Perioperative Management of Systemic Cancer Therapies for Solid Organ and Hematologic Malignant Neoplasms: Recommendations From the Emory University Systemic Therapies Perioperative Management Group.

Abstract

The use of novel drugs has changed the natural histories of many solid organ and hematologic cancers, whether localized or metastatic disease, and is associated with improved survival. Patients may require surgery for both oncologic and benign diseases while taking these medications. The new classes of anticancer medications include antibody-drug conjugates, T-cell engagers, hormonal therapies, immune checkpoint inhibitors, targeted therapies, and bone-modifying agents. Each drug class has an adverse effect profile that may play a role in how the drug should be managed in the perioperative setting. A modified Delphi methodology was used by a multidisciplinary committee composed of board-certified oncology pharmacists, internists specializing in perioperative medicine, and orthopedic oncologists to offer consensus recommendations on the perioperative management of these novel anticancer agents. The mechanism of action, adverse effect profile, and perioperative recommendations are presented for 151 Food and Drug Administration-approved anticancer agents. Optimal medication management is integral to quality perioperative medical care. Serious consideration must be given to balancing risks of continuing medication perioperatively versus holding and interrupting necessary oncologic treatment.