Topic Thread

glucarpidase (VORAXAZE)

  • 1.  glucarpidase (VORAXAZE)

    Posted 8 days ago
    ​Hi,

    We're getting hit hard by the rep for glucarpidase (Voraxaze) lately.  Our hospital does NOT frequently administer high dose MTX so it was not a medication I'm familiar with.  I was asked to review it's value for P&T, given its high cost.  However, when I'm looking into it more, it appears that it was approved in 2012... Does anyone know why there is so much marketing for it right now?
    And I have a couple questions for the group:
    (1) Do you routinely stock glucarpidase?
    (2) Does your center administer high dose MTX frequently?

    Thanks in advance!

    ------------------------------
    Krissy Vaden Tuttle, PharmD, BCOP
    Oncology Clinical Specialist
    Overlake Hospital
    Bellevue, WA
    Kristine.Tuttle@OverlakeHospital.org
    ------------------------------


  • 2.  RE: glucarpidase (VORAXAZE)

    Posted 7 days ago

    Hi Krissy,

    Hello from Sydney, Australia!

    We have had one instance in the last 12 months where we had to obtain Glucarpidase for a sarcoma patient who was administered high dose Mtx and whose levels were not going down despite folinic acid rescue (we have at least 1-2 high dose mtx patients per week). We eventually received permission by our hospital executives for funding of drug (cost is $22,000 AUD for this dose) to obtain this.

    However the process in Australia is slightly different - we do not purchase stock directly via our regular wholesaler or from the drug company (despite their head office being based in Sydney). We have to contact the Peter MacCallum Cancer Centre (PMCC) in Melbourne (whose Pharmacy department hold stock and dispatch this to hospitals that require this within 24-48 hours. Note that in the event of requiring Glucarpidase out of normal business hours, their on-call pharmacist is able to facilitate this as well).

    We were able to borrow stock from a major paediatric hospital in Sydney so that we were able to treat the patient sooner and then replace the hospital with the stock ordered from PMCC, which arrived the following day.

    I have been working in oncology/haematology pharmacy for over ten years and it was the first time we have had to use Glucarpidase. Unless your hospital have high incidences of mtx toxicity refractory to leucovorin rescue, and if the procurement process of glucarpidase is more than 24 hours it may be a financial risk to keep stock on hand.

    Hope that helps!



    ------------------------------
    Raymond Tung BPharm
    Director of Pharmacy, Chris O'Brien Lifehouse
    ------------------------------



  • 3.  RE: glucarpidase (VORAXAZE)

    Posted 7 days ago

    We have a lot of patients on high-dose MTX but do not stock glucarpidase. Since its approval, we have not used the drug more than a handful of times. The company can usually provide this agent in less than 24 hours, if needed. I would not succumb to the pressure from the rep, but ensure that there is a process in place for ordering the drug whenever needed.

    Sepideh  

     

    Sepideh Shayani, Pharm.D., BCOP

    Clinical Manager  | Department of Pharmacy Services

    Director | PGY-2 Residency, Oncology/Hematology/Stem Cell Transplant

    City of Hope National Medical Center, Duarte, California

    Phone#: 626-218-2510 | Pager: 626-423-6471

    <a href=image002.png@01D16AFA.E6B53AA0">

     



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  • 4.  RE: glucarpidase (VORAXAZE)

    Posted 7 days ago
    ​Hello Krissy,

    At our health system we commonly administer HDMTX, but don't stock glucarpidase. We have used it once in the past year. We were able to fly in the drug within 12 hours of request. Hope this is helpful.

    Best,
    Justin


    ------------------------------
    Justin P. Huynh, PharmD, BCOP
    Clinical Pharmacy Specialist, Hematology/Oncology
    Director, PGY-2 Oncology Pharmacy Residency
    Rhode Island Hospital | Lifespan Cancer Institute
    Providence, RI
    ------------------------------



  • 5.  RE: glucarpidase (VORAXAZE)

    Posted 7 days ago

    Hi Kristine,

     

    (1)  Do you routinely stock glucarpidase?

    Our hospital does not stock glucarpidase routinely.


          (2) Does your center administer high dose MTX frequently?

    We do frequently administer high dose MTX as a lot of the lymphoma and leukemia regimens contains HDMTX. However, we haven't had to use a dose of glucarpidase in years. The last time we used it, I remember we call a 1-800 number and it gets overnighted to us. Meanwhile, we hydrate the patient aggressively and administer larger doses of leucovorin and watch for signs of mucositis. The paper we have been following in regards to managing patients who have received HDMTX is: Understanding and Managing Methotrexate Nephrotoxocity, Brigitte et. al., The Oncologist June 2006 vol. 11 no. 6 694-703. Our standard practice has since migrated to alklanizing patients with 150meq of sodium bicarb in 1L of D5 or  SWFI and run at 150mL/hr. We maintain pt at that rate unless their serum CO2 starts to approach 30, then we back off on the sodium bicarb content in each bag. We also give the patient leucovorin at 50mg PO Q6hrs 24hrs from the end of MTX infusion (unless otherwise specified by specific study protocols). Our pharmacists facilitate the initiation of leucovorin and MTX lab ordering. We have since not had to use any glucarpidase.

     

    Hope this is helpful

     

    Hongchao Liu, PharmD, BCOP

    Oncology pharmacist

    University of New Mexico Comprehensive Cancer Center

    505-925-0123

     






  • 6.  RE: glucarpidase (VORAXAZE)

    Posted 2 days ago
    We infuse a 2-3 HD MTX a month and didn't plan to stock glucarpidase. However, we did order in 1 vial for a patient that we ended up not using, so now I have 1 in stock.  Once that is used (or more likely expires), we will not be routinely stocking it since the shipping time is short and we can support the patient until the product arrives.

    There is data supporting a fixed dose 1000 units in adults, and lower doses in peds, rather than using the full weight based dose:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770903/ - reviews peds data for 15-90 units/kg
    https://www.ncbi.nlm.nih.gov/pubmed/23880719 - Used 1,000 unit fixed dose (15% of the calcuated dose per mfg dosing) in an adult

    Hope this helps!

    Teresa

    ------------------------------
    Teresa Slagle BCOP,PharmD
    Oncology Pharmacist
    Providence Alaska Medical Center
    Anchorage AK
    teresa.slagle@providence.org
    ------------------------------