Armada Summit CE Session: Lung Cancer Patient Management and Specialty Pharmacies

Emerging therapies and the role of specialty pharmacies in the treatment of non-small cell lung cancer were discussed during a continuing education session at the annual Armada summit.

Specialty pharmacies can help lung cancer patients mitigate adverse events and stay on their therapies longer, according to Donna M. Smith, PharmD, director of clinical affairs at Avella Specialty Pharmacy.

Dr. Smith presented a continuing education session on lung cancer patient management for specialty pharmacies on May 6, 2014, at the annual Armada Health Care Specialty Pharmacy Summit and Expo in Las Vegas. The program was sponsored by the Pharmacy Times Office of Continuing Professional Education and the Specialty Pharmacy Association of America, and was supported by educational grants from Astellas Scientific and Medical Affairs, Inc, and Genentech.

During the session, Dr. Smith discussed clinical features and outcomes in non-small cell lung cancer, the rationale for gene mutation and rearrangement testing, emerging therapies, and the role specialty pharmacies play in optimizing clinical outcomes. Given the significant impact of adverse events on patients utilizing various drug therapies, Dr. Smith said specialty pharmacies serve as a positive influence to improve medication adherence.

“When you’re feeling tired all the time, when you’re feeling nauseous all the time, when you have diarrhea all the time, it’s just not a very fun time for anybody given the prognosis,” Dr. Smith told the audience. “Specialty pharmacy does have its place to try and reduce the adverse events to not only help them stay on the drug longer, but to help them enjoy their time with their family a little bit longer.”

There were more than 224,000 new cases of lung cancer with 160,000 deaths in 2013, Dr. Smith said, making the disease the leading cause of cancer-related death in the United States. The 5-year survival rate from 2004 to 2010 was 16.8%, with a 1-year survival rate of 42%.

She noted that treatment options are gradually moving toward molecular-targeted therapies that block the proliferation of cancer cells.

“The patient can have some of the tumor removed and then have chemotherapy right before or after,” she said. “[Chemotherapy] does not differentiate between healthy cells and tumor cells, so it kind of wipes out everything there is. With molecular-targeted therapies, we’re looking at preserving more of the healthy cells and attacking the tumor cells.”

Quality of life issues, while dependent on the stage of disease and treatment strategy, include hair loss, nausea and vomiting, appetite loss, and impaired physical functioning. Dr. Smith also reviewed current and emerging therapies during the session, with a focus on erlotinib (Tarceva), afatinib dimaleate (Gilotrif), bevacizumab (Avastin), and crizotinib (Xalkori).

Due to the high cost of these therapies, Dr. Smith noted that specialty pharmacies play a vital role in making sure patients get the appropriate treatment and stay on their medications. This includes obtaining prior authorization for medications, providing patient and provider training, and establishing the length of therapy for treatments with a recommended duration.

“These drugs don’t work unless the patient takes it, but as we’ve gone through in this presentation there are lots of adverse drug events that happen to the patients where it becomes intolerable to them,” Dr. Smith said. “The specialty pharmacy has a role in trying to mitigate those adverse events so the patient can stay on the drug longer.”

Click here for more information on CE sessions offered by the Pharmacy Times Office of Continuing Professional Education for specialty pharmacy.