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A multidisciplinary team recommended modifications to the medication-use system regarding U-500 regular insulin after review of a medication error. No errors involving U-500 regular insulin have been reported since implementation of the changes.

Sipuleucel-T is an immunotherapy indicated for the treatment of metastatic prostate cancer. It offers a new mechanism to treat prostate cancer without the side effects of hormone therapies and chemotherapies. In previous studies sipuleucel-T did not delay disease progression, but demonstrated an overall survival benefit compared to placebo. While clinical trials have evaluated the effects of sipuleucel-T on overall survival and progression, more studies are needed to evaluate its effectiveness and role in the management of prostate cancer. The objective of this study is to identify the incidence and possible predictors for disease progression in patients receiving sipuleucel-T. A retrospective review of patients who received sipuleucel-T between 1 September 2010 and 11 October 2011 was conducted (n = 36). Patients who changed therapy or died within 120 days were classified as experiencing rapid progression. Potential predictors of rapid progression were examined using logistic regression. Seven patients met criteria for rapid progression. Progression occurred in 72.2% of all patients. The median days to progression was 158. No significant predictors of rapid progression were identified. Currently no predictors have been found to be associated with rapid progression in prostate cancer patients on sipuleucel-T.

Background: Despite demonstrated clinical benefits of first line (1L) cyclin-dependent kinases 4/6 inhibitors (CDK4/6i) and their preferred status in the NCCN guidelines, many appropriate patients with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC) in the United States (US) may still receive chemotherapy or endocrine monotherapy. US oncologists may consider treatment expectations, patient clinical characteristics, and non-clinical factors (e.g., cost, anticipated adherence) when selecting 1L mBC treatment regimens. However, little is known about how prevalent these decision factors are among US oncologists. Comprehensively understanding the decision-making process in 1L treatment selection is a critical step towards ensuring equitable care for patients with HR+/HER2- mBC. Objective: To describe self-reported clinical and non-clinical factors considered by US oncologists in selection of 1L treatment for HR+/HER2- mBC. Methods: Data were collected through from an anonymous cross-sectional online survey from a convenience sample of US oncologists from August-October 2021. Eligible oncologists were board certified, in practice 2-30 years, ≥50% of time spent in direct patient care, and managed ≥5 1L patients with HR+/HER2- mBC in past 3 months. Respondents were sampled from a national research database of physicians sourced from multiple databases (e.g., American Medical Association Physician Masterfile). The survey captured self-reported demographic and practice characteristics and reported importance of the following factors in selecting 1L treatment for patients with HR+/HER2-mBC: anticipated treatment efficacy and safety, patient demographics, and clinical and non-clinical characteristics. Study variables were summarized via descriptive statistics. Correlation analyses evaluated associations between patient demographics, clinical characteristics, treatment expectations, and non-clinical characteristics and oncologists’ self-reported 1L prescribing rates of CDK4/6i, aromatase inhibitor (AI) monotherapy, and chemotherapy. Results: 250 oncologists participated; 67% from community practice and the remainder from academic institutions (Table 1). Anticipated treatment efficacy and safety/tolerability were ranked as the most important factor considered by oncologists when selecting 1L treatments. 1L CDK4/6i prescribing was most strongly correlated with patient Medicare eligibility (r, 0.54, p< 0.05) and postmenopausal status (r, 0.67, p< 0.05). 1L chemotherapy prescribing was most strongly correlated with patient premenopausal status (r, 0.42, p< 0.05) and perimenopausal status (r, 0.31, p< 0.05), and physician consideration for patient symptom burden (r, 0.31, p< 0.05). 1L AI monotherapy prescribing was most strongly correlated with concerns with expected patient compliance to treatment (r, 0.42, p< 0.05) and patient cost/logistical challenges (r, 0.41, p< 0.05). Conclusion: This study found a variety of patient, clinical, and non-clinical factors may underlie US oncologists’ selection of 1L treatment for HR+/HER2- mBC. Anticipated efficacy and safety/tolerability were reported as the most important factors in 1L treatment decisions. Patient demographics, clinical characteristics, and considerations for cost and compliance challenges varied in association with 1L CDK4/6i, chemotherapy, and AI monotherapy prescribing patterns among US oncologists. Table 1. Oncologist Demographic and Practice Characteristics Citation Format: Adam M. Brufsky, Martine C. Maculaitis, Lewis Kopenhafer, Patrick Olsen, Ashley S. Cha, Lillian Shahied Arruda, Wendy Heck, Samantha K. Kurosky. Identifying Drivers of First-Line HR+/HER2- Metastatic Breast Cancer Treatment Choices [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-09.