Heather Moore, BCOP, CPP, PharmD

Pharmacists play a crucial role in managing drug interactions and optimizing treatment with CDK4/6 inhibitors for HER2-positive breast cancer patients.

Panelists discuss how CDK4/6 inhibitors can be considered for patients with visceral crisis based on limited data from the RIGHT Choice trial (though historically chemotherapy has been preferred), and how the number of positive lymph nodes in early-stage breast cancer drives treatment selection based on the specific inclusion criteria from the monarchE and NATALEE trials, with dual-eligible patients requiring consideration adverse effect profiles and patient-specific factors.

Panelists discuss how FDA-approved CDK4/6 inhibitors are used in early breast cancer (abemaciclib and ribociclib with different trial designs and dosing regimens) and metastatic breast cancer (palbociclib, ribociclib, and abemaciclib showing approximately 2-year progression-free survival advantages in various combination therapies).

Panelists discuss how there have been many new agents being studied and released at the current time and how the development of these agents is moving at a rapid pace. The adverse effect profiles of newer antibody-drug conjugates create a greater opportunity for pharmacists to be involved in toxicity management.

Panelists discuss how optimizing antibody-drug conjugate (ADC) therapy in patients with metastatic breast cancer (mBC) requires interdisciplinary care, including oncologists, pharmacists, and nurses. Adherence barriers such as cost, access, and insurance are addressed via financial and social support.

Panelists discuss how health care professionals use clear, tailored communication to explain antibody-drug conjugate (ADC) risks, benefits, and regimens. They provide education, address concerns, and ensure adherence through counseling and shared decision-making.

Panelists discuss how health care professionals use standardized antibody-drug conjugate (ADC) pathways to guide dosing, adverse effect (AE) management, and transitions. Protocols ensure monitoring, toxicity mitigation, and seamless shifts between therapies for optimal care.

Panelists discuss how pharmacists should monitor neutropenia, diarrhea, and mucositis from sacituzumab govitecan (SG); interstitial lung disease (ILD) and neutropenia from trastuzumab deruxtecan (T-DXd); and neutropenia and ILD from datopotamab deruxtecan (Dato-DXd). Proactive management is essential for patient safety.

Panelists discuss how antibody-drug conjugates (ADCs) often cause toxic adverse events (AEs). Supportive care includes antiemetics, corticosteroids, and growth factors. Infusion reactions are managed with premedication and slow titration.

Panelists discuss how antibody-drug conjugates (ADCs) often show more diverse outcomes in real-world settings compared with clinical trials, with varying efficacy and adverse effect profiles. Key practical considerations for pharmacists include appropriate dosing based on patient factors, managing drug interactions, implementing premedication protocols to minimize adverse reactions, and providing comprehensive supportive care. Careful monitoring and individualized patient management are essential for optimal therapeutic outcomes.

Panelists discuss how patient characteristics significantly impact antibody-drug conjugate (ADC) therapy selection, with key factors including the presence and location of brain metastases (due to blood-brain barrier penetration), organ function and comorbidities affecting toxicity risks, and prior treatment history that may influence both efficacy and safety. Treatment decisions require careful individualization.

Panelists discuss how emerging antibody-drug conjugates (ADCs) in metastatic breast cancer (mBC) treatment demonstrate innovation through optimized drug-to-antibody ratios, novel payloads, and targeted approaches to different breast cancer subtypes. Key trials explore combinations with established therapies and potential for improved tolerability profiles. Additional notable studies include comparative effectiveness research between approved ADCs and investigation of biomarker-driven patient selection strategies to maximize therapeutic benefit while minimizing adverse effects.

Panelists discuss how when making antibody-drug conjugate (ADC) treatment decisions for patients with metastatic breast cancer (mBC), pharmacists primarily consider patient-specific factors such as biomarker status, prior therapies, disease burden, and comorbidities. ADCs are typically introduced after standard first-line treatments show inadequacy or in specific molecular subtypes that demonstrate strong responses to targeted therapy.

