Targeted Treatment of HR+/HER2-Breast Cancer - Episode 16

Pharmacist Involvement in Treatment Management for Breast Cancer

Alisa Vinokurov, PharmD, and Wassim McHayleh, MD, MBA, FACP, discuss pharmacists’ evolving role in treatment management for breast cancer.

Alisa Vinokurov, PharmD: Pharmacists are involved in a lot of things in terms of patients with breast cancer, specifically HR [hormone receptor]-positive, HER2-negative breast cancers. The initial decision will always be [made by] the oncologist. They’re the point of care for the patient who’s coming to see them, so they’re making that initial decision. Then we come in as the follow-up and for any dose adjustments or supportive care medications. We send out the [orders for] Compazine, Zofran, and dexamethasone [when necessary]. We come and fill in what needs to be filled, guide decisions, and help the APPs [advanced practice providers] on the day of therapy. We’re the drug information experts, so Dr McHayleh sometimes comes up and ask questions, such as “Is this contraindicated with this drug? Are there any drug-drug interactions?” With those types of things, we come in.

In terms of initial decision-making, that isn’t us in our current practice. But something in the works in our institution is that we’ll be providing a service where we’re the decision-makers with the oral medications, oral chemotherapy. It has been started in one of our Orlando locations, specifically the gynecologic oncology clinics, where the pharmacist is seeing the patients on oral chemotherapy. The follow-ups are spaced out depending on when they started it. If the patient initially started on Verzenio or a drug that requires more monitoring for adverse effects, we’d see them 1 to 2 weeks after the start and then follow through later and later and push that interval further. We would be the one seeing them, asking them about drug toxicities and how they’re handling everything, and adjusting the doses how we need to with the collaborative practice agreement.

Wassim McHayleh, MD, MBA, FACP: I’d like to add to Alisa’s comments. I like to involve the clinical pharmacist as early as possible in the process, even though we make the decision on the initial treatment plan. They play a very important role in choosing the therapy. She talked earlier about patient comorbidities, medications, drug interactions, conditions that will force you to change therapy, and patient support programs for particular treatment options when you have more than 1 potential option. They help us make the right decision for a particular patient, what would fit them better with a more appropriate co-pay, more compliance, etc, in addition to what she said about monitoring therapy and patient education.

I call pharmacists the gatekeepers. Any time someone calls me with any particular medication question or label question, I always refer back to the pharmacist. I say, “If you want to know about the label, ask them, because they know the label.” That’s just to add to what she said. [It’s] an extremely valuable and underused role that we’re trying to push forward for the benefit of the patients.

Transcript edited for clarity.