Tumor analysis, prediction of transplant complications, and management of blood potassium levels take top honors at annual seminar

Studies on the use of tumor DNA analysis in selecting drug therapies, the risk of diabetes resulting from lung transplantation, and pharmacological management of elevated blood potassium, took top honors at the Department of Clinical Pharmacy’s 20th annual Spring Research Seminar.

UCSF School of Pharmacy PharmD students, residents, and faculty members presented 39 projects to the pharmacy community on May 2, 2018, at the Parnassus campus.

Top researchers received Gary Rifkind Spring Research Seminar Awards for their efforts, an annual prize of $1,000 made possible by Gary Rifkind, PharmD ’60.

Rifkind, who founded the awards to recognize and celebrate clinical pharmacy research, attended the award presentation on June 5, accompanied by his wife, Joyce.

Hyperkalemia, hypoglycemia: maintaining a healthy bloodstream

Allen Tran, PharmD Class of 2019, won the Rifkind honor in the student category for his poster presentation, “Inpatient Management of Hyperkalemia with Insulin: Decreasing Post-Treatment Hypoglycemia.”

Hyperkalemia, or elevated blood levels of potassium, can result from kidney failure or complications from cardiac arrest. It is associated with an increased risk of death in hospitalized patients, and is typically treated with insulin. However, insulin itself can lead to hypoglycemia, or low blood sugar, so insulin is often administered alongside dextrose, a sugar, when treating hyperkalemia.

In this study, Tran and colleagues tested the impact of using a revised order set, or clinical protocol, for treating hyperkalemia with insulin at UCSF Medical Center, with the goal of preventing subsequent hypoglycemia. The researchers found that hypoglycemia resulting from insulin administration could be reduced by 50 percent if clinicians used weight-based insulin dosing options and were alerted to patients who were at high risk of developing the disorder.

Predicting transplant complications

Erik Henricksen, PharmD, a PGY2 pharmacy specialty resident in solid organ transplant at UCSF, won in the resident category for his poster entitled, “Polymorphisms in the KCNJ11 Gene are Associated with New Onset Diabetes after Lung Transplantation.”

Transplant patients must take immunosuppressant drugs to prevent the body from rejecting a newly transplanted organ. However, these drugs can interfere with the normal function of the pancreas, which is responsible for producing insulin, leading to new-onset diabetes after lung transplantation (NODAT), a condition in which blood sugar levels are chronically elevated.

Henricksen’s team hypothesized that mutations that increase the risk of NODAT in kidney transplant patients might have a similar effect in lung transplant patients. To test this hypothesis, they looked at genetic data from 198 lung transplant recipients, 112 of whom had developed NODAT following their transplant.

Among the 198 subjects, the researchers found two mutations, both located in the same gene, that significantly increased the risk of diabetes following lung transplantation. The researchers are hopeful that this study will help clinicians identify patients who may have a high risk of developing diabetes after a lung transplant, and provide those patients with blood sugar monitoring and education on the disease.

Molecular tumor board demonstrates its value

Jennifer Grabowsky, PharmD, won in the faculty category for her poster presentation entitled, “Retrospective Analysis of Clinical Outcomes in Cancer Patients who Underwent Tumor Genomic Testing Using Next-Generation DNA Sequencing Panels.” Gabrowsky is a clinical oncology pharmacist in the Experimental Therapeutics Program of the Helen Diller Family Comprehensive Cancer Center, and serves as a volunteer faculty member in the School of Pharmacy.

In this study, Grabowsky and colleagues took a retrospective look at the impact of the UCSF Molecular Tumor Board (MTB) on outcomes for cancer patients. The MTB is an advisory group of cancer experts, ranging from practicing oncologists to genetic counselors, who use molecular diagnostic tests of tumor DNA to customize drug therapies for individual patients.

The researchers reviewed over 1,000 cases that were overseen by the MTB and found that its drug recommendations, when followed, led to a marked increase in patient survival. However, the MTB was able to make recommendations for only 14 percent of these patients overall, and less than one-third of those patients ultimately received the recommended drug.

The study highlights the benefits of using the MTB to develop therapy plans for individual cancer patients. Grabowsky and colleagues intend to further investigate barriers to patient access to recommended drugs, as well as the factors that may lead cancer patients to forego a recommended therapy.