Panelists discuss how antibody-drug conjugates (ADCs) for breast cancer (BC) differ in their safety profiles, with trastuzumab deruxtecan (T-DXd) having notable interstitial lung disease risk, sacituzumab govitecan (SG) associated with neutropenia/diarrhea, and datopotamab deruxtecan (Dato-DXd) showing a relatively favorable safety profile but still requiring monitoring.

Panelists discuss how HER2 testing optimization requires multisite sampling and quantitative assessment methods to account for intratumoral heterogeneity. Beyond HER2, biomarkers such as PI3K mutations, hormone receptor status, and tumor mutational burden can guide therapy selection for metastatic breast cancer (mBC), enabling more personalized treatment approaches.

Panelists discuss how antibody-drug conjugates (ADCs) show varying efficacy and adverse event (AE) profiles based on their payload potency, linker stability, and drug-to-antibody ratio. Cleavable linkers enable targeted drug release but may increase toxicity, while noncleavable designs offer better stability. Payload selection impacts both therapeutic index and AEs, with more potent warheads requiring careful optimization of targeting and release kinetics.

Panelists discuss how antibody-drug conjugates (ADCs) combine monoclonal antibodies with cytotoxic payloads, enabling precise targeting of breast cancer (BC) cells through specific antigen recognition. Upon binding, the ADC-antigen complex is internalized, releasing the toxic payload inside cancer cells while largely sparing healthy tissue. This targeted approach offers improved efficacy and reduces systemic toxicity compared with traditional chemotherapy's broad cytotoxic effects.

Panelists discuss how the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines for HER2-negative breast cancer (BC) have evolved to recognize HER2-low (IHC 1+  or 2+/ISH-negative) and HER2-ultra low (IHC 0) as distinct categories. These classifications, particularly HER2-low, guide eligibility for targeted therapies such as trastuzumab deruxtecan, expanding treatment options beyond traditional chemotherapy for previously categorized HER2-negative patients.

Key opinion leaders (KOLs) provide key takeaways on metastatic breast cancer and early breast cancer, emphasizing the enthusiasm surrounding recent advances in the field and the potential for improved patient outcomes.

The panelists share their concluding thoughts on the importance of collaboration between academic and community practices to achieve the best outcomes for their patients, which includes seeking second opinions and incorporating insights from tumor board discussions.

Medical experts discuss their perspectives on therapy approval and the significance of formulary inclusion, emphasizing the need to carefully consider both toxicities and benefits, which may ultimately lead to the operationalization of a drug in clinical practice.

Key opinion leaders (KOLs) discuss the use of CDK4/6 inhibitors in early breast cancer, specifically in patients who have undergone chemotherapy and surgery. They highlight the key factors that help determine which patients are most likely to benefit from receiving these medications.

The panelists discuss the clinical and economic factors that influence treatment decisions for early breast cancer (eBC), as well as the differences between eBC and metastatic breast cancer (mBC) in terms of adverse event management protocols and strategies for optimizing patient adherence.

Heather Moore, BCOP, CPP, PharmD, discusses the importance of treatment for early breast cancer, highlighting the use of chemotherapy followed by endocrine therapy. She notes that CDK4/6 inhibitors are being added for higher-risk patients, and oral selective estrogen receptor degraders may also be used in advanced cases.

Frank Scimeca, PharmD, MBA, BCOP, discusses the crucial collaborative effort between academic and community practices in managing and monitoring patients receiving CDK4/6 inhibitors, emphasizing the importance of communication and coordination to ensure optimal patient care.

Heather Moore, BCOP, CPP, PharmD, discusses switching from CDK4/6 inhibitors to later lines of therapy, typically due to toxicities, to alleviate symptoms. She emphasizes the goal of finding a new therapy rather than abandoning treatment altogether, and notes that targeted therapy may be necessary in cases of disease progression.

Frank Scimeca, PharmD, MBA, BCOP, discusses strategies for implementing cost-saving measures and utilizing patient assistance programs to help patients access therapy, while emphasizing the importance of mitigating financial toxicities for patients.