Impact of Pharmacist Outpatient Interventions on Management of Lenvatinib for Thyroid Cancer Patients

Background: In the SELECT trial, incidence of Lenvatinib (LEN) temporary discontinuation or dose reduction was 93.3% in Japanese population, therefore, management of adverse drug reaction is important in LEN oral chemotherapy. Medical oncologists and pharmacists at the National Cancer Center Hospital East established integrated support system for LEN oral chemotherapy using a comprehensive pharmacist outpatient intervention (POI), which a pharmacist contacted to patients before Medical oncologist's clinical examination and explained patient's treatment for patients after the examination, and pharmacist's telephone follow-up intervention (TFI).Objective: We evaluated impact of the pharmacist integrated intervention on management of LEN.Method: We retrospectively evaluated thyroid cancer patients who received a LEN between May 2015 and December 2015. We excluded patients who already have received LEN in clinical trials. We classify pharmacist POIs and TFIs into two categories, level (Lv) 1: pharmacist interventions which needed oncologist's decision but no treatment changes and Lv 2: pharmacist intervention which changed patient's medication according to oncologist's confirmation.Results: During the study period, there were 45 LEN interruption events in 11 patients. There were total 40 pharmacist POIs: Lv 1 was 2 (5%) and Lv 2 was 38 (95%). Of 38 Lv2 intervention, 24 interventions were related with hypertension due to LEN. There were total 17 pharmacist TFIs: Lv 1 was 3 interventions (18%) and Lv 2 was 14 interventions (82%). In the total 17 interventions, Lv 2 interventions was only one intervention was for hypertension and there were various adverse drug reactions due to LEN.Conclusion: Incidence of Lv 2 was 80-90% both in POIs and TFIs, and most interventions were related with hypertension due to LEN. The study clarified that pharmacist outpatient interventions, such as POIs and TFIs, were effective to manage hypertension due to LEN. Background: In the SELECT trial, incidence of Lenvatinib (LEN) temporary discontinuation or dose reduction was 93.3% in Japanese population, therefore, management of adverse drug reaction is important in LEN oral chemotherapy. Medical oncologists and pharmacists at the National Cancer Center Hospital East established integrated support system for LEN oral chemotherapy using a comprehensive pharmacist outpatient intervention (POI), which a pharmacist contacted to patients before Medical oncologist's clinical examination and explained patient's treatment for patients after the examination, and pharmacist's telephone follow-up intervention (TFI). Objective: We evaluated impact of the pharmacist integrated intervention on management of LEN. Method: We retrospectively evaluated thyroid cancer patients who received a LEN between May 2015 and December 2015. We excluded patients who already have received LEN in clinical trials. We classify pharmacist POIs and TFIs into two categories, level (Lv) 1: pharmacist interventions which needed oncologist's decision but no treatment changes and Lv 2: pharmacist intervention which changed patient's medication according to oncologist's confirmation. Results: During the study period, there were 45 LEN interruption events in 11 patients. There were total 40 pharmacist POIs: Lv 1 was 2 (5%) and Lv 2 was 38 (95%). Of 38 Lv2 intervention, 24 interventions were related with hypertension due to LEN. There were total 17 pharmacist TFIs: Lv 1 was 3 interventions (18%) and Lv 2 was 14 interventions (82%). In the total 17 interventions, Lv 2 interventions was only one intervention was for hypertension and there were various adverse drug reactions due to LEN. Conclusion: Incidence of Lv 2 was 80-90% both in POIs and TFIs, and most interventions were related with hypertension due to LEN. The study clarified that pharmacist outpatient interventions, such as POIs and TFIs, were effective to manage hypertension due to LEN.