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Purpose To summarize the pharmacology, efficacy, safety, dosing, administration, and pharmacist perspectives related to operationalization of new and emerging bispecific therapies indicated for the treatment of various cancers. Summary In recent years, there have been significant advancements in the expansion of immunotherapeutics in the treatment of various malignancies. Bispecific T cell–engaging therapies represent an emerging therapeutic drug class for the treatment of cancer. These therapies are unique antibody constructs that bind simultaneously to 2 targets, a tumor-specific antigen and CD3 on T cells, to elicit an immune response. Recently, several bispecific therapies have been approved, including epcoritamab, glofitamab, mosunetuzumab, tebentafusp, and teclistamab. Epcoritamab and glofitamab have been approved for diffuse large B cell lymphoma, while mosunetuzumab, tebentafusp, and teclistamab have been approved for follicular lymphoma, uveal melanoma, and multiple myeloma, respectively. As a result of their mechanism of action, the approved bispecific therapies have the potential to cause cytokine release syndrome, and, along with this, they all have unique and specific monitoring parameters and operational considerations that require clinician awareness when administering these therapies. Such operational challenges include within-patient dose escalations at therapy initiation, hospitalization for monitoring, and various pharmacological strategies for prophylaxis of cytokine release syndrome. Conclusion Bispecific therapies have continued to evolve the therapeutic landscape of cancer, primarily in hematological malignancies. Health-system pharmacists have the opportunity to play a key role in the operationalization and management of this new and emerging drug class. [ABSTRACT FROM AUTHOR]

Chemotherapy‐induced thrombocytopenia (CIT) remains a common complication of cancer therapy with no approved available treatments in most of the world. Although a prior clinical trial of avatrombopag for CIT did not meet its primary end‐point, a report from Galamaga and colleagues raises prospects for a second chance for avatrombopag in CIT, highlighting the differences between nadir and persistent CIT and the importance of patient selection in CIT treatment.Commentary on: Galamaga et al. Avatrombopag for the treatment of patients with chemotherapy‐induced thrombocytopenia: a case series. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19797 [ABSTRACT FROM AUTHOR]

Clinical pharmacists practicing in academia have access to resources and pathways for professional development that clinical pharmacists practicing outside of academia may lack. With timely concerns of premature attrition and burnout in the clinical pharmacy profession, it is critical that employers and professional organizations help meet the professional development needs of clinical pharmacists practicing in outside of academia. Implementation of career ladders, creation of hybrid leadership‐practice positions, achievement of operational excellence, cultivation of a positive culture, and development of optimal metrics may all help employers meet these needs. Professional organizations are called on to provide clinical pharmacists with a clear path for advancement within the organization to contribute to their ongoing professional development; this centers on the development of mentorship programs and opportunities to expand the professional portfolio of the clinical pharmacist practicing outside of academia. It is imperative that employers and professional organizations address the lack of existing career advancement and professional development opportunities to combat the premature attrition of clinical pharmacists from practice, improve the "life span" of the clinical pharmacist, and ultimately maintain the clinical pharmacy profession as a whole. [ABSTRACT FROM AUTHOR]

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosing and administration, and place in therapy of avatrombopag for the treatment of immune thrombocytopenia and chronic liver disease-associated thrombocytopenia. Summary: Avatrombopag is an orally administered thrombopoietin receptor agonist approved for the treatment of immune thrombocytopenia and is the first oral thrombopoietin receptor agonist approved for the treatment of perioperative thrombocytopenia associated with chronic liver disease in adults. The efficacy and safety of avatrombopag has been demonstrated in a multicenter, randomized, double blind, placebo-controlled phase III study in the setting of immune thrombocytopenia and in 2 identically designed, multicenter, randomized, double blind, placebo-controlled phase III trials in the setting of thrombocytopenia associated with chronic liver disease. The most common adverse events reported in the clinical trials were headache, fatigue, and gastrointestinal toxicities. The incidence of bleeding events was comparable between the avatrombopag and placebo treatment groups in each study. Avatrombopag has not been shown to be associated with hepatoxicity and does not require food restriction like the other oral thrombopoietin receptor agonist for immune thrombocytopenia, eltrombopag. Also, unlike eltrombopag for immune thrombocytopenia, it can be dosed less frequently than once daily. Conclusion: Avatrombopag offers another safe and effective oral option for the treatment of immune thrombocytopenia without food restrictions and an alternative, transfusion-sparing option for thrombocytopenia associated with chronic liver disease patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with bleeding disorders are best served by multidisciplinary teams. Pharmacists can play a critical role in the optimal management of patients with bleeding disorders through blood factor stewardship strategies and programs. An educational program was developed and implemented wherein a hematology pharmacist provided brief recorded lectures to an entire department of pharmacists in a multi-site health-system with the goal to improve the knowledge base and confidence among this population of general practitioners. Methods: The primary objective of this study was to evaluate the educational outcomes of a blood factor education program for pharmacists. The impact of the educational program was determined by measuring the difference in mean test scores between the pre- and post-program surveys. Results: The final analysis included 214 participants. The primary endpoint of mean competency test score was significantly improved in the post-test compared to pre-test (78.33% vs 52.83%; P <.0001). Any degree of test score improvement was observed in 99% (n = 212) of participants. Pharmacist confidence was significantly improved in all 20 domains of bleeding disorders and blood factor product verification and management. Conclusion: This program identified that most pharmacists in a large multi-site health-system were not familiar with bleeding disorders to a satisfactory degree, commonly because of the relative rare encounters with bleeding disorder-related orders, and that despite systems-based support there was an opportunity to improve practice through education. Such educational programming could be beneficial for the development of pharmacist-provided care and is a measure that could be implemented as part of blood factor stewardship initiatives. [ABSTRACT FROM AUTHOR]

A recent study evaluated the safety outcomes of transitioning obinutuzumab, an anti-CD20 monoclonal antibody, from a standard rate to a short duration infusion (SDI) in patients with chronic lymphocytic leukemia (CLL). Infusion-related reactions (IRRs) are a common adverse event associated with obinutuzumab, and the study aimed to assess the impact of the updated infusion rate on safety outcomes and infusion chair time. The study found that SDI obinutuzumab was safe and well-tolerated, with no incidents of IRRs observed in patients transitioning to the SDI rate. The use of SDI obinutuzumab has the potential to save significant infusion chair time and improve patient convenience and satisfaction. However, the study had limitations, and further research is needed to confirm these findings in a larger cohort of patients with CLL. [Extracted from the article]