Presentation Details
| Perioperative Management of Systemic Cancer Therapies for Solid Organ and Hematologic Malignancies: Recommendations from the Emory University Systemic Therapies Perioperative Management Group Jennifer R Culley, Jonathan M Morris, Gaybrielle R Moore, Sara A Scott, Annalise E Labatut, Danielle E Rider, Shervin V Oskouei. Emory University School of Medicine, Atlanta, GA, USA |
Abstract
BACKGROUND: The use of novel drugs has changed the natural histories of many solid organ and hematologic cancers, and are associated with improved overall survival. Patients require surgery for both malignant and benign conditions while taking these medications. The new classes of medications include Antibody Drug Conjugates, T-cell engagers, Hormonal Therapies, Immune Checkpoint Inhibitors, Targeted Therapies, and Bone Modifying Agents.The purpose is to offer consensus peri-operative recommendations with regards to holding criteria and additional perioperative side effects that should be considered.
PURPOSE: A modified Delphi methodology was utilized by a multi-disciplinary committee composed of Board-Certified Oncology Pharmacists, Internists specializing in Perioperative Medicine, and Orthopedic Oncologists to review the side effect profiles and allow for consensus recommendations. The mechanism of action, side effect profile, and perioperative recommendations are presented for the 147 FDA-approved medications in the above classes of medications
RESULTS: Each of the new classes of medications presents its own side effect profile and plays a role in how the drug should be managed in the perioperative setting. The common rule to hold therapy for five half-lives perioperatively may not be clinically feasible nor always apply if there is a low likelihood that treatment-related adverse events could impact surgical outcomes The purpose was to offer consensus peri-operative recommendations with regards to holding criteria and additional perioperative side effects or additional preoperative testing that should be considered
CONCLUSIONS: Optimal medication management is integral to quality perioperative medical care. Serious consideration must be given to balancing risks of continuing medication perioperatively versus holding and interrupting necessary oncologic treatment. This information is meant to offer clinical guidance to oncology pharmacists, medical oncologists, perioperative internists, anesthesiologists, and surgeons treating patients who are actively taking or receiving these novel medications.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: A modified Delphi methodology was utilized by a multi-disciplinary committee composed of Board-Certified Oncology Pharmacists, Internists specializing in Perioperative Medicine, and Orthopedic Oncologists to review the side effect profiles and allow for consensus recommendations. The mechanism of action, side effect profile, and perioperative recommendations are presented for the 147 FDA-approved medications in the above classes of medications
RESULTS: Each of the new classes of medications presents its own side effect profile and plays a role in how the drug should be managed in the perioperative setting. The common rule to hold therapy for five half-lives perioperatively may not be clinically feasible nor always apply if there is a low likelihood that treatment-related adverse events could impact surgical outcomes The purpose was to offer consensus peri-operative recommendations with regards to holding criteria and additional perioperative side effects or additional preoperative testing that should be considered
CONCLUSIONS: Optimal medication management is integral to quality perioperative medical care. Serious consideration must be given to balancing risks of continuing medication perioperatively versus holding and interrupting necessary oncologic treatment. This information is meant to offer clinical guidance to oncology pharmacists, medical oncologists, perioperative internists, anesthesiologists, and surgeons treating patients who are actively taking or receiving these novel medications.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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