The future of oncology pharmacy: European Conference of Oncology Pharmacy 2018 The way we treat cancer is changing. Scientific and technological advances such as tumour profiling, ‘big data,’ and an increasing number of targeted therapies and combination regimens will result in a paradigm shift away from a ‘one-size-fits-all’ concept toward personalized, on-demand, precision medicine, which will result in smaller, more defined patient populations. In parallel, the global incidence of cancer is rising, which is placing an increasing strain on medical oncology centres, and driving the evolution of oncology pharmacy. Clinical pharmacists can reduce the pressures on other healthcare resources by taking an increased role in patient care and providing a broader range of services. Pharmacists recognize that technological developments will lead to significant changes in pharmacy services, which will require greater integration with other services within the healthcare system. Members of the European Society of Oncology Pharmacy (ESOP) met at the 4th European Conference of Oncology Pharmacy (ECOP) meeting in October 2018 for a symposium entitled The Future of Oncology Pharmacy 2025. This review summarizes several topics discussed at the meeting, including the future of medicine, oncology and pharmacy healthcare, provides an update on ESOP activities and presents the ECOP 2018 resolution. This position statement outlines the ESOP perspective on how oncology pharmacy will change over the next decade, and how it will respond to these changes to support oncology pharmacists and achieve better outcomes for patients with cancer.

Simulation to assess intelligent video camera system's actual production performance during chemotherapy preparation Introduction: DRUGCAM is a new approach to control the chemotherapy preparations with an intelligent video system to assist the pharmacy technician during compounding process. This tool is able to control all of our production (except for colored and dark anticancer drugs) with an in-process control and a posteriori inspection. We first aimed to estimate DRUGCAM's performance in real-life production by simulation and to compare it with the double human control. Furthermore, factors influencing the performance of both controls were observed and preventive solutions will be envisaged to optimize our activity. Equipment and methods: Each day during 30 days, between 11:30 AM and 12:30 AM, we controlled 20 different volumes contained in syringes, in real production conditions (clean room) both by human visual inspection then by automated video control. Working conditions have been observed and tasks disturbances and interruptions have been noted. A set of information has been collected: the syringe's model, the volume of product and the disturbances. A statistical analysis has been conducted to interpret results. Results: With 24 errors throughout the 600 volume controls, the error rate for the visual human control is 4%. Seven checked volumes were superior to the expected volume (overdosing) and 17 were inferior (underdosing). The error rate for DRUGCAM is 0.17%. Among the disturbance factors, the type of syringe used is responsible for errors: 13 errors have been noticed with the 1 mL syringe and 8 errors with the 10 mL syringe which represent higher error rates than with the other syringes. The “permanent” staff members of the unit present an error rate of 5.3%, more important than the “non-permanent” ones (1.8%). More mistakes are done in the presence of a pharmacist than in its absence (13% against 4%). Conclusion: Our studies justify the superiority of the DRUGCAM system toward double human control. Moreover, the double human control could possibly be disturbed by external factors whereas DRUGCAM is not. Using DRUGCAM is to be considered to establish preventive measures and reduce tasks interruptions or disturbance factors thanks to video analysis.

Chemotherapy supply chain safety: current data from public oncology centers in Morocco Introduction: Since 2006, Morocco has been involved in care development for cancer patients, through regionalization of oncology centers, setting up of a program for cancer prevention, control, and treatment, finally by ensuring the quality of treatment. Chemotherapy is a risk-complexed process because of involving many health professionals. Our objective is to focus on the current state of public oncology hospitals and evaluate the chemotherapy process. Methods: An anonymous questionnaire was sent to 12 public centers by e-mails. It contains 4 items that establish chemotherapy process starting by receiving and storage of anticancer drugs, pharmaceutical validation of therapeutic protocols, until the administration of chemotherapy as well as the management of medical waste and expired medications. Results: Results showed that public regional centers represent 58.4% of participating centers, and university hospital centers represent 41.6%. Three quarters (73.3%) of hospital pharmacies have enough and appropriate receiving space. Sixty percent of pharmacist did not do any training to receive anticancer drugs. Oncology treatment protocols received in 53.3% of hospitals are not computerized. Biological data for pharmaceutical validation are not available on chemotherapy protocol in 73% of cases. All participating centers in the study confirmed that they have subcontracting contracts with companies specialized in the management of expired anticancer drugs and chemotherapy waste. Conclusion: Our study has shown that much effort has been made concerning the provision of oncology centers in several regions of the kingdom, anticancer drugs compounding centralization, and establishment-quality procedures that accompanied the chemotherapy process.

Afatinib, an irreversible ErbB family blocker for the treatment of epidermal growth factor receptor mutation-positive non-small cell lung cancer Targeted inhibition of epidermal growth factor receptor (EGFR) signaling has emerged as the standard of care for EGFR mutation-positive non-small cell lung cancer (EGFRm+ NSCLC). Afatinib, an oral irreversible ErbB-family blocker, has been extensively studied in this context. Recent studies have highlighted the benefit and tolerability of afatinib treatment in patients with EGFRm+ advanced/metastatic NSCLC. The LUX-Lung 3 and 6 phase III studies showed greater efficacy with first-line afatinib compared with platinum-doublet chemotherapy, whereas LUX-Lung 7 highlighted the enhanced benefits of afatinib over the first-generation EGFR tyrosine kinase inhibitor (TKI), gefitinib. The nearly inevitable emergence of resistance to afatinib, coupled with recent data for the third-generation TKI osimertinib, highlight the need to identify an optimal treatment sequencing strategy to achieve long-term benefit and survival. The available data suggest that optimal treatment could involve first-line afatinib, followed by osimertinib upon acquired resistance to afatinib through the T790M mutation. This review discusses the pharmacology of afatinib, efficacy and safety results of key trials in the afatinib clinical study program, management of adverse events, and sequencing strategies following acquired resistance. Afatinib data are discussed in the context of recent studies of other EGFR TKIs, to provide considerations around their use and inform potential sequential treatment approaches.

Improving the safety of chemotherapy process by a risks management tool: Chemotherapy compounding in Oncology Center in Oujda (Morocco) Objectives: Chemotherapy compounding is a main step of chemotherapy cancer process. This step is formed by many parts. A multidisciplinary team is assembled to define critical points and failures linked to this process and proposed different actions to secure them and improve chemotherapy cancer process. Methodology: By a prospective analysis risks tool: the failure modes, effects, and criticality analysis (FMECA), anticancer drug process compounding was sequenced in many parts. During the brainstorming, different ideas expressed and were classified into an Ishikawa cause–effect diagram. The criticality indexes (CI) are calculated from occurrence, severity, and the detection probability. Results: The sum of CIs of 18 identified failure modes was CI = 3607 for the decentralized system and CI = 726 after the new organization of compounding process. The chemotherapy production step represents 37.17% (CI = 1341) of all failures in the old process. The greatest risk reductions between the old and the new process concerned the risk of ‘Double check missing before delivery to the ward’ by a factor reduction of 28.0). Among the CIs remaining superior to 100, there was one failure: ‘Typing error during prescription’ (CI = 144). Conclusion: Modification of the chemotherapy-compounding process by centralization, training program, and implementation of procedures resulted in an important risk reduction as shown by risk analysis. Our study illustrates the usefulness of risk analysis methods in the healthcare system. A systematic use of risk analysis is needed to improve the safety of high-risk activities in healthcare processes.