Chronic lymphocytic leukemia (CLL) is a hematologic malignancy that has seen significant advances in care over the last 5 years with the approval of oral agents such as ibrutinib and venetoclax for the treatment of this disease. As such, there has been a substantial shift away from the traditional chemotherapy infusions which have allowed patients greater autonomy with oral cancer therapies. This paradigm shift poses new challenges for the medical team, including drug–drug interactions, adherence counseling, and financial toxicity. Pharmacists are uniquely trained and equipped to help to manage the changing landscape of CLL care. From identifying common medications which may impair ibrutinib clearance to ensuring patients are on the appropriate anti-infective prophylaxis while receiving obinutuzumab, pharmacists can play a vital role in ensuring the highest quality of patient care. Furthermore, additional credentialing of clinical pharmacists in select states allows for independent visits with the pharmacists, allowing for greater involvement, particularly for initiation of venetoclax and management of ibrutinib-induced toxicities. Pharmacists are essential to both expanding and enhancing the care of patients with CLL and should be leveraged to improve patient outcomes whenever possible.

HER2 mutations have been identified as potential mechanisms of resistance to EGFR-directed therapies in patients with advanced or metastatic NSCLC. Here, we report the case of a 65-year-old female with metastatic, EGFR exon 19-mutant NSCLC initially treated with first-line osimertinib. After several subsequent lines of treatment including erlotinib and carboplatin+pemetrexed+osimertinib, repeat genetic sequencing identified a HER2 exon 20 insertion (A775_G776insYVMA) in both blood and tissue. She was treated using fam-trastuzumab-deruxtecan, which resulted in a disease response lasting for 8 months. This report represents the first published case detailing the safety and efficacy of a combination fam-trastuzumab-deruxtecan and osimertinib in a patient with NSCLC and HER2-mutated resistance after EGFR-targeted therapy. The findings from this report suggest that fam-trastuzumab-deruxtecan can be safely given in combination with osimertinib and should be considered as subsequent-line therapy for patients who progress on osimertinib and develop a HER2 resistance mutation.

Concept maps are graphical representations of how various concepts relate to one another. Assessment of concept maps developed by students in the pharmacy curriculum helps to evaluate student understanding of course material. However, providing feedback on concept maps can be time-consuming and often requires the grader to be a content expert. The purpose of this study was to develop and validate a software program to provide students with feedback on their concept map performance. Student maps for four different disease states were compared against expert concept maps. The analysis of the program compared favorably to a manual assessment of student maps for the maps’ complexity and content but did not correlate for their organization. The value of using a software program to quickly and efficiently analyze concept maps is discussed.

Historically, systemic therapy for resectable non-small cell lung cancer (NSCLC) has been associated with a modest impact on overall survival. The current treatment options for early-stage resectable NSCLC include neoadjuvant, adjuvant, and perioperative immunotherapy in combination with chemotherapy. In this review, we explore the current treatment paradigms and emerging opportunities for improved survival outcomes from using immunotherapeutic approaches in the treatment of early-stage resectable NSCLC. The incorporation of immunotherapy into neoadjuvant, adjuvant, and perioperative treatment of surgically resectable NSCLC has yielded improved outcomes beyond chemotherapy-alone approaches. Despite this, there remains a margin for improving survival outcomes for patients. Clinical trials utilizing novel agents and approaches that modulate the anti-tumor immune response are currently ongoing and will likely inform the future treatment landscape for early-stage surgically resectable NSCLC.

Introduction: Osimertinib is a common treatment for epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). EGFR inhibitors, such as osimertinib, are known to cause cutaneous toxicities including acneiform rash, paronychia, dry skin, and rarely urticaria. For patients with severe reactions that need osimertinib rechallenge, they can undergo a complex desensitization with serial drug dilutions. Case report: We describe a case of osimertinib-related severe urticaria in a 47-year-old male with EGFR-mutated NSCLC. Ten days after initiation of osimertinib, the patient developed diffuse urticaria that was refractory to systemic corticosteroids. He was subsequently switched to erlotinib, which was discontinued due to a severe acneiform rash. It was decided to rechallenge with osimertinib. Management and Outcome: Osimertinib rechallenged using intensive urticaria prophylaxis with a regimen of loratadine, famotidine, and montelukast. The patient was slowly titrated off each agent and at the time of this report, the patient continues with loratadine twice daily and has remained on osimertinib for more than three years without recurrence of urticaria. Discussion: Although cutaneous toxicities are well described with osimertinib, management of severe urticaria utilizes complex desensitization or drug discontinuation. This case may represent a more pragmatic approach to osimertinib rechallenge that may be implemented for select patients.