Commentary
Video
Joshua K. Sabari, MD, highlights pharmacists’ roles in coordinating access, financial assistance, and early side effect management for patients starting zongertinib (Hernexeos).
In an interview with Pharmacy Times®, Joshua K. Sabari, MD, assistant professor at the department of medicine at NYU Grossman School of Medicine, emphasized the importance of pharmacists in ensuring timely access to zongertinib (Hernexeos; Boehringer Ingelheim) through collaboration with care teams, financial services, and specialty pharmacies. Sabari encouraged pharmacists to educate patients about side effects and to schedule follow-ups within 2 weeks of treatment initiation.
Pharmacy Times: How can pharmacists collaborate with the care team and specialty pharmacies to help ensure patients have timely access to zongertinib based on the NCCN guidelines, and what resources are available to help with financial or logistical barriers?
Joshua K. Sabari, MD: It’s critical to work closely with the care team and financial approval team when prescribing zongertinib. Because it’s a new drug, it’s not yet included in many pathways, which can create early barriers. We’ve been able to prescribe it as a standard of care, but there can be financial challenges. If issues arise, the manufacturer, Boehringer Ingelheim, offers generous patient assistance programs for financial support. Specialty pharmacies can usually ship the drug within a week, though this may take longer than arranging an IV infusion, which can often happen within 24 to 48 hours. The priority should always be determining the best option for each patient, even if that means a brief wait.
It’s also important to follow up with patients about two weeks after starting therapy to check liver tests and assess tolerance. In the clinical trial, dose discontinuation rates were only 3.9%, and dose reduction rates were about 7%, which is significantly lower than the 15% to 20% seen with trastuzumab deruxtecan. Educating patients upfront and proactively managing side effects are essential to maintaining adherence.
Pharmacy Times: Is there anything else that you would like to add?
Sabari: One area of ongoing study is central nervous system (CNS) activity and penetration. In our data published in The New England Journal of Medicine, we saw a 43% response rate in the brain among patients with a mix of untreated and previously treated CNS metastases. There’s an ongoing trial cohort evaluating zongertinib in patients with active, untreated CNS metastases. For patients with small, asymptomatic brain metastases, I feel comfortable starting zongertinib and scheduling a short-interval MRI. For those with symptomatic or larger lesions, vasogenic edema, or who need anti-epileptics, I recommend referral to radiation oncology before starting zongertinib.
Stay informed on drug updates, treatment guidelines, and pharmacy practice trends—subscribe to Pharmacy Times for weekly clinical insights.
