Discussing the Role of the Pharmacist in the Management of Biliary Tract Cancer

Pharmacists play a crucial role in biliary tract cancer treatment selection and optimization through their comprehensive medication knowledge, including administration protocols, dosing frequencies, adverse effect profiles, and monitoring requirements. This expertise proves invaluable when collaborating with physician colleagues to choose between treatment regimens, particularly when considering patient-specific factors such as existing comorbidities. For instance, pharmacists can identify potential risks like pulmonary toxicity with trastuzumab deruxtecan in patients with preexisting respiratory conditions and help establish appropriate monitoring parameters to ensure safe medication administration. Their knowledge base extends to educating both health care providers and patients about the unique toxicity profiles of these specialized agents, which often differ significantly from traditional chemotherapy expectations.

Toxicity management represents a cornerstone of pharmaceutical care in biliary tract cancer, with pharmacists developing comprehensive monitoring algorithms and patient education strategies. For FGFR inhibitors, pharmacists establish systematic approaches for monitoring hyperphosphatemia, including laboratory check frequencies, phosphate binder initiation protocols, and patient counseling on low-phosphate diets. They provide detailed education on managing dermatologic and nail toxicities while emphasizing the importance of reporting rare but serious ocular complications. For HER2-targeted therapies, pharmacists coordinate monitoring for interstitial lung disease with trastuzumab deruxtecan and establish cardiac monitoring protocols for ejection fraction assessment, ensuring patients understand the rationale behind these safety measures.

Treatment optimization focuses on maximizing time on therapy while maintaining quality of life, given the limited therapeutic options available for biliary tract cancers. Pharmacists advocate for continuing effective treatments as long as patients demonstrate response or stable disease, recognizing that many patients prefer oral targeted therapies over intravenous infusions due to convenience and reduced clinic burden. The transition from first-line to subsequent-line therapy occurs only when current treatments lose efficacy, emphasizing the critical importance of proactive toxicity management to maintain patients on beneficial therapies for extended periods while minimizing treatment-related complications.