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binds and neutralises all human VEGF forms via recognition of binding sites for the two human VEGF receptor types.19 Cetuximab is a recombinant chimeric (human and mouse combination) MAB and panitumumab is a humanised MAB. They bind to the epidermal growth factor receptor (EGFR). Anti-EGFR MABs inhibit proliferation and induce apoptosis (cell death) of tumour cells that overexpress EGFR.17,18 Anti-EGFR MABs should only be prescribed for patients whose tumours are RAS wild type. BRAF is a component of the RAS-RAF-MAPK signalling pathway and the presence of BRAF mutations have been identified as a marker of poorer prognosis, and potentially predictive of resistance to EGFR antagonists.19 Prominent adverse effects Pharmacists should be aware of the common adverse effects of the main colorectal cancer therapies outlined in Table 1. The most obvious adverse effects we think of when assisting patients receiving chemotherapy is nausea and vomiting immediately post chemotherapy, and neutropenia seven to 14 days following each cycle. Oxaliplatin and irinotecan are moderately emetogenic (30-70 per cent risk of nausea and vomiting) and hence these patients should have been given prescriptions/medicines for nausea/ vomiting prevention and treatment.12 Patients are advised not to associate with individuals who have infections when they are likely to be neutropenic, as the infection risk is high. If the patient presents to your pharmacy requesting remedies to help with cough, colds or “flu-like” symptoms, with or without a fever, and they are being treated with chemotherapy, advise them to either visit their GP promptly or call their oncology team and/or the medical oncology day unit for advice. Neutropenic sepsis is a life threatening toxicity and is treated as a medical emergency.12 See the eviQ webpage for clinical resources and adverse effect toxicity management eviq.org.au/ clinical-resources/side-effect-and-toxicity- management for more information. Bowel cancer screening Faecal occult blood tests (FOBT) used for screening have demonstrated a significant reduction in colorectal cancer-specific mortality, compared with no screening. An immunochemical faecal occult blood CPD ACTIVITY 51 test (iFOBT) is recommended as the screening modality for the detection of colorectal cancer in the average-risk population (those aged 50-74 years). The frequency of tests are every two years. The iFOBT kit including a reply- paid envelope is posted to individuals who are in this group. Pharmacists should encourage discussion about screening with this group, particularly during June, which is Bowel Cancer Awareness Month. Discussion can include details about the testing, the benefits and some of the psychological issues related to testing and waiting for results. Prevention Primary prevention Lifestyle Lifestyle, lifestyle, lifestyle! In so many areas of health and wellbeing, lifestyle has a major impact. Lifestyle advice for the prevention of colorectal cancer is outlined in Box 2.20 An interesting point to discuss with patients, and for that matter, your work colleagues, is the recommended daily intake of fibre, set by the National Health and Medical Research Council: 30g for men and 25g TO PAGE 52 Become a member of the new look Australasian College of Pharmacy Australasian College of Pharmacy With many new education opportunities Visit acp.edu.au to learn more and sign throughout 2021, now is a great time to up for updates. become part of the College community. +61 7 3144 3680 • info@acp.edu.au • acp.edu.au ABN: 44 008 588 841 • RTO Code: 88112 RETAIL PHARMACY • JUN 2021 21_00006N