Navigating Emerging Precision Oncology Trends in Clinical Practice

In this interview with Pharmacy Times at Oncology Pharmacists Connect in Austin, TX, Courtney C. Cavalieri, PharmD, BCOP, clinical oncology pharmacist, University of Utah Huntsman Cancer Institute, discusses key considerations for evaluating oncology data presented at major conferences such as ASCO. She highlights the importance of assessing trial populations, study design, and phase of development before incorporating new findings into clinical practice. Cavalieri also addresses challenges associated with implementing promising therapies earlier in treatment sequences, particularly when reimbursement and guideline updates lag behind emerging evidence. Additionally, she shares strategies for staying current with oncology advances and discusses growing interest in circulating tumor DNA (ctDNA), antibody-drug conjugates (ADCs), and other precision medicine approaches that are reshaping cancer care.

Pharmacy Times: Major oncology conferences often feature a large volume of practice-changing data. When evaluating new research, what factors do you consider most important in determining whether findings are ready to influence clinical practice versus requiring additional validation?

Courtney Cavalieri, PharmD, BCOP: That is a good question. One of the first things I always look at is the patient population that was included in the study. There are so many abstracts, especially at ASCO, that come from a single institution or even a single region. Because of that, we have to carefully consider whether the findings are truly applicable to the patients we see in clinical practice or whether we need to wait for additional data from a larger or more globally representative population.

Another important consideration is the phase of the trial. Earlier-phase studies are often focused on helping us learn more about the drug itself, its safety profile, and how it performs in combination with other therapies. The phase of development can influence how we incorporate new findings into practice, how quickly we adopt a therapy, or whether we decide to wait for additional evidence from larger, randomized phase 3 trials before changing our approach.

Pharmacy Times: Among the updates highlighted in your session, which developments do you believe are most likely to have an immediate impact on oncology pharmacy practice, and why?

Cavalieri: Our session was a little different this year because it did not focus on a single disease state. Instead, we selected a number of abstracts that may not have been covered in other sessions.

I do not think any of the abstracts we discussed were truly practice changing, but several were reaffirming of current clinical practice. For example, Eugene presented an abstract that examined frailty in patients undergoing treatment. The findings reinforced the idea that frailer patients may not be appropriate candidates for some of the more toxic treatment options.

A couple of the abstracts I covered also served to reinforce existing challenges in oncology care. Specifically, they highlighted the continued lack of effective treatment options for patients experiencing cancer-related or chemotherapy-induced fatigue, as well as peripheral neuropathy. Overall, the session covered a broad range of topics. While the abstracts may not have introduced practice-changing findings, they provided valuable confirmation of several principles and challenges that clinicians already recognize in practice.

Pharmacy Times: Translating conference findings into patient care can sometimes be challenging due to issues such as access, reimbursement, or operational constraints. What barriers do oncology pharmacists commonly face when implementing new evidence, and how can they help overcome them?

Cavalieri: One of the biggest barriers I face in clinical practice occurs when a therapy or treatment regimen moves to an earlier line of treatment. For example, a drug that has traditionally been used in the second- or third-line setting may generate new data demonstrating efficacy in the first-line setting. When the evidence is compelling, providers often want to incorporate those findings into practice as quickly as possible.

However, obtaining coverage for those therapies can be challenging. This is particularly true when the supporting data have been presented but the full manuscript has not yet been published. The challenge is often compounded by the fact that the new evidence has not yet been incorporated into clinical guidelines. As a result, securing insurance approval for use in the earlier treatment setting can be difficult.

This is often one of the biggest hurdles I encounter following major oncology meetings. When a treatment appears ready to move into an earlier line of therapy, the challenge becomes determining how to obtain coverage and ensure that patients have access to what may be the most effective treatment option available to them.

Pharmacy Times: For oncology pharmacists who may not have the opportunity to attend every major conference, what strategies do you recommend for staying current with emerging data and identifying the updates most relevant to their practice

Cavalieri: I really love this question. I get it a lot from residents as well because there are so many updates. They often ask, "How do you stay current?" and "How do you decide what you're supposed to learn?"

One of the most effective strategies for me personally has been subscribing to different email newsletters and email updates. It can become overwhelming, especially after ASCO, when it feels like there is a new email every hour. However, I find them incredibly helpful. I can quickly scan the subject lines or open the emails and review them briefly to see whether there is anything relevant to my practice. If there is, I can then spend more time exploring the data in greater detail.

These newsletters help consolidate a large amount of information because they often highlight the most important changes and major findings coming out of meetings. Being able to quickly review those summaries allows me to stay informed without having to sift through everything on my own.

Another valuable approach is simply talking with my providers. They are speaking with colleagues and often attend these meetings more frequently than I do. Asking questions such as, "What did you hear?" "What was exciting?" or "What are you interested in incorporating into practice?" helps me identify areas where I should take a closer look at the data that were presented.

Yes to all of those things. It is a very exciting time in oncology because there have been so many new types of therapies emerging.

Pharmacy Times: Looking across the major oncology meetings from the past year, have you noticed any broader trends in cancer care—such as precision medicine, immunotherapy, bispecific antibodies, or ADCs—that you believe will continue to shape practice in the coming years?

Cavalieri: One of the most interesting developments in precision medicine, particularly in solid tumors, has been the increasing use of residual disease biomarkers. Specifically, circulating tumor DNA (ctDNA) has started to be incorporated into clinical practice, and we are beginning to see more data that help guide how to interpret and act on that information.

I think this is a particularly exciting area because, in hematologic malignancies, similar approaches have been used for many years. We are now starting to learn how to apply these concepts more effectively in the solid tumor setting and determine how they can inform treatment decisions.

Beyond that, there continues to be a steady stream of new therapies entering the field. We are seeing new combinations involving immunotherapies, additional antibody-drug conjugates (ADCs), and many other novel treatment approaches. Keeping track of all of these therapies, including where they are being used, which disease states they target, and where they fit within the treatment sequence, can be challenging. However, it is also an incredibly exciting time in oncology because of the rapid pace of innovation and the growing number of treatment options available for patients.