Pharmacists Help Bridge Practice Gaps in CML TKI Management

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Allison Morse, PharmD, BCOP, discusses common challenges in optimizing tyrosine kinase inhibitor (TKI) therapy for patients with chronic myeloid leukemia (CML), including medication access, adherence, and toxicity management. She emphasizes the importance of up-front patient education and frequent pharmacist touchpoints between visits to identify adverse effects, address cost concerns, and support continued treatment. Morse also highlights the potential future role of genomics in personalizing TKI dosing and assessing toxicity risk.

Pharmacy Times: In your session, you focus on bridging knowledge and practice gaps in CML—what are the most common challenges you see in optimizing TKI therapy in real-world settings?

Allison Morse, PharmD, BCOP: Awesome, that’s an excellent question. I think one of the biggest initial barriers is that we sometimes have issues getting medications. I’m fortunate to be at an institution where we have a large team of people [who] help to obtain grant funding if needed and help with prior authorizations, that sort of stuff, which a very savvy patient could do on their own. But sometimes that’s an area that the pharmacist gets looped into.

Additionally, toxicity is an area that I think is a struggle sometimes for patients. So we do diagnose them, and then typically it’s about every 3 months that we’re seeing these patients, so we may not know what’s happening in between those 3 months. That’s a great area to help optimize, because we don’t know what’s going on in between those months, and we may have toxicity develop that the patient isn’t aware of. So it’s really important to educate them up front.

Pharmacy Times: Patient adherence is critical to TKI success—what pharmacist-led strategies have proved most effective in improving adherence among patients with CML?

Morse: Another good question. One of the biggest aspects is education—early, up-front education—so patients understand what toxicities they are looking for. Do they know what to anticipate, or do they have no idea that a headache may be prompted by this medication? That would be the best initial situation. Then, at our different assessment points, oftentimes the pharmacist will be calling the patient in between their fills, just to ensure that they have the medication and they know where to send it. Usually, these are delivery-type medications, so that’s another good checkpoint to understand how they’re doing on this medication and to assess adherence.

Pharmacy Times: With your background in pharmacogenomics, how do you see genomic insights influencing TKI selection or management in CML moving forward?

Morse: I think this is a really interesting question. I’m glad you brought it up. Genomics is an evolving field, and it’s not something that I’ve seen us use necessarily with TKIs, but I think that understanding how the patient’s genes work and how they can be different with different medications could help us optimize treatment. Maybe that means starting at a different initial dose—a higher dose or a lower dose—depending on how the patient metabolizes the medication, and potentially understanding which toxicities they may be at higher risk for based on their genetics.

Pharmacy Times: For community oncology pharmacists looking to expand their role in CML care, what key opportunities exist to enhance patient outcomes and support long-term disease management?

Morse: Another good question. I think it’s these frequent touchpoints. Going back to the initial education with patients, they need to understand what they’re looking out for. Then, when you’re calling patients to discuss the medication and send out new refills, you’re really checking in with them—understanding if they’re having any issues with cost, any issues with [adverse] effects, or anything else that’s causing them to have a problem taking their medication or that would warrant a switch. Those frequent touchpoints are much more accessible than the physician can be, so being able to have that collaboration with the physician and the community pharmacist is really beneficial.