Chiaramente, ogni formato ha i propri vantaggi e svantaggi comprare doxycycline senza ricetta per effettuare un acquisto, non è necessario fornire la prescrizione medica.
TOP_August 2012_FINAL_v2_TOP 8/20/12 9:57 AM Page 1
CANCER CENTER PROFILE
University of Arizona Cancer
T-DM1 in Metastatic Breast
The Expanding Role of the Oncology Pharmacist
It's Just the Beginning for an Exciting New Class
By Caroline Helwick
The biggest newsmaker at the 2012 healthy tissue, T-DM1 not only has
Annual Meeting of the American
potent antitumor effects but is also very
Society of Clinical Oncology
(ASCO) was a compound whose name
Trastuzumab emtansine (T-DM1) is
and actions sound practically missilelike:
part of an emerging class of drugs called
T-DM1. Because of its highly targeted
antibody-drug conjugates (ADCs) that
and potent effect that spares surrounding
link a monoclonal antibody (in this case,
Continued on page 4
RENAL CELL CARCINOMA
Quality of Life Drives Patient
Preference for Metastatic Renal
Daniel Butcher, Outpatient Oncology Pharmacy Supervisor, and Susan Vande Geest, Clinical StaffPharmacist, at the University of Arizona Cancer Center.
Cell Carcinoma Drug
Photo courtesy of the University of Arizona Cancer Center.
The University of Arizona Cancer Center (UACC) in Tucson is 1
of 41 National Cancer Institute (NCI)-designated comprehen-
Society of Clinical Oncology, held in
sive cancer centers in the United States. Called a "high-per-
The surprising results of a random-
ized trial on patient preference for
forming" center by US News & World Report
, the center has 29 beds
one cancer therapy over another
In a double-blind, crossover trial, 169
on a dedicated oncology wing, plus beds in surgery, gynecology,
show that patient-reported quality-of-life
patients with metastatic renal cell carci-
and pediatric units. The total number of beds in the facility is 487.
(QOL) differences influence treatment
noma (mRCC) were randomized 1:1 to
UACC has 2 outpatient clinics: UACC North Campus is for
preference far more than physicians had
10 weeks of 800 mg of pazopanib or 50
clinic/office visits, infusions, and Mohs surgery; and UACC Orange
imagined, suggested researchers at the
mg of sunitinib as first-line cancer treat-
Continued on page 7
2012 Annual Meeting of the American
ment; after a 2-week washout period,
Continued on page 25
CONFERENCE NEWS: MASCC
Advances in Supportive
. . . . . . 24
Exploring the Drug
Updates on Oral Chemotherapy
Adherence—Where Are We Today?
Quantifying the Drug
ConferenCe newS: aSCo 2012
Shortage: One Center's
Olanzapine Ef ective Antiemetic
Management of Febrile
for Breakthrough CINV . . . . . 26
At the recent 2012 symposium of
the Multinational As sociation
of Supportive Care in Cancer
Advances over the past few decades
Duloxetine in Peripheral
(MASCC), held in New York City,
have led to reduced morbidity and mor-
Considerations in Multiple
experts discussed a wide range of topics
tality from chemotherapy-induced fe -
Myeloma—Ask the Experts:
Ginseng Improves Cancer-
related to management of treatment-
brile neutropenia (FN). FN was once
Related Fatigue . . . . . . . . .
induced side effects. Below are some
considered fatal, but in the modern era,
highlights from the MASCC annual
mortality is about 5% and FN-related
Continued on page 9
2012 Green Hill Healthcare Communications, LLC
TOP_August 2012_FINAL_v2_TOP 8/20/12 9:58 AM Page 7
Cancer Center Profile
University of Arizona Cancer Center Continued from cover
Grove Campus offers clinic/office visits,
infusions, and radiation oncology.
Surgery and radiation oncology services
are also offered at the University
Campus hospital center.
In the fiscal year of 2011, 8560
patients were treated at UACC for
solid tumor, soft tissue, and skin and
blood cancers. UACC is best known
for its specialties: lymphoma, skin can-
cer and melanoma, gastrointestinal
cancer, gynecologic cancer, and breast
cancer. UACC encompasses 11 multi-
disciplinary clinics for major disease
sites, as well as a separate clinic for
high-risk cancer genetics.
Research is a major focus at UACC.
Currently, more than 200 clinical trials
are open for enrollment at UACC.
• Study to determine if ursodeoxy-
cholic acid (a natural bile acid) can
reverse the cellular damage of
• Research to see if taking high-dose
vitamin D (cholecalciferol) twice a
week for 8 to 9 weeks prevents skin
cancer in people with sun damage
and low levels of vitamin D.
Jerrelee Hollings, Pharmacist; Daniel Butcher, Outpatient Oncology Pharmacy Supervisor; and Amy Smith, Pharmacy Technician (left to right), at the University of Arizona Cancer Center.
