Multidisciplinary Collaboration Optimizing PARP Inhibitor Regimens


The significance of multidisciplinary teams in ovarian cancer treatment is highlighted.

Ryan Haumschild, PharmD, MS, MBA: We leverage a multidisciplinary approach [for patients with ovarian cancer]. That’s the best way to care for a patient. You have a lot of people who are treating patients, and the providers are finding out the diagnostics: what are the genomic criteria, are they BRCA expressive, are they not, are they HRD [homologous recombination deficiency]? Once we go through that initial diagnostic and work-up, they look to the nurse team member, the advanced practice practitioner [APP], but also the PharmD to make the best treatment recommendation for that patient. What does the clinical trial say? Is this in the frontline setting? Is this in the maintenance setting? Once we pick the treatment, the team looks to the pharmacist and some of our advanced practice practitioners to have that conversation with the patient. Here are some of the medications available, here’s how they work, and here are the adverse effects. When you have a provider who’s doing a great diagnostic work-up, making sure they’re treating that patient for the best genomic expression and line of therapy. When they have an APP there, that’s going to help with the treatment journey and educating the patient. The pharmacist can get into the nitty-gritty and review the drug-drug interactions, drug-food interactions, and talk about dose reductions and common adverse effects. That’s when you have a great holistic management of that patient. Obviously, the clinic nurse can help navigate the patient through those appointments, making sure they’re getting the necessary labs. By having those frequent touch points, patients appreciate it; they feel engaged in their therapy. And at the end of the day, if any changes are needed, we can be early in that recognition and allow for the best progression-free survival that we saw in the clinical trial.

When it comes to keeping adherence and reducing abandonment rates, a proactive strategy is the best way to go about it. What do I mean by that? No. 1 is being proactive with your patients when starting a PARP inhibitor. Talk about the great science and the great progression-free survival, but also talk about the adverse effects in a way that they understand this might be part of their treatment journey. Make sure they have the education on the front end. How do you recognize them? When do you reach out? Do you initiate supportive care medications when a patient starts therapy? It doesn’t mean they’re going to be taking supportive care or medications that will help mitigate adverse effects at the beginning, but they’ll have them on hand when something comes up. Also, you’ve got to be proactive when you talk about dose reductions. Sometimes patients might not want to report an adverse effect. They’ll say, “They’re going to change my dose, and I may not have as great efficacy because of it.” But in the clinical trial, these dose reductions were studied; they’re part of the package insert. We want to position it in a way so that patients let us know when they come up. We’d rather know about the adverse effect, dose reduce you, and keep you on therapy longer than find out that you have an adverse effect once it’s debilitating and we can no longer even have you continue your PARP treatment. That’s a key takeaway from this message.

Transcript edited for clarity.

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