Drug assessment by a Pharmacy and Therapeutics committee: from drug selection criteria to use in clinical practice

Figures & data

Table 1 Indicator calculations

Drug and indications	Criteria for usea
Bevacizumab
Metastatic colorectal cancer	C1.1	C2.1	C3.1
	Life expectancy >3 monthsb	XELOX + bevacizumab	First-line
Metastatic breast cancer	C1.2	C2.2	C3.2	C4.2
	No brain metastasis	HER2-negative or prior treatment with trastuzumab	First-line	In combination
Non-small-cell lung cancer	C1.3	C2.3	C3.3	C4.3	C5.3	C6.3
	No squamous cells	Stage IIIB–IV	No brain metastasis	Cisplatin + gemcitabine + bevacizumab	First-line	No hemoptysis
Cetuximab
Colorectal cancer	C1.4	C2.4	C3.4	C4.4
	Metastasis	EGFR expression	Prior treatment with oxaliplatin or irinotecan	In combination with irinotecan
Locally advanced head and neck cancer	C1.5	C2.5
	Concomitant radiotherapy	Not eligible for treatment with cisplatinc
Trastuzumab
Early breast cancer	C1.6	C2.6	C3.6	C4.6
	HER2 3+	After: surgery, adjuvant or neoadjuvant chemotherapy or radiotherapy	Carboplatin + docetaxel + trastuzumab	Treatment duration 1 year
Metastatic breast cancer	C1.7	C2.7
	HER2 3+	Monotherapy, with docetaxel or paclitaxel or aromatase inhibitor
Bortezomib
Multiple myeloma	C1.8	C2.8
	Relapsing or refractory	Prior treatment

Notes:

a Each indication for each drug is designated a code, which is further subdivided according to the criteria set out by the Cabueñes Hospital Pharmacy and Therapeutics Committee. For each criterion, a score (yes =1; no =0) is given; scores are totaled to calculate the compliance with Pharmacy and Therapeutics committee criteria

b Karnofsky score ≥50³³ was used to determine life expectancy >3 months

c patients who had a history of renal failure, hearing problems, or cardiovascular disease were considered ineligible for treatment with cisplatin.

Abbreviations: EGFR, epidermal growth factor receptor; HER2, human epidermal growth factor receptor 2; XELOX, capecitabine + oxaliplatin.

Table 2 Drugs requested for inclusion in hospital formulary

Year	Drug (therapeutic groupa)
	Not included n=8 (20%)	Included n=32 (80.0%)
		With criteria for use n=28 (87.5%)	Without criteria for use n=4 (12.5%)
May 2007 to April 2008	Eplerenone (C03DA)	Glutamine (B05XB)	Clonidine (C02AC)
	Botulinum toxin type B (M03AX)	Bortezomib (L01XX)b	Levetiracetam (N03AX)
	Bemiparin (B01AB)	Entecavir (J05AF)	Olanzapine (N05AH)
		Aprepitant (A04AD)	Ranibizumab (S01LA)
		Gadobutrol (V08CA)
		Emtricitabine/tenofovir (J05AR)
		Trastuzumab (L01XC)b
		Cetuximab (L01XC)b
		Eptacog alfa (B02BD)
		Bevacizumab (L01XC)b
May 2008 to April 2009	Ibandronic acid (M05BA)	Fosfomycin-trometamol (J01XX)
	Insulin analogs (aspart, glulisine and detemir) (A10A)	Chlorthalidone (C03BA)
		Esmolol (C07AB)
		Nitrous oxide/oxygen (N01AX)
		Linezolid (J01XX)
		Pegfilgrastim (L03AA)
		Abatacept (L04AA)
		Emtricitabine/tenofovir/efavirenz (J05AR)
		Zoledronic acid-osteoporosis (M05BA)
May 2009 to April 2010	Levobupivacaine (N01BB)	Natalizumab (L04AA)
	Purified botulinum toxin type A (M03AX)	Sulpur hexafluoride (V08DA)
	Zoledronic acid-bone metastases (M05BA)	Thyrotropin alfa (V04CJ)
		Fosamprenavir (J05AE)
		Voriconazole (J02AC)
		Caspofungin (J02AX)
		Mifepristone (G03XB)
		Misoprostol (G02AD)
		Procainamide (C01BA)

Notes:

a Drug codes according to the Anatomical Therapeutic Chemical classification system.

b Drugs that were considered in the current study.

Figure 1 Indicator scores for the degree of compliance of prescriptions for cancer drugs with criteria for use.

Notes: The black horizontal line shows the percentage of patients who fulfilled all the criteria. “Mean” refers to the mean score for patients treated with each drug in each clinical indication based on the scores in compliance with Cabueñes Hospital Pharmacy and Therapeutics Committee criteria.

Table 3 Patient baseline characteristics

n	Bortezomib	Cetuximab		Trastuzumab		Bevacizumab
	62	35		78		112
	Multiple myeloma	Head and neck cancer	Colorectal cancer	Early breast cancer	Metastatic breast cancer	Non-small-cell lung cancer	Metastatic colorectal cancer	Metastatic breast cancer
Patients n (%)	62 (21.6)	10 (3.5)	25 (8.7)	41 (14.3)	37 (12.9)	48 (16.7)	57 (19.9)	7 (2.4)
Age mean (SD)	67.7 (8.9)	57.3 (9.3)	61.9 (12.2)	55.7 (11.1)	60.3 (12.6)	60.8 (8.0)	62.6 (9.6)	60.4 (12.4)
Sex
Male n (%)	37 (59.7)	8 (80.0)	17 (68.0)	0 (0.0)	1 (2.7)	39 (81.2)	33 (57.9)	0 (0.0)
Female n (%)	25 (40.3)	2 (20.0)	8 (32.0)	41 (100.0)	36 (97.3)	9 (18.8)	24 (42.1)	7 (100)
Stage: n
I		1		10
IB						1
II		1
IIA				11
IIB				5		1		1
III		3	2				1
IIIA				11		9	1
IIIB				4		11	1
IV		5	23		37	26	53	6
Unknown	13						1
ISS-I	10
ISS-II	17
ISS-III	22
PS (ECOG) n
0		7	11	38	14	30	34	3
1		3	10	1	12	16	23	4
2			2	1	10	1
Unknown			2	1	1	1

Abbreviations: ISS, International Staging System; PS, performance status (no data collected for multiple myeloma); ECOG, Eastern Cooperative Oncology Group.

ReubenDBMorVHirisJClinical symptoms and length of survival in patients with terminal cancerArch Intern Med19881487158615913382303

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