Oncology Fundamentals Day 2018 Session Descriptions

Malignant Melanoma – Glenn Myers, The Moncton Hospital, Moncton, NB

Speaker Biography

Malignant melanoma was once thought to have the poorest outcomes amongst solid tumour malignancies due to a lack of response to conventional therapy such as chemotherapy or radiotherapy. Melanoma has arguably seen with the most impressive therapeutic advances within medical oncology in the 21st century due to development of targeted anti-cancer therapies (e.g. BRAF and MEK inhibitors) and immune checkpoint inhibitors (e.g. ipilimumab, nivolumab, pembrolizumab) that contribute to a significant improvement in disease control and overall survival. This presentation will give a brief introduction to the diagnosis, assessment, and therapeutic approach to malignant melanoma in this new era of targeted anti-cancer therapy and immunotherapy.  

Learning Objectives:

  1. Recognize the basic subtypes, associated risk factors, and simplified approach to diagnosis of malignant melanoma;
  2. Summarise the role of clinically relevant mutations found in malignant melanoma as it pertains to choosing the most appropriate anti-cancer therapy;
  3. Review the most up to date evidence when choosing the most appropriate therapy for patients with adjuvant and metastatic melanoma;
  4. Demonstrate a baseline understanding of the clinically significant toxicities of targeted anti-cancer therapies (e.g. BRAF and MEK inhibitors) and immune checkpoint inhibitors used in the treatment of malignant melanoma; and
  5. Implement risk reduction strategies using patient education and non-pharmacologic methods in an effort to improve patient awareness of melanoma risk factors. 

Pediatric Oncology – Mark Diachinsky, Alberta Health Services, Edmonton, AB

Speaker Biography

In Canada, an average of 880 children per year are diagnosed with cancer and approximately 150 will die from the disease. The incidence of childhood cancer has remained relatively stable for the past two decades; however, mortality has decreased significantly largely due to access to clinical trials and co-operative research groups. The types of cancers that occur in children are different from those seen in adult populations. While treatment and complications may be similar, there are important differences in the therapy and management of this population group. There are unique challenges to consider when providing treatment to pediatric populations, and the pharmacist is an essential part of the care team.

Learning Objectives:

  1. Understand the prevalence of childhood cancer;
  2. Understand common childhood malignancies;
  3. Recognize the importance of collaboration and research in the success of childhood cancer;
  4. Identify unique challenges associated with the treatment of adolescent and young adults with cancer; and
  5. Discuss the late effects of treatment on survivors of childhood cancer.

Glioblastoma and Neurological Supportive Care – Uzo Onochie-Roy, The Ottawa Hospital Cancer Centre/Irving Greenberg Family Cancer Centre, Ottawa, ON

Speaker Biography

Primary Central Nervous System (CNS) cancers are a heterogeneous group of tumours which originate in the brain or the spinal cord.  Glioblastoma multiforme (GBM) is the most common and most aggressive form of primary brain malignancy; prognosis is dismal.  Treatment modalities include surgery, radiation therapy and chemotherapy (temozolomide), either in combination or individually, depending on prognosis. Care and treatment of brain cancer patients is very complex and requires management beyond what is required for tumour control.  The pharmacotherapy of supportive care issues will also be reviewed, including seizures, venous thromboembolism, brain edema/mass effect, cognitive dysfunction and fatigue. 

Learning Objectives:

  1. Recognize the grading principles of CNS cancers and how this affects patient prognosis and treatment;
  2. Describe the potential initial clinical presentation of a CNS cancer patient;
  3. Identify the main treatment alternatives for GBM cancers and monitoring involved;
  4. Discuss the various supportive care issues related to CNS cancers and monitoring involved with their care; and
  5. Identify the role of the pharmacist in providing care to patients with GBM and other CNS cancers.

