Oral chemotherapy agents present new challenges as the regimens can be complex and patients may not be monitored as frequently as those receiving intravenous chemotherapy. 19% of our centre’s patients receive oral chemotherapy agents. Pazopanib is an oral agent that has been PBS approved since 2012 for use in the treatment of advanced and/or metastatic renal cell carcinoma. Following an adverse event an audit was undertaken to assess adherence to toxicity monitoring. Adherence to NSW cancer Institute eviQ guidelines and ASCO Chemotherapy Administration Safety Standards was assessed. The notes of all patients who received pazopanib between March 2012 and June 2014 were auditted. 13 patients and 87 clinic reviews were reviewed.
69% of patients were female. The median age was 60 years (38-77). The mean duration of treatment was 5.2 months (1 – 12 months) with 6 patients still receiving pazopanib at the time of analysis. Pazopanib was ceased in 2 patients following hepatic toxicity and in 5 patients after disease progression. Baseline investigations had been completed as follows; ECG for QTC prolongation 0%, blood pressure 69%, urinanalysis for proteinuria 0%, routine bloods including liver function 100%, thyroid function 69%. Analysis of follow-up reviews revealed blood pressure was assessed at least once in 85% of patients and in 59% of reviews. 0% had an ECG, urinanalysis or echocardiogram at any point. Thyroid function was assessed at least once throughout treatment in 69% of patients however in only 17% of all clinic reviews. There was poor compliance with ASCO monitoring recommendations; of reviewing current medication and allergies at each review, with 54% patients taking interacting or contraindicated medication.
Monitoring of hypertension, proteinuria and QTC prolongation can be improved. Drug interactions occur commonly and may have contributed to an adverse outcome in one of our patients. Current medication and allergies should be assessed at every review appointment.