Missing Concept Ancestor Relationship for ADO-Trastuzumab Emtansine

[cukarthik]

I was looking at ado-trastuzumab emtansine 160 MG Injection [KADCYLA] and it maps to RxNorm code 1658091. When I look at the concept ancestor table or concept relationship table I can't get to the RxNormExtention code for ado-Trastuzumab emtansine. I happened to run into this issue but I think this might exist for other cancer related drugs, especially if I'm using HemOnc.

Tagging @cgreich

[cgreich]

That's an issue of the ingredient vs precise ingredient. The precise ingredient is used in the RxNorm name, but the generic ingredient is in the path of the hierarchy. It's a tricky issue, which is to decide whether trastuzumab and ado-trastuzumab emtansine.

[cukarthik]

So this is the case even if I go through ATC for ado-trastuzumab emtansine? I see potential children via the 'Drug class of drug (OMOP)' relationship, but these children are not in the concept_ancestor table.

[cgreich]

Not sure I follow. The issue is that RxNorm makes no distinction between the precise ingredients, even though it uses the precise ingredient in the concept_names. They are all trastazumabs.

[vladkorsik]

Not sure I follow. The issue is that RxNorm makes no distinction between the precise ingredients, even though it uses the precise ingredient in the concept_names. They are all trastazumabs.

Oh, but emtansine is not the same as anion or cation usually defining Precise Ingredient Class by RxNorm. This is a relevant substance directly linked to Trastuzumab making the ingredient pharmacologically distinct from trastuzumab and its biosimilars. The concurrent issue - emtansine is not used as single agent therapeutics, that is why it can not be used not create the parent-child axis in RxNorm. Does it need to be raised somewhere outside the Github to make the Drug conjugates a RxNORM ingredients?

[dimshitc]

Vlad, do you have a list of such drugs? So we can show them to RxNorm people.

On Fri, Oct 29, 2021 at 7:26 PM Vlad @.***> wrote:

Not sure I follow. The issue is that RxNorm makes no distinction between the precise ingredients, even though it uses the precise ingredient in the concept_names. They are all trastazumabs.

Oh, but emtansine is not the same as anion or cation usually defining Precise Ingredient Class by RxNorm. This is a relevant substance directly linked to Trastuzumab making the ingredient pharmacologically distinct from trastuzumab and its biosimilars. The concurrent issue - emtansine is not used as single agent therapeutics, that is why it can not be used not create the parent-child axis in RxNorm. Does it need to be raised somewhere outside the Github to make the Drug conjugates a RxNORM ingredients?

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[dimshitc]

On behalf of @vladkorsik irinotecan liposomal doxorubicin liposome paclitaxel protein-bound ado-trastuzumab emtansine trastuzumab deruxtecan

We sent the email to RxNorm people describing the issue that precise ingredients have now forms really different from the actual ingredients

[Alexdavv]

We're currently working on the proposal around the handling of the precise ingredients.