A panel of medical experts begin a discussion surrounding key updates in treatment and management of HR+/HER2- metastatic breast cancer.
Ryan Haumschild, PharmD, MS, MBA: Welcome to this Pharmacy Times exchange, “Key Updates in CDK4/6 Inhibitors for HR+/HER2– Metastatic Breast Cancer.” My name is Dr Ryan Haumschild, director of pharmacy at Emory Winship Cancer Institute [in Atlanta, Georgia]. Joining me today in this discussion are Dr Heather Moore, clinical pharmacist practitioner [at] Duke Cancer Center Breast Clinic in Durham, North Carolina, [and] Dr Rose DiMarco, oncology pharmacy manager and pharmacy quality lead [at] Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital [in Philadelphia, Pennsylvania]. And joining us virtually is Dr Jacob Kettle, director of the Ellis Fischel Cancer Center [at] the University of Missouri Health Care in Columbia. Today we’re going to talk about several topics, including a background on metastatic breast cancer, latest data for CDK4/6 inhibitors in HR+/HER2– metastatic breast cancer, and the importance of multidisciplinary care and metastatic breast cancer. Let’s first talk about the background of metastatic breast cancer. Let’s talk through the prognosis [for] patients [with] HR+/HER2– [disease] and how the pharmacist can empower these patients. Dr Moore, I’d love for you to start.
Heather Moore, PharmD, CPP, BCOP : So thinking about the prognosis over decades for these patients, what we’ve seen is that with the development and implementation of more targeted therapies, the prognosis for these patients is significantly longer than what we would have otherwise anticipated. And what’s helpful in thinking about our role as pharmacists is how we can help and support those patients in helping to identify more targeted therapies [and] next-line agents, because we do have significantly more therapy options [when] thinking about our treatment paradigm than what we’ve had in the past. So it’s helpful to encourage them, especially for patients who [have received a new diagnosis]. [They] are always concerned that this is [their] only line of therapy, but [encourage] them that we have in our back pockets the ability to do dose modifications [and] supportive care [and that we are] thinking about other targeted agents or lines of therapy that may come later.
Ryan Haumschild, PharmD, MS, MBA: You [said] a lot of great things, and one of the first ones is [that a] pharmacist can help manage a patient. They can manage them from the adverse effect profile, even from therapy selection and subsequent treatments, as we start to get into later lines of therapy and keep the patient motivated. So many of these patients need that adherence monitoring and [to learn] how to deal with toxicities to make sure that they can stay adherent, [with] a good proportion of days covered. And speaking of toxicities, we know that sometimes they can have a negative impact on the metastatic breast cancers [and] quality of life. And that’s something that we really want to home in on because the better [the] quality of life, the better [the] activities of daily living and hopefully the better [the] outcome. Thinking about that, I want to look to you, Dr DiMarco. Can you describe the ways in which metastatic breast cancer can have a negative impact on a patient’s quality of life?
Rose DiMarco, PharmD, BCPS, BCOP: There are a lot of different ways that metastatic breast cancer [affects] their quality of life. We can look at the disease and see how they present. So if they come in with brain metastases, their cognitive function, their physical functioning might be off. If they come in with pain, that can be difficult to manage. Then we add in treatment that’s controlling disease but causing more adverse effects. And then when we think about it, they have a cancer diagnosis. And usually, the first time we’re meeting them is the first time they’re hearing it, so that emotional distress can cause anxiety [and] depression and not just [for] the patient. It’s their family and their caregivers, their friends. So all those things together can [affect] their health [and] quality of life.
Ryan Haumschild, PharmD, MS, MBA: And quality of life, as you mentioned, [affects] caregivers. It [affects] the patients themselves. It [affects] their ability to show up to work and be productive. When we think about health plans that are covering these patients or even health care providers, a system [such as] some of the systems we work for, if there [are] team members that have breast cancer [who] have to be out of work, not only is it [affecting] that individual, but it’s [affecting] the organization. And right now, a lot of these staffing agencies that we have to utilize to backfill the position, they’re even more expensive. And so the better we can manage a patient, keep them as a productive member of society, it’s good for them, it’s good for their employers and the organization as a whole, because the more and more we think about it, there are economic impacts…. Dr Kettle, I’m excited to have you [as] part of this discussion. And we talk about breast cancer, there’s treatment, there’s quality of life, but there’s also the cost considerations. Could you characterize for us the economic impact that metastatic breast cancer can have?
Jacob K. Kettle, PharmD, BCOP: It’s important to think of it both on the macro and microlevel. So [on the] macrolevel, it has a huge impact on our ability as a society to produce and generate income and all those pieces that go along with that, especially now [that] we start seeing breast cancer trending a little bit younger…. It’s affecting women…in their prime, whether it’s [in] prime earning years of their life, they’re responsible for care [of] a child, or maybe they’re responsible for the care [of] an older adult. Those years between 45 and 65 are critical, productive years for our society. And so [there is a] tremendous impact on the macrolevel. But whether we’re talking about lost days of work or lost ability to support a family, that affects society on a larger level, and there are older data that will say [a] $250 to $300 million national impact on that level from lost days of work. What’s more important is how it affects things on a microlevel. At least that’s what we feel and see day to day in clinic as we take care of patients. In Columbia, Missouri, we take care of a lot of rural patients. So when we treat patients with metastatic cancer, breast cancer included, we have a lot of patients in those rural communities that are self-employed, whether it’s farm labor or other things [such as] that. Those are typically not jobs that can have sick leave and other support that you see in more metropolitan areas. So it’s a major impact on folks as they go through that, because maybe they don’t have the safety net to get care or they have to take a loved one to bring them to and from clinic. And maybe it’s a 3-hour drive multiple days a week, and that takes them out of their earning time. So it’s a major impact, and it goes beyond the cost of drugs and co-pays and those things. But [it goes] back to the ability to produce, earn, [and] support family, loved ones, self, all those things. So it’s a major impact on society. But in particular, we think about it how it affects the individual.
Ryan Haumschild, PharmD, MS, MBA: That was a great holistic overview of the economic impact. You even had some of the social determinants of health: transportation, travel. Someone can have transportation vulnerability whether they’re 6 miles away or 600 miles away. It’s great [to put] that into considerations with the patients.
Transcript is AI generated and edited for clarity and readability.