Important developments in chemotherapy for metastatic colorectal cancer over the last years are reviewed, with an emphasis on the most recently published data from clinical trials. The systematic review of current literature was conducted involving Pubmed Central® research and full articles were obtained and analyzed when appropriate.Fluorouracil still constitutes the backbone of metastatic colorectal cancer treatment; fluorouracil combination plus either irinotecan (FOLFIRI), oxaliplatin (FOLFOX) or capecitabine (CAPOX or XELOX) are chemotherapy protocols established as treatments producing similar outcomes.Actual treatment involves these chemotherapy protocols in combination with new molecular targeted drugs: bevacizumab and aflibercept (anti-vascular endothelial growth factor monoclonal antibody) and cetuximab and panitumumab (anti-epidermal growth factor receptor monoclonal antibody for patients with wild type KRAS) which confer significant survival benefits in select patients as first- or second-line therapies. The factors affecting the decisions for one treatment over other are related to the patient and toxicity drug.Finally, metastatic colorectal cancer patients progressing after all standard therapies (maintaining a good ECOG performance status) could be candidates for further therapies such as regorafenib and TAS-102.Regarding the future, promising therapies are under development for the metastatic colorectal cancer treatment and several agents are currently being evaluated in different clinical trials.

BackgroundA Quality Management System (QMS) analyses, controls and monitors the processes in order to identify areas that require improvement.PurposeTo describe the incidents detected by the staff of a Pharmacy Service (PS) during the implementation of a QMS based on the ISO 9001:2008 standard.Material and methodsDescriptive study (December 2013–August 2014). The quality improvement logbook, in which the incidents were recorded, was designed by the PS Quality Manager (PSQM), based on the experience of other hospitals and according to a general procedure, authorised by the PS Quality Subcommittee and reflected in the PS Organisation Handbook. The logbook was presented in a PS meeting, where its location and how to fil it in [record number, date, process involved, description of the incident, reporting/detecting staff, first actions taken] were explained. Once the incident is booked, it was reviewed by the PSQM and the responsible pharmacist. If needed, due to frequency and/or severity, the PSQM proceeds with the opening of a nonconformity and/or a corrective/preventive action, communicating this to the PS Manager. These are evaluated by the PS Quality Subcommittee.Results60 incidents in 4 key processes and 1 support process were recorded. Process distribution: logistics (37), dispensing (11), sterile (6) and non-sterile (5) preparation, pharmacoeconomics management (1). With respect to the logistics incidents, 18 of them were identified jointly by nursing and administrative assistants and the most common incidents involved the lack of a standard label on the outer package, to indicate that the drug can’t be dispensed outside the hospital (25) and incorrect temperature in fridge (4). In relation to incidents to do with productions, 6 nonconformities were opened (expired drug dispensed, wrong non-sterile preparation dispensed, autologous serum contamination, laminar flow cabinet contamination, mislabelling of a cytostatic and delay in orders for non-sterile materials).ConclusionIt is important to educate health staff in detecting weaknesses or failures in the system in order to perform the “Deming Continuous Improvement Cycle”.References and/or acknowledgementsNo conflict of interest.

BackgroundTo increase the pharmacist presence in the computerised medical record (CMR) emerged as one of the improvement actions (IA) when internal customer feedback (satisfaction surveys to medical staff) was examined during the implementation of a Quality Management System (QMS) based on ISO 9001:2008 standard in a Pharmacy Service.PurposeTo analyse the degree of acceptance (DA) of the pharmacotherapeutic recommendations (PRs) after pharmacist participation in the CMR.Material and methods4-week ambispective quasi-experimental study (pre-intervention (A) 15 August–30 August’14; post-intervention (B) 1 September–15 September’14) performed in the Unit-Dose Drug Dispensing System (UDDDS) with manual prescription, nurse transcription and subsequent validation by a pharmacist, in a level-II hospital (411 beds, 52.8% of them with UDDDS). During period B the pharmacist wrote an advisory note in the CMR (MambrinoXXIv5.4®) called “Pharmaceutical Care”, in addition to submitting the printed PR form (PPRF) with the prescription; while during period A, only the PPRF was sent. End points: ward [medical, surgical, medical-surgical (MS)], drug, type of PR, degree of acceptance. Data collection and processing: Farmatools-Dominion, Excel.Results93 PRs were recorded [period A (38 PRs, 32 patients, 74.9 ± 13.4 years old; 63.2% male); period B (55 PRs, 47 patients, 72.8 ± 17.6 years old, 74.5% male)]. Type of ward: medical (39.5% A vs. 36.4% B), surgical (57.9% A vs. 52.7% B) and MS (2.7% A vs. 10.9% B). Main drugs involved: proton pump inhibitors (15.8% A vs. 9.1% B), potassium-fluid replacement treatment (15.8% A vs. 5.5% B), not included in guide (NIG) (42.1% A vs. 36.4%B). Major types of PR: substitution of medicines NIG for available therapeutic alternatives (36.8% A vs. 34.5% B), dose/dosage regimen modification (10.5% A vs. 16.4% B), drug interactions (10.4% A vs. 8.9% B), monitoring hypo/hyperkalaemia (21.1% A vs. 5.5% B). The degree of acceptance was 63.3% A vs. 79.5% B.ConclusionThe QMS identified weak points in order to establish IA. Moreover, sharing the CMR and making it accessible to health personnel was found to improve coordination and communication of care, creating an opportunity for pharmacists to develop a comprehensive patient-centred plan and to promote their integration in the interdisciplinary healthcare team.References and/or acknowledgementsNo conflict of interest.

No abstract