The Impact of Pharmacogenomics on Chemotherapeutic Drug Development and Use

Cancer therapy is largely dependent on general treatment guidelines, and patients undergoing chemotherapy often experience treatment failure with standard drugs. The development of individualized drug therapy through pharmacogenomics has the potential to enhance chemotherapy regimen selection and improve patient outcomes. Antineoplastic agents such as cetuximab and trastuzumab are effective in treating cancers possessing specific genetic biomarker characteristics. Patients need to undergo genetic testing before these agents are administered to ensure appropriate use. Cetuximab has been shown to improve outcomes in metastatic colorectal cancers and head and neck squamous cell carcinomas positive for EGFR. Trastuzumab has shown benefit in human epidermal growth factor receptor 2 (HER2) overexpressing cancers affecting the breast tissue and gastrointestinal tract. High costs associated with the development of targeted drugs and a lack of clinical studies exploring the effects genetic variations can have on drug therapy limit implementation of pharmacogenomics into routine practice. As drug therapy experts, pharmacists need to be aware of advances in the field of pharmacogenomics and facilitate the use of this new class of personalized drugs

Healthy People 2020: Identifying Roles for Pharmacists in Public Health

Healthy People, sponsored by the United States Department of Health and Human Services, utilizes evidence-based medicine to create objectives addressing significant preventable health issues. The vision of Healthy People is to improve the quality and length of life free from preventable disease, disability, injury and death. Based on objectives outlined by Healthy People 2020 (HP 2020) pharmacists can play a role in public awareness, collaborate with other health care professionals and help achieve goals set forth by HP 2020. Based on the expertise and accessibility of the pharmacist, pharmacists can impact nine of the 13 new focus areas pf HP 2020, including adolescent health, blood disorders and safety, dementias, early/middle childhood, global health, health care-associated infections, older adults, emergency preparedness, and sleep health. HP 2020 is now an Internet-accessible, user-friendly, interactive database, that can further enhance communication between patients and pharmacists. Pharmacists and student pharmacists can use the various tools and resources available to them to implement these health improvement priorities and realize the goals and objectives set forth by HP 2020

Impact of Community Pharmacists on Management of Cancer Chemotherapy and the Resulting Side Effects

The severe side effects of chemotherapy negatively affect quality of life and may limit the amount of life-saving drug delivered to patients with cancer. These adverse events can be difficult to manage and evidence-based guidelines are lacking. Insufficient supportive care can amplify common side effects, such as chemotherapy-induced nausea and vomiting (CINV), myelosuppression, alopecia, gastrointestinal effects and neuropathy. Therefore, it is important to recognize the most commonly dispensed chemotherapy agents and the side effects that accompany them. Community pharmacists, as easily accessible health care professionals, can provide valuable supportive care to help manage potentially debilitating side effects. However, a major limitation when managing side effects secondary to chemotherapy is the limited access to patient information in most community pharmacies. By allowing community pharmacists increased access to patient health records using technology, limitations experienced in practice can be averted and quality care provided

The Use of Crizotinib in Late Stage Lung Cancer Patients with an Abnormal ALK Gene

The relatively new anti-cancer drug, crizotinib (Xalkori®, Pfizer), has created excitement in the research community. This drug has exhibited dramatic clinical benefits for select non-small cell lung cancer patients showing evidence of a mutation in the EML4-ALK gene. This gene mutation is present in 4 to 5 percent of non-small cell lung cancer patients. Crizotinib acts through a tyrosine kinase inhibition pathway, targeting the ALK and MET tyrosine kinases, to inhibit phosphorylation of activated ALK, which halts the ALK gene mutation and impedes metastasis. In phase I clinical trials, a 57 percent overall response rate was shown, and researchers calculated that the six-month progression-free survival was 72 percent.1 Therefore, patients treated with crizotinib had an increased survival rate when compared to conventional chemotherapy. Although the success rate of crizotinib is high, the mutated ALK gene has been shown to develop resistance to it. However, the predicted impact of this drug is still promising

Role of Non-nutritive Sweeteners In Obesity and Diabetes

Artificial sweeteners have become a central component of the Western diet in order to facilitate weight loss and enhance glucose control. Despite their popularity, evidence supporting the benefits of artificial sweeteners remains contradictory; different trials have shown weight loss, weight gain or no change with artificial sweetener consumption. Multiple trials have correlated artificial sweetener usage, in the form of diet soda, with an increased risk of obesity, diabetes and/or metabolic syndrome. Hypotheses speculate that individuals who consume larger loads of artificial sweeteners may be more likely to make unhealthy lifestyle choices, putting them at an increased risk for the development of these disease states. Although the link between artificial sweeteners and developing obesity or diabetes remains unclear, it is important for the general public and health care professionals to be aware of this potential relationship in order to make educated decisions about the foods and beverages they consume

Fidaxomicin (Dificid®): New Antibiotic Approved for the Treatment of \u3ci\u3eClostridium difficile\u3c/i\u3e Infections

Clostridium difficile is a gram-positive, spore forming bacteria normally transmitted by the fecal-oral route. Infection develops in patients with decreased normal gut flora and is typically associated with recent antibiotic use. Other risk factors include bowel surgery, compromised immune system function, extended hospital stays, and other underlying diseases. C. difficile bacteria produce two toxins, which cause increased intestinal fluid secretion and inflammation. Patients commonly present with diarrhea, abdominal discomfort, loss of appetite, and nausea. Current treatment guidelines are to discontinue antimicrobial agents and increase hydration. Less severe C. difficile associated diarrhea (CDAD) cases are treated with metronidazole 500 mg three times daily for 10 to 14 days and more severe cases treated with vancomycin 125 mg four times daily for 10 to 14 days. Recently, the FDA announced approval of Dificid® (fidaxomicin) for treatment of CDAD. Fidaxomicin is currently dosed 200 mg twice daily for 10 to 14 days. Several studies have shown fidaxomicin is non-inferior to vancomycin in treatment of CDAD. For the purpose of this article, we will further investigate CDAD treatment guidelines and the effectiveness of fidaxomicin