• Study in breast cancer patients or
Photo courtesy of the University of Arizona Cancer Center.
women at high risk who are taking
tamoxifen to determine if a sup-
The multidisciplinary approach is
How has the role of the oncology
nings of cancer. My job as an oncology
plement called diindolylmethane
based on the recognition that a diagnosis
pharmacist changed over the past
pharmacist is an extension of that. One
(DIM) can reduce risk of cancer
of cancer has physical and psychological
in 4 deaths in the US are due to cancer.
ramifications. With our pool of experts,
It is exciting to see that the oncol-
I felt I had the necessary qualifications to
• I-SPY2 breast cancer trial, which is
we are well equipped to address the
ogy pharmacist is needed more now
help cancer patients.
a collaborative study to obtain
entire disease spectrum and to help with
than ever before. Our role has expand-
genetic and biological markers from
healing. We provide active supportive
ed significantly from compounding and
What advice would you give to
individual patients' tumors to screen
care for treatment-related and disease-
dispensing drugs to helping manage
oncology pharmacists just
several promising treatments simul-
related side effects as well as for healing,
patients with complex diseases and
entering the field?
with psychological and family support.
therapies. I firmly believe that oncology
Oncology can be overwhelming
UACC is affiliated with St. Joseph's
and the work environment is complex.
Hospital and Medical Center in
One piece of advice is not to be afraid
Phoenix, and the Cancer Centers
to ask questions. You are working with
of Northern Arizona Healthcare in
"Our role has expanded significantly from
patients at the most stressful time in their
Sedona. UACC's research facility has
lives and the work can be emotionally
compounding and dispensing drugs to helping manage
73 laboratories and about 300 re -
taxing. Be sure to have a planned out-
searchers drawn from the University of
let to process your work experiences in
patients with complex diseases and therapies."
Arizona and other institutions.
a positive manner. You will see the full
The Oncology Pharmacist
—Daniel Butcher, PharmD
range of emotions with your patients,
Daniel Butcher, PharmD, Outpatient
like an emotional roller coaster. You
Oncology Pharmacy Supervisor, at the
will need a good support system to pro-
University of Arizona Cancer Center to
What are you excited about in the
pharmacists can ease the burden on our
vide balance. Learn from your patients.
get his perspective on the role of the
field of oncology?
providers by implementing collaborative
They are a valuable educational re -
oncology pharmacist at his institution.
Research. Since we are an NCI-des-
practice agreements that allow us to
source on a daily basis. Your clinical
ignated comprehensive cancer center,
apply our specialized knowledge.
experience with patients is as impor-
What approach does the University
a lot of studies are being conducted at
This can have a financial impact. New
tant as reading journals.
of Arizona Cancer Center take to
our site. Trying to keep up with current
therapies are extremely expensive and I
treat people with cancer?
studies can be daunting. It is rewarding
believe we can guide appropriate use of
If you were not an oncology pharma-
Daniel Butcher (DB):
We are an NCI-
to watch agents that we have studied
these therapies to improve outcomes for
cist, what would you be doing?
designated comprehensive cancer cen-
make it to the marketplace; for exam-
The quality that attracted me to
ter that employs experts in all related
ple, nab-paclitaxel (Abraxane) and
oncology is an interest in how things
fields. We use a multidisciplinary ap -
ipilimumab, an immunotherapy for
What inspired you to become an
work. I think I would be a mechanical
proach for each patient to identify the
melanoma. We can have disappointing
engineer or a nuclear physicist. When
best treatment options.
results as well. Initially, we had the
When I was in pharmacy school, I
I was a kid, I would take apart appli-
impression that CVAX would be an
became interested in oncology drugs. I
ances and other household items to see
How does your approach translate
effective treatment for melanoma, but
found the biology fascinating, including
how they worked, and I always man-
to better outcomes for your
then the trial was halted because
the prepharmacy courses about DNA
aged to put them back together in
results were not promising.
and RNA and the biological underpin-
AugusT 2012 I VOL 5, NO 5 7
C D K a k t u e l l Kontaktblatt für Christen im Gesundheitsdienst Christen im Dienst an Kranken e.V. (CDK e. V.) CDK e.V. ist eine Vereinigung von Ärzten, Krankenpflegepersonal und anderen Mitarbei-tern im Gesundheitsdienst, die ihre Arbeit in christlicher Verantwortung zu erfüllen suchen. Außerdem gehören dazu Menschen aus anderen Berufen, die unsere Ziele mitunterstützen. Unser Maßstab dafür ist die Bibel, das Wort Gottes.
Hélène Delerue Niagara Falls, Ontario Université du Québec à Montréal McGill University PRATIQUES DE PROTECTION DES ACTIFS INTELLECTUELS: UN ÉTAT DE L'ART Comment les entreprises protègent-elles leurs actifs intangibles et leur propriété intellectuelle ? Comment les entreprises s'approprient-elles la valeur de leurs investissements en R&D ? En d'autres termes, comment maintiennent-elles l'unicité et la valeur de la propriété intellectuelle? Ce papier présente une revue de la littérature et fait état des différentes pratiques susceptibles de compléter et renforcer les mécanismes légaux de protection des actifs intellectuels.