. In this review, we discuss the strategies to manage classical Hodgkin lymphoma during the DTIC shortage and propose a treatment algorithm on the basis of fitness and ability to receive anthracyclines safely.

The CORAL study highlighted the need to develop novel salvage regimens in relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) previously treated with R-CHOP. Carfilzomib (CFZ) can overcome rituximab-chemotherapy resistance in lymphoma pre-clinical models by targeting the ubiquitin-proteasome system (UPS). We conducted an investigator initiated, single-center, open-label, prospective phase 1 study evaluating the safety and efficacy of CFZ in combination with R-ICE in high-dose chemotherapy with autologous stem cell transplant (HDC-ASCT) eligible R/R DLBCL pts (NCT01959698). In the dose-escalation phase, 18 pts were enrolled at six dose levels with no dose-limiting toxicities noted. CFZ 45 mg/m2 was selected as the recommended dose for expansion. Eleven additional pts were enrolled in the dose-expansion phase. Overall response rate (ORR) was 66% (48% CR, 17% PR), 52% pts underwent HDC-ASCT. An ORR of 85% was observed in pts with non-germinal center B-cell-like (non-GCB) DLBCL compared to only 13% in GCB-DLBCL. Median PFS was 15.2 months (5.1 mo- not reached), and median OS was 22.6 months (6.8 mo- NR). Pts with non-GCB subtype had a significantly longer PFS (NR vs. 6.6 mo, p= 0.0001) and OS (NR vs. 6.6 mo, p= 0.001) than those with GCB-subtype. C-R-ICE is well tolerated in pts with R/R DLBCL with toxicities comparable to R-ICE therapy. Our data show that pts with non-GCB DLBCL benefit significantly from incorporating CFZ into second-line therapy and HDC-ASCT.

e18813 Background: Use of biosimilars is an effective strategy in expanding access to care and lowering healthcare costs. Literature about the successes, challenges, and best practices of biosimilar adoption in oncology is limited. We aim to describe the current state of biosimilars in oncology practices and barriers to adoption. Methods: A 40-question survey was developed to gather information regarding biosimilar use in the following areas: formulary management, product usage, policies, technology, safety, and education. The following biosimilars were evaluated: bevacizumab (B), filgrastim (F), epoetin (E), infliximab (I), pegfilgrastim (P), rituximab (R), and trastuzumab (T). The survey was distributed to Hematology/Oncology Pharmacy Association members. Results: A total of 179 surveys were initiated, with a completion rate of 31%. Six surveys were removed due to duplication, resulting in 50 unique surveys with 21 responses (42%) from NCI-designated comprehensive cancer centers. Inpatient formulary decisions were driven by acquisition cost followed by reimbursement. In the outpatient setting, equal consideration was given to acquisition cost and reimbursement for formulary decisions. Thirty-two percent of institutions restricted biosimilars to their FDA approved indication. Sixty-six percent of institutions had a biosimilar interchangeability policy in place. For the corresponding reference products, overall average utilization of biosimilars was B 74%, F 88%, E 82%, I 57%, P 52%, R 73%, and T 71%. More than 90% of institutions had a preferred biosimilar on formulary. Based on the results, 72% stated payors specified the selection of biosimilars, and 76% stated payor reimbursement limited ability to participate in contract pricing. Insurance reimbursement was recognized as the main barrier to adoption (Table). Medication errors related to biosimilar use were reported by 26% respondents, with the most common cause listed as communication. Thirty-six percent of institutions provided education on the general use of biosimilars and 38% had biosimilar products in treatment specific education. Conclusions: Biosimilar adoption is consistent across responding institutions, with noted utilization shift towards biosimilar products compared to reference. Decisions for biosimilar adoption are made based on cost and reimbursement. Opportunities exist in the collaboration of health systems and payors to align formularies and promote safe and cost-effective care for their members.[Table: see text]