World Genomics Evaluation in Clinical Trials Sparks Worldwide Interest

Breast cancer expert joined a panel to discuss aromatase inhibitors at the San Antonio Breast Cancer Symposium (SABCS) on December 6, 2022.

William Jacot, MD PhD, professor at the Institut du Cancer de Montpellier, Université de Montpellier, Paris, France, speaks with Pharmacy Times about global interests in genomic evaluations and enlightening patients on drug-drug interactions.

PT Staff: What are some important factors pharmacists and providers should keep in mind about genomics for patients with metastatic breast cancer?

William Jacot, MD: It's really dependent on the part of the world where you are practicing. For example, from a French point of view (I’m French), we have quite an extremely restrictive level for alcoholism. So today, for example, the genomics are quite outside of a clinical trial without added value.

Today, a C01 that is clearly defined are breast cancer (BRCA)1 and BRCA2 mutations. We need, with the introduction of poly-ADP ribose polymerase (PARP) inhibitors, to access information in most parts of the world. And one can say that ESA1 mutation could be of interest for adaptation of hormonal therapy, it's something that is quite a little bit tricky in the evaluation, because it is important to insert perspective of selective estrogen receptor degraders (SERDs) and Faslodex, fulvestrant to use, and most of the time, these kinds of mutations do not arise in, and before, an extended exposure to aromatase inhibitor.

So the next step would be fulvestrant exposure. So is it really needed, or not, depending on, let's say, context of reflection? So many interests of the world genomics evaluation will be included in clinical trials, but you need to have the access of some units with dedicated students.

PT Staff: How can pharmacists bring more clarity to patients about their treatment options?

William Jacot, MD: More critical aspects of pharmacist counseling is clearly on drug-drug interactions and the mitigation of side effects. So I think that it's really tricky and needs to be, most of the time, focused on a small proportion of the pharmacists that are already enlightened on these kind of anti-cancer drugs (as we have many different options) but focusing on a small proportion of the world patients.

I think that continuous education for these new drugs is critical because most of them, [take] cyclin dependent kinase (CDK)4/6 inhibitors, are really good examples of that. We have numerous drug-drug interactions, and, for example, with ribociclib, the classic QT-interval (QTc) increased due to classical communications that can become dramatic in conjunction with ribociclid. So consultation, up-to-date information regarding this kind of direction and global pharmaceutical counseling [can] foster communication.

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