Rareful readers of P&T know that I have tackled the issue of the relationship between academic medicine and the pharmaceutical industry before. Although my editorial, “Seeking Middle Ground” (P&T, February 2004), laid the framework for this relationship, it did not offer specific guidance. I hope to accomplish aspects of that mission in this editorial.
It seems paradoxical that the federal agency that administers Medicare would refuse to fund advanced pharmacist clinical education less than a year before the new Medicare drug benefit goes into effect, but that is the position of the Centers for Medicare & Medicaid Services (CMS). Once again, the agency is saying—by virtue of its silence—that it will not kick in money for second-year hospital pharmacy residency programs in areas such as oncology, primary care, geriatrics, and infectious diseases, to name a few possibilities.
Problem: The Institute for Safe Medication Practices (ISMP) has received several reports in which patients were given undiluted intravenous (IV) epinephrine 1:1,000 (1 mg/ml) instead of the 1:10,000 (0.1 mg/ml) concentration. In each case, the more diluted epinephrine (1:10,000) was available for use, but the staff inadvertently prescribed or selected the 1:1,000 concentration.
Speaker: Norman Wolmark, MD, Chairman and Professor, Department of Human Oncology, Drexel University College of Medicine and Allegheny Cancer Center, and Chairman of the National Surgical Adjuvant Breast and Bowel Project.
The addition of oxaliplatin (Eloxatin®, Sanofi-Aventis) to standard fluorouracil (5-FU) (Efudex®, Roche)/leucovorin (LV) (Wellcovorin®, Immunex) therapy (FULV) significantly improved three-year disease-free survival in patients with early-stage colorectal cancer, markedly reducing the risk of disease recurrence by 21%.
Speaker: John Kirkwood, Professor of Medicine and Director, the Melanoma Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Long-term follow-up results for a minimum of 24 months demonstrated that adding oblimersen sodium (Genasense®, Genta), also called Bcl-2 antisense, to dacarbazine (DTIC-Dome®, Bayer)—the only chemotherapy agent approved for the treatment of advanced melanoma—achieved a significant increase in “durable” responses (lasting longer than six months) and a near-significant trend toward increased survival, when compared with dacarbazine alone in patients with this cancer.
Speaker: Adam Brufsky, MD, PhD, Co-Director, Magee Women’s Hospital/University of Pittsburgh Cancer Institute, Comprehensive Breast Cancer Center, and Assistant Professor of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
“Up-front” zolendronic acid (Zometa®, Novartis), an intravenous (IV) bisphosphonate, when given with adjuvant letrozole (Generic Femara, Novartis) therapy, was able to inhibit bone loss in postmenopausal women with early breast cancer. At 12 months, bone mineral density (BMD) was significantly increased in patients receiving this regimen, compared with patients who received the aromatase inhibitor letrozole canadian and delayed zolendronic acid.
Anastrozole in Localized Breast Cancer
Speaker: David Cella, PhD, Director of Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare, and Professor, Northwestern University Medical School, Evanston, Illinois.
A five-year quality-of-life (QOL) follow-up study of adjuvant endocrine therapy for postmenopausal women with early breast cancer in the Arimidex or Tamoxifen Alone or in Combination (ATAC) trial demonstrated the superiority of anastrozole (Arimidex drug, AstraZeneca) over tamoxifen (Generic Nolvadex, AstraZeneca) without a detrimental impact on overall QOL. Findings were reported in the ATAC Completed Treatment Analysis (CTA).