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Introduction
From 27–29 September 2012, the European Society of Oncology Pharmacy (ESOP) held its first annual European Conference of Oncology Pharmacy (ECOP) in Budapest, Hungary. The meeting attracted more than 500 participants, drawn mainly from Europe—a total of 49 countries. The 10 most represented countries were Germany, Hungary, Austria, Italy, France, China, Spain, the UK, The Netherlands and Greece.
Keynote lecture
The conference began with a keynote lecture on personalised anticancer therapy from Professor Martine J Piccart-Gebhart, former President of the European Organisation for Research and Treatment of Cancer, and President-Elect of the European CanCer Organisation.
Over the past decade, the complete sequencing of the human genome and the development of high-throughput processing methods have significantly advanced our ability to identify molecular alterations in individual cancers. These technological and biological discoveries, however, have not produced the same advances in cancer treatment.
In 2004, the translational research network of the Breast International Group launched a new research programme, with the objective of improving the tools used to evaluate the prognosis of breast cancer. Results showed that different gene expression prognostic signatures had similar prognostic performance if not higher than currently used risk-assessment tools, e.g. Adjuvant! Online [1].
The challenge for women who need treatment because of their high risk of relapse is selecting the best treatment at an individual level. In an attempt to generate level I evidence on the utility of the 70-gene classifier MammaPrint in routine clinical practice, the MINDACT trial [2] has recruited more than 6,600 participants, with final results to be published soon.
Targeted drugs’ use could be optimised in the future by changing their clinical development: moving from initial activity demonstrated in unselected patients with advanced refractory disease, and subsequent retrospective biomarker discovery and validation in adjuvant therapy, to the discovery and validation of predictive biomarkers into earlier phases of drug development in neoadjuvant therapy, e.g. NeoBIG programme [3].
Professor Dr Dieter K Hossfeld, former President of the Federation of European Cancer Societies and the European Society for Medical Oncology, spoke about his personal experience of the field of medical oncology, which has spanned 50 years. His career began in the 1960s, when a diagnosis of cancer was hardly mentioned to the patient, and few, if any, cytotoxic drugs were available.
By the 1980s, many chemotherapy drugs had been discovered, with the growing hope that cancer could be defeated. Despite good results being achieved in child leukaemia, the reality is that we still struggle to cure all cancers. A new era has arisen with targeted therapies: future challenges are to personalise anticancer drugs to the tumour and also to the patient.
ECOP 2012 Scientific Programme
To cater for the educational needs of all participants, the ECOP 2012 Scientific Programme was divided into two separate tracks: clinical and practical. The conference has been granted recognition for continuous medical education by the Accreditation Council of Oncology in Europe and the EU of Medical specialists/European Accreditation Council for Continuing Medical Education.
Clinical track
One of the clinical sessions was dedicated to oral chemotherapy. This topic presents a major challenge to healthcare professionals in treatment adherence and self-management of side effects. Oncology pharmacists have the opportunity to play a crucial role in patient education programmes, provided that they can demonstrate adequate training in particular communication skills.
Dr Debbie Wright presented the clinical experience of oral chemotherapy at Southampton Oncology Centre, and Professor Ulrich Jaehde showcased positive results of oral chemotherapy adherence of pharmacist-led interventions.
Another clinical session provided insights into the innovative roles and responsibilities of pharmacists within the healthcare team. One example, discussed by Ms Fiona MacLean, is the extended prescribing rights given to oncology pharmacists in the UK. Dr Klaus Ruberg paid tribute to the pivotal role that community pharmacists play in the continuity of patient care, and elaborated on the German programme under way.
Pharmacovigilance is also increasingly considered essential to patient safety, and recent European guidance was detailed by Ms Doris Haider.
In recent years, the rising cost of oncology drugs has caused significant concern among government and healthcare agencies, healthcare providers and patients. Consequently, more sophisticated measures are being used by healthcare systems to address this. For oncology pharmacists, this has resulted in greater decision-making responsibility, e.g. in patient access schemes and health technology assessment. The oncology pharmacist’s role in accessing new high-cost cancer drugs was discussed in a special session involving European experts from Italy (Dr Andrea Messori), Spain (Dr Ana Estela Clopes) and the UK (Ms Jackie Turner).
Practical track
The practical track included an in-depth discussion of physico-chemical stability issues in cytotoxic drugs and monoclonal antibodies, drawing on the work of French experts, Professor Alain Astier and Dr Jean Vigneron; results of stability studies were presented either as oral communications or posters.
New data were presented on eribulin, bortezomib for SC injection, or rituximab stability in conjunction with pneumatic conveying systems. A debate-based session on dose banding gave specialists in the field of chemotherapy preparation and dose banding the opportunity to present their case in favour of or against dose banding in an attempt to convince the audience.
