YAKUGAKU ZASSHI

Our Treatment Strategy for Patients with Hereditary Breast Cancer Syndrome in Hamamatsu Medical Center

Among breast cancer cases, 5-10% are thought to have germline mutations in genes associated with onset. Among these, hereditary breast cancer-ovarian cancer syndrome, which develops from breast cancer susceptibility (BRCA) gene mutation, has become widely known. Since 2018, olaparib has been clinically available for patients with inoperable or recurrent breast cancer. However, to use this medicine, BRCA gene mutation must be confirmed. Our hospital has prepared a BRCA genetic testing procedure, counseling system, and environment for the safe use of olaparib for BRCA genetic mutation positive patients. Until patients get the results of the BRCA gene examination, the attending physician and certified in breast cancer nurse care for the patient. If a positive result is obtained, we have established cooperation with a neighboring hospital, since our hospital cannot provide the genetic counseling. The main role of pharmacists is to develop a description system, as with other therapeutic agents, and to develop measures to help with supportive care for side effects. Also important is the development of a system to provide information to community pharmacies. At this symposium, we will report on how we developed our treatment strategy for patients with hereditary breast cancer syndrome, and the integrated role of pharmacists at Hamamatsu Medical Center.

Establishment of Mono-scaled Benefit/Risk Analysis of HPV Vaccine

Decisions concerning approval of human papillomavirus (HPV) vaccines and their use are based on expert evaluation of the vaccines. However, the quantitative differences between vaccine benefits and risks are difficult for non-experts to understand. In this study, we developed a new method to calculate the benefits and risks of the HPV vaccines using disability-adjusted life year (DALY) as the mono-scaled weight for various benefits and risks relevant to the vaccines. We evaluated benefits as a gain of DALY values for cervical cancer and risks as the loss of DALY values for various adverse events by the vaccination. To calculate the loss of DALY values, we integrated all adverse events in the International Classification of Diseases chapters. The novel method reflected the men-women ratio of this epidemiological disease to a certain extent. Among the vaccinated women, 111372 and 477190 received a bivalent and quadrivalent vaccine, respectively. The DALY rate of cervical cancer was 148.7. The calculated benefit for the bivalent and quadrivalent vaccines was 149.1 and 638.8, respectively, and set as the theoretical maximum. The risk was calculated as 129.3 and 49.6 in the bivalent and quadrivalent vaccines, respectively. Since HPV vaccines prevent several other cancers, the benefit of the vaccination extends beyond the risk according to this new method.