Pharmacists’ Expanding Role in Optimizing Oral Endocrine and Targeted Breast Cancer Therapies

At the San Antonio Breast Cancer Symposium (SABCS) in San Antonio, Allison Butts, PharmD, BCOP, discussed the growing complexity of oral breast cancer therapies and the critical role pharmacists play in optimizing their use. She emphasized that as treatment options continue to expand, it is increasingly important to identify patients most likely to benefit from and tolerate specific therapies, particularly as agents with similar mechanisms enter clinical practice.

Pharmacy Times: SABCS often brings forward advances in precision medicine, including biomarker-driven therapy selection. How do you see the pharmacist’s role evolving as breast cancer care becomes even more individualized?

Allison Butts, PharmD, BCOP: So, having more and more therapy options is great, but we need to do a better job, as we get more therapies, at identifying patients who are most likely to benefit from and tolerate those therapies. I think one example that’s come out of the conference so far is that we’ve got data now on giredestrant, which is the third oral SERD that really seems to be coming along. We’ve got two, elacestrant and imlunestrant, which was recently approved in the metastatic hormone receptor–positive space, specifically in those with the ESR1 mutation.

What makes the new study with giredestrant different is, one, that it’s in the adjuvant population, but we know that ESR1 mutations are virtually unheard of in that population. So, I think we really need to be aware of how these different therapies that may seem like “me too” drugs differ from one another in their indications and toxicities. I think that’s a really good example of needing to be aware of how biomarkers impact the indication for a class of drugs.

Pharmacy Times: A recurring conversation at SABCS is how to reduce treatment-related toxicities without compromising efficacy. From a pharmacy coordination standpoint, what strategies or pharmacist-driven interventions have shown the most promise?

Butts: Another example that we’ve been working on recently, which had additional data presented at San Antonio this year, is the new ramp-up dosing strategy that’s in place for abemaciclib. That’s something that we’ve certainly translated into the clinic, and that requires quite a bit of coordination in terms of making sure the prescription is ordered appropriately and making sure that it will get filled. Right now, the manufacturer doesn’t necessarily make a dose pack or anything like that for this dose escalation. It would be great if they did, but for now, we have to be a little bit strategic in how we’re prescribing it and then make sure the patient is aware of that ramp-up and how to take the medication appropriately. As I said, more data from this conference has shown that this ramp-up is an effective strategy.

Another hot topic that pharmacists have been really involved in recently is hyperglycemia management with our PI3K and AKT inhibitors. We’ll see, as the conference goes on, if we get more data about those drugs, but it seems like we’re using those more and more every day. That’s another area where, going forward, pharmacists will have a major role in coordinating care for those types of therapies as well.