Professor Graham Sewell, worldwide recognised expert in dose banding; and Professor Etienne Chatelut, who presented pharmacokinetic data, were challenged by Professor Christian Dittrich and Mr Klaus Meier. Although practical feasibility evidence and pharmacokinetic results support the dose banding approach, clinical data are still needed before rolling it out to clinical practice.
The oncology pharmacist plays a central role in optimising the preparation processes and endorsing adequate procedures, e.g. safe handling. This topic was discussed in a ‘Meet the Experts’ session with Professor Robert M Mader, Mr Thomas Hinrichs and Ms Ewelina Korczowska.
Progress made in the last decade has led to new standards being set in the handling of cytotoxic agents. These improvements were based on (1) a deeper understanding of the critical steps in the handling procedure workflow; and (2) technical developments of devices that help improve the safe handling of anti-neoplastic agents.
In parallel, several monitoring studies have helped to identify weak points in our system, and stress the relevance of ongoing research in this field. Preparation robots are among the new technologies recently introduced to the field of chemotherapy preparation. Advantages of this new technology include less staff exposure to cytotoxic drugs, and the potential diversion of human resource to other activities.
Among the experts presenting on developments in automation were Dr Robert Terkola, who talked about PharmaHelp, and Professor Vagn H Handlos, who focused on Cytocare robots. The Best Poster Award was granted to Dr Bénigne Gandré from Professor Irene Krämer’s team, on his work on cytotoxic surface contamination in a robotic system compared with compounding. More than 80 posters (over 123 submitted) were presented at ECOP on practical, clinical or research studies; abstracts were highlighted as oral communications or poster discussion forums.
The role of the oncology pharmacist has expanded in recent years to include the analysis of error medication and prevention. Contributors to this topic included Ms Doris Haider and Ms Stravoula Kitiri. Dr Roman Gonec also presented how radio-frequency identification technology can help secure preparation and administration of chemotherapy.
Closing session
At the closing session, Dr Gabor Pogany, President of HUFERDIS (Hungarian Federation of People with Rare and Congenital Diseases), on behalf of Professor Louis Denis from Europa Uomo, shared some patient expectations from oncology pharmacy. Along with our duties in preventing medication errors and drug interactions, quality control, and preparation of prescription drugs, patients would like pharmacists to feel responsible for the information, education and counselling of cancer patients, as they would expect from the medical and nursing community.
Klaus Meier Award
Finally, a lifetime achievement award was offered to Mr Klaus Meier, President and Founder of ESOP.
In recognition of an ESOP member who has made a significant or sustained contribution to oncology pharmacy practice, it was announced that a ‘Klaus Meier’ Award would be created and granted at the next ECOP meeting in 2014. I encourage you all to attend.
Special thanks to ECOP 2012 Scientific Programme Committee
Mikael Daouphars (France), Chair
Alain Astier (France)
Ahmet Bosnak (Turkey)
Mirjam Crul (The Netherlands)
Fiona Fenech (Malta)
Per Hartvig-Honoré (Denmark)
László Horváth (Hungary)
Klaus Meier (Germany)
Adrián Munilla (Spain)
Irena Netikova (Czech Republic)
Vesna Pavlica (Croatia)
Ioanna Saratsiotou (Greece)
Bogumila Julia Sobkowiak (Poland)
András Sule (Hungary)
Robert Terkola (Austria)
Stavroula Theophanous-Kitiri (Cyprus)
David Thomson (United Kingdom)
Marta Trojniak (Italy)
This short overview of ECOP 2012 will be covered more extensively in future issues of EJOP, as the editorial office has invited some authors to present a report article, so that ESOP members who could unfortunately not be present at this special event, can nonetheless benefit from the information. ECOP Best Poster Award winners will present their work in future EJOP issues. Other ECOP authors are of course welcome to submit their results to EJOP editorial committee.
Author
Mikael Daouphars, PharmD, PhD
Pharmacy
Cancer Centre Henri Becquerel
1 rue d’Amiens
FR-76000 Rouen, France
References
1. Buyse M, Loi S, van’t Veer L, Viale G, Delorenzi M, Glas AM, d’Assignies MS, Bergh J, Lidereau R, Ellis P, Harris A, Bogaerts J, Therasse P, Floore A, Amakrane M, Piette F, Rutgers E, Sotiriou C, Cardoso F, Piccart MJ; TRANSBIG Consortium. Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 2006;98(17):1183-92.
2. Rutgers E, Piccart-Gebhart MJ, Bogaerts J, Delaloge S, Veer LV, Rubio IT, Viale G, Thompson AM, Passalacqua R, Nitz U, Vindevoghel A, Pierga JY, Ravdin PM, Werutsky G, Cardoso F. The EORTC 10041/BIG 03–04 MINDACT trial is feasible: results of the pilot phase. Eur J Cancer. 2011;47(18):2742-9.
3. Metzger-Filho O, de Azambuja E. Neoadjuvant chemotherapy and targeted therapies: a promising strategy. J Natl Cancer Inst Monogr. 2011;(43):116-9.