Renal Cell Carcinoma – Tom McFarlane, University of Waterloo, Kitchener, ON

Speaker Biography

Renal cell carcinoma (RCC) is a group of cancers affecting the kidneys which comprise about 3-4% of cancers diagnosed in Canada annually, with incidence continuing to rise. Most tumours are of clear cell origin and tend to originate in the proximal convoluted tubule of the nephron. RCC prognosis tends to be good if discovered early, but patients who present with advanced disease initially it remains a therapeutic challenge for clinicians, despite the fact that many new targeted agents have been introduced in recent years which have improved survival for RCC patients. Given that these agents tend to be orally administered drugs, there is a role for pharmacists in both oncology and primary care to manage toxicities and potential drug interactions which can arise from their use. Additionally, the role of immunotherapies such as checkpoint inhibitors is on the rise in this area, which will require vigilance from patients and pharmacists in order to ensure proper and safe use.

Learning Objectives:

  1. To describe the etiology, pathophysiology, epidemiology, and prognosis of RCC;
  2. To understand the workup, staging, and treatment options for patients with RCC, especially oral targeted agents;
  3. To explore emerging treatment options for RCC, including immunotherapy;
  4. To understand common sequelae experienced by patients with RCC; and
  5. To outline strategies for managing issues around oral RCC therapy, including toxicities and drug interactions.

Myelodysplastic Syndrome – Tara Leslie, University of Alberta/Tom Baker Cancer Centre, Calgary, AB

Speaker Biography

Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid clonal disorders characterized by various cytopenias. Patients are vulnerable to complications associated with these cytopenias such as infections, bleeding, and anemia.  They are also at risk of their disease evolving to an acute myeloid leukemia.

Learning Objectives:

  1. Define myelodysplastic syndrome (MDS) and describe the diagnostic criteria and prognostic factors;
  2. Describe the treatment options for MDS with a focus on those suitable for elderly patients; and
  3. Describe the common complications and symptoms of MDS and the frequently employed management strategies for these issues.

Infusion and Hypersensitivity Reactions – Nicole MacDonald, Dr. H. Bliss Murphy Cancer, St. Johns, NL

Speaker Biography

A hypersensitivity reaction is an allergic reaction while an infusion reaction is an acute reaction due to cytokine release syndrome. Most hypersensitivity reactions are considered Type 1 hypersensitivity reactions, which are IgE mediated and can result in urticaria, rash, angioedema, bronchospasm, and/or hypotension after re-exposure to the sensitizing agent. Other hypersensitivity and infusion reactions can present very similar to Type 1 reactions. Common medications used to prevent and/or treat an infusion or hypersensitivity reaction include antihistamines, corticosteroids, and H2 antagonists. Agents that are at increased risk of infusion or hypersensitivity reactions including monoclonal antibodies, platinum agents, and taxanes. 

Learning Objectives:

  1. Define hypersensitivity versus infusion reactions for monoclonal antibodies and chemotherapy agents;
  2. Describe the physiology of different hypersensitivity and infusion reactions that can occur with monoclonal antibodies and chemotherapy;
  3. Recognize monoclonal antibodies and chemotherapy agents that have a greater risk of hypersensitivity or infusion reactions; and
  4. Identify appropriate prevention and treatment strategies for hypersensitivity and infusion reactions.

Bone Health – Michael Collins, Grand River Regional Cancer Centre and Grand River Hospital, Kitchener, ON

Speaker Biography

Cancer and cancer-related treatments can greatly affect the architecture of healthy bone.  As cancer treatment continues to evolve, the long-term consequences of antineoplastics are of increasing concern for patients and providers.  Several cancers, including breast, prostate and multiple myeloma, have an affinity for bone and subsequent metastatic growth putting these patients at risk for skeletal-related events.  Pharmacists in all areas of practice should be aware of the evidence behind the various bone-targeted agents available for use in cancer patients.  This presentation will provide an overview of treatment options in both the preventative and metastatic setting.

Learning Objectives:

  1. Understand the incidence, epidemiology, patho\physiology and clinical consequences of cancer-induced and cancer-treatment related bone disease;
  2. Describe the general management and prevention of metastatic bone disease;
  3. Understand the mechanism of action, efficacy and safety of common bone-targeting agents used in cancer patients; and
  4. Explain the role of bone-targeted treatment options in the prevention of bone metastasis.