The SRC-ABL inhibitor bosutinib is one of the five tyrosine kinase inhibitors currently approved for the treatment of Philadelphia chromosome-positive leukemias. Bosutinib has shown activity against all phases of resistant chronic myeloid leukemia that do not harbor the T315I or V299L ABL kinase domain mutations. Bosutinib is overall well tolerated; transient diarrhea is the most common side effect. This article summarizes the pharmacokinetics, pharmacodynamics, safety and efficacy of bosutinib for the treatment of Philadelphia chromosome-positive leukemias.
1523 Background: The primary purpose of tumor mutation profiling (TMP) is to molecularly characterize tumors to identify targeted treatments and improve outcomes, but it may also uncover germline mutations with implications for patients and families. In September 2016, the National Comprehensive Cancer Network (NCCN) added “BRCA1/2 mutation detected by TMP” as a criterion for germline BRCA1/2 testing. This study aims to assess rates of germline testing, with and without genetic consultations, for individuals with a somatic BRCA1/2 finding in community oncology centers. Methods: Retrospective data was abstracted from an internal database of results from four TMP laboratories. Individuals with a somatic BRCA1/2 pathogenic/likely pathogenic (P/LP) variant reported from January 1, 2017 to December 31, 2019 were included. Clinical data was obtained from electronic medical records. The project was approved by the Texas Oncology Privacy Board. Results: 221 patients had a P/LP somatic BRCA1/2 result on TMP, 138 of which were BRCA1/2 spectrum tumors (breast, ovary, pancreas, prostate). 144/221 patients (65.2%) had BRCA1/2 germline testing. 133/221 (60.2%) met NCCN guidelines for germline BRCA1/2 testing independent of their somatic results; they were statistically more likely to undergo germline testing than patients who did not otherwise meet germline BRCA1/2 testing criteria (p=2.3e-16) (Table). 70/144 (48.6%) had a germline P/LP BRCA1/2 mutation identified. At locations with genetic providers versus those without, there was a significant difference in rates of genetic consultation (p=0.02) but not in the rate of germline testing (p=0.3). This indicates patients were more likely to receive pre- and post-test counseling at clinics offering in-house genetic consultations. Conclusions: Most individuals who had a P/LP somatic BRCA1/2 mutation identified on TMP underwent germline genetic testing. As 60.2% of our cohort qualified independently for germline testing, somatic BRCA1/2results may not have been the driving force behind germline testing. However, individuals who had a non- BRCA1/2-spectrum tumor were significantly less likely to have the recommended confirmatory germline testing. Quality improvement initiatives can focus on improving rates of counseling and germline testing for patients with somatic BRCA1/2 mutations, regardless of tumor type.[Table: see text]
Bone marrow procedures are a common diagnostic tool utilized in hematology/oncology and can be completed in the office by trained clinicians. Currently, there are limited guidelines for appropriate training and competency for bone marrow procedures performed by advanced practice providers (APPs) in a community oncology practice setting. The need to create a standardized training and competency protocol for APPs in this setting was recognized. A comprehensive, standardized educational and procedural toolkit was created. The creation of a comprehensive training toolkit for APPs in the community oncology practice setting helps to ensure a high standard of procedural proficiency and consistency among individual providers and practices. The creation of such an extensive toolkit is time consuming. By adopting and standardizing toolkits such as this one, community hematology/oncology practices can ensure the delivery of high-quality patient care by highly trained and proficient APPs.
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