Prophylactic therapy with exogenous albumin is not an effective strategy for the prevention of IIE. The novel risk-stratification model appears to be an effective method for predicting patients with the greatest potential for developing this adverse effect.

Resistance to first-and second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) and development and progression of central nervous system metastases remain significant issues in the treatment of ALK-positive non-small-cell lung cancer. Lorlatinib is a novel third-generation ALK TKI that is able to penetrate the blood-brain barrier and has broad-spectrum potency against most known resistance mutations that can develop during treatment with crizotinib and second-generation ALK TKIs. The safety profile of lorlatinib is distinct from those of other ALK TKIs. Adverse events are typically mild to moderate in severity, seldom result in permanent discontinuations, and are generally manageable through lorlatinib dose modifications and/or standard medical therapy. This article provides guidance to advanced practice providers (e.g., nurses, nurse practitioners, physician assistants) and oncology pharmacists for the clinical management of key lorlatinib-emergent adverse reactions (i.e., hyperlipidemias, central nervous system effects, bodyweight increase, edema, and peripheral neuropathy). As lorlatinib is both a substrate and inducer of the CYP3A enzyme system and is contraindicated with strong CYP3A inducers, relevant drug-drug interactions are also highlighted.

Purpose Although low-molecular-weight heparin (LMWH) remains the standard of care, factor Xa inhibitors such as rivaroxaban may serve as an alternative treatment for venous thromboembolism (VTE) in patients with active malignancy. The purpose of the analysis was to evaluate outcomes of VTE management in cancer patients treated with rivaroxaban compared to enoxaparin. Methods This single-center retrospective analysis was conducted on patients with malignancy-associated VTE initiated on treatment with either rivaroxaban or enoxaparin. The primary endpoint was the incidence of recurrent VTE. Secondary outcomes included a comparison in rates of bleeding, mean duration of treatment, and mean time to recurrence of VTE. Results A total of 45 patients were included in each group. The incidence of recurrent VTE was 8.9% in the rivaroxaban group versus 13.3% in the enoxaparin group ( p = 0.53). There were no statistically significant differences in the secondary outcomes with the exception of longer mean duration of treatment in the rivaroxaban group compared to the enoxaparin group (169 vs. 110 days, respectively; p = 0.04). Conclusions This study provides important preliminary information regarding the efficacy and safety of rivaroxaban for treatment of VTE in cancer patients. Although LMWH should remain the standard of care, these results provide initial reassurance that rivaroxaban serves as a viable alternative in the event that injectable anticoagulation is not an acceptable approach to VTE management.

Purpose Denosumab is a crucial supportive care agent for patients with advanced cancers affecting the bone. Despite the importance of treatment, logistical and financial obstacles hinder the ability to maintain long-term adherence. This analysis was designed to provide preliminary data regarding the feasibility of extended denosumab dosing intervals. Methods This retrospective, case cohort study was conducted on patients receiving treatment with denosumab for malignancies with bone involvement. A total of 60 patients were identified for analysis and were divided into cohorts according to the average number of days between denosumab doses. The standard interval group was comprised of patients receiving treatment once every 27-30 days ( n = 29), whereas the deviated interval group was comprised of patients with an interval of 31-56 days between injections ( n = 31). The primary outcome was the percentage of patients developing a skeletal-related event. Secondary efficacy outcomes included rate of pathologic fracture, spinal cord compression, radiation therapy, surgery, and hypercalcemia. Results Patients in the deviated interval arm experienced significantly more skeletal-related events compared to the standard interval group (61% vs. 31%, respectively; p = 0.02). Secondary efficacy endpoints trended in favor of the standard therapy arm except for requirement for surgery (results were virtually equivalent) and hypercalcemia (no events in either group). Conclusions Non-adherence with the standard denosumab dosing schedule demonstrated an increased risk of experiencing a skeletal-related event. Preservation of denosumab dose density appears imperative to maintain efficacy and as such extending the dosing interval should be discouraged.