eGFR Adoption in Oncology Will Take Teamwork Across Disciplines, More Education, and New Trial Data

In this National Kidney Foundation (NKF) panel, Andrew Bzowyckyj, PharmD, BCPS, CDCES, senior scientific director and learning consultant at NKF, is joined by 2 clinical pharmacists:

• Angie Maynard, PharmD, MS, BCOP, assistant professor at the Lipscomb University College of Pharmacy and Health Sciences in Nashville, Tennessee;
• and Rachel Pokorny, PharmD, BCPS, BCOP, clinical pharmacy specialist in neuro-oncology and the director of the PGY2 oncology pharmacy residency program at Vanderbilt University Medical Center in Nashville, Tennessee.

In the final part the 3 experts explain how oncology pharmacists can work more closely with nephrology during the shift from Cockcroft-Gault to estimated glomerular filtration rate (eGFR). Pokorny called for multidisciplinary working groups to write institutional guidelines on race-free eGFR in hematology/oncology practice. Those guidelines should also cover what to do when different methods give conflicting results. She suggested that these groups should include pharmacy, nephrology, physicians in hematology, oncology, and stem cell transplant, pediatric hematology/oncology specialists, and informatics specialists from the start.

Pokorny also said education and awareness remain the biggest needs, because health care professionals trained on Cockcroft-Gault will need to change both their practice and their thinking. She urged oncology pharmacists to follow the evolving evidence. She also encouraged them to speak up in departmental, policy, and pharmacy and therapeutics meetings to help shape how the change is put into practice. That includes how electronic health record builds should handle patients whose kidney function changes. Bzowyckyj noted that the NKF work group’s recommendations apply only to adults and called pediatric dosing guidance the next major hurdle. He also pointed to the non–US International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction as a useful source of supporting literature.

To finish, Maynard asked drug companies to use the newer equations in oncology clinical trials so health care professionals can feel more confident about outcomes. Pokorny said national consensus statements from organizations such as the National Comprehensive Cancer Network or American Society of Clinical Oncology could help make adoption more uniform. Bzowyckyj encouraged researchers to go beyond studies that only show the equations produce different doses. He called for studies that link dosing to drug concentrations and therapeutic outcomes, which would give pharmacists the safety data they need to make the switch.

Learn more about the National Kidney Foundation at kidney.org and at this link.