Oncology Pulse Points: ASCO Living Guideline Updates in Metastatic Castration-Resistant Prostate Cancer

Pharmacy Times interviews Christine Barrett, PharmD, BCOP to discuss key updates to the ASCO Living Guideline for systemic therapy in metastatic castration-resistant prostate cancer and their implications for pharmacists and clinical practice.

Barrett discussed key updates to the 2026 ASCO guidelines for systemic therapy in thyroid cancer, emphasizing the growing role of precision medicine and molecular testing in treatment selection. The updated guidance incorporates new evidence-based recommendations across multiple thyroid cancer subtypes, including well-differentiated, differentiated high-grade, poorly differentiated, anaplastic, and medullary thyroid cancers.

According to Barrett, one of the most significant changes is the introduction of a clear treatment algorithm for patients with progressive radioactive iodine-refractory differentiated thyroid cancer. While multikinase inhibitors have historically served as the standard treatment option, the updated guidelines now prioritize genomically targeted therapies as a frontline consideration when actionable driver mutations or fusions are identified. Barrett noted that patients with these molecular alterations should receive targeted therapy upfront, highlighting the increasing importance of genomic profiling in treatment decision-making.

Barrett explained that the guidelines reflect the complexity of thyroid cancer management, given the distinct biologic characteristics and treatment approaches associated with each subtype. She emphasized that molecular testing has become a critical component of care, helping clinicians identify patients who may benefit from targeted therapies. However, she also acknowledged practical challenges in real-world practice, including delays between ordering and receiving molecular testing results. In aggressive diseases such as anaplastic thyroid cancer, Barrett noted that bridging chemotherapy may sometimes be necessary while awaiting genomic data.

From a pharmacy perspective, Barrett highlighted the essential role pharmacists play in treatment selection, toxicity monitoring, and adverse event management. She noted that both multikinase inhibitors and targeted therapies are associated with a broad range of toxicities that often require prompt intervention, dose interruptions, or dose reductions.

Overall, Barrett said the guideline updates largely align with current clinical practice but reinforce the need for early molecular testing to ensure results are available when systemic therapy becomes necessary. She concluded that although treatment advances continue to improve care, additional research is needed to clarify optimal sequencing strategies between targeted therapies and multikinase inhibitors and to determine the best timing for initiating systemic treatment.