ADVANCED STREAM

The COSA CPG offers an interactive, expert-led forum for pharmacists working at an advanced clinical level, who have a good understanding of oncology and/or haematology pharmacy practice.
The 2025 program will focus on advances in Cancer Genomics, Precision Medicine, and DOAC Monitoring and reversal.

Recent research in cancer genomics has significantly advanced precision medicine by refining the understanding of cancer types and subtypes through genetic profiles, enabling more accurate diagnoses and personalized treatment strategies. Key developments in molecular biology have led to new diagnostic and therapeutic techniques such as retroviral therapy and the silencing of oncogenes.

In ovarian cancer, particularly the high-grade serous subtype, molecular analysis has revealed genetic heterogeneity, which opens opportunities for more targeted therapies.

Colorectal cancer (CRC) treatment now requires molecular profiling to guide therapy, especially in both early and metastatic settings. Liquid biopsy with circulating tumour DNA (ctDNA) is emerging as an essential tool for monitoring therapy and adjusting treatment plans. Approximately 75% of CRC cases feature identifiable driver mutations, with 5% being heritable, necessitating careful testing and surveillance for other malignancies.

Acute myeloid leukemia (AML) diagnosis and treatment are increasingly dependent on genomic sequencing, allowing for risk stratification and identification of mutations that inform treatment decisions. The classification of AML is evolving with the integration of new genomic data.

Advancements in genetics have also influenced lymphoma treatment. Personalized treatments based on the genetic characteristics of lymphoma cells are becoming central to therapy, with targeted therapies showing great promise. Understanding the genetic drivers of lymphoma has led to the development of more effective treatments with improved specificity and reduced side effects.

In non-malignant hematology, direct oral anticoagulants (DOACs) typically do not require routine monitoring, but special circumstances may require laboratory measurement or reversal. Assays like the thrombin time and anti-Xa assay can quantify DOAC levels. For minor DOAC-related bleeding, supportive care is usually enough, but severe cases may need reversal agents. While nonspecific agents carry risks, specific agents like idarucizumab and andexanet alfa are in clinical development for targeted reversal.

The below program is subject to change.