Streamlining bortezomib regimen: A quality improvement project for cost-effective and patient-friendly protocol.

Abstract

94 Background: Bortezomib is a novel first-in-class proteasome inhibitor and received it’s FDA approval with twice weekly dosing on day 1, 4, 8 and 11 of a 21-day cycle with weekly complete blood count (CBC). However, subsequent studies have shown that weekly dosing has equal drug efficacy. Our clinical practice at Feist-Weiller cancer center is to administer weekly subcutaneous bortezomib injection after reviewing the CBC. Objective: To analyze hematological toxicities with weekly bortezomib and assess the need for CBC prior to administration of bortezomib. Methods: A retrospective analysis of CBC results was done for every patient receiving bortezomib as part of bortezomib and dexamethasone +/- lenalidomide regimens in a 2-year period (2017-2018). The data extraction was done using Epic Clarity database using an SQL script which identified each treatment duration in minutes between check in and check out, Absolute neutrophil count (ANC) and platelet count on each treatment day. Results: A total of 38 patients received 626 treatment doses of bortezomib. The average patient stay between check-in and check-out was 227 mins. There was very low incidence of grade 3 thrombocytopenia (0.64%) and grade 3 neutropenia (0.32%). There is no evidence of grade 4 cytopenia’s or any dose changes from cytopenia’s. This data suggests that weekly lab monitoring may not be necessary prior to drug administration. Conclusions: Using this data, we have streamlined our approach for monitoring patients receiving weekly bortezomib. During weekly bortezomib administration, we propose to obtain a CBC on day 1 of every 4 weeks. If either platelet count is less than 75,000 /μl and ANC is less than 1000/μl on day 1, we will monitor labs weekly until count recovery. We believe that this new protocol may result in 75% reduction in the average patient stay for the treatment. It will reduce the need for phlebotomy and lab services. We believe that this change will improve patient satisfaction and an another step forward to efficient and safe patient care at our institute.