Pharmacy Times interviewed Breanne Peyton-Thomas, PharmD, BCOP, clinical pharmacy specialist – hematology/oncology, bone marrow transplant/cellular therapy at Ochsner Health in New Orleans, Louisiana, on the role of the bone marrow transplant pharmacist in CAR T-cell therapy and her collaboration with the CAR T-cell therapy team at Ochsner.
Pharmacy Times: What is your role in CAR T-cell therapy?
Breanne Peyton-Thomas, PharmD, BCOP: So being the pharmacist, I'm in charge of anything and everything pharmaceutical. We make sure that the patient is getting the right dose, the at the right frequency, and for how many doses. And so, we would also assess like their liver function and renal function, in case the any of the drugs happen to go through the liver or kidneys. So, we can make dose adjustments to keep it safe for the patient, that's when they come and get their chemotherapy. The other thing that we do is we sit with the patient before everything even starts, and we go over in detail the drugs that they're going to be receiving, and then a little bit about the CAR T product, mostly like an infusion reaction that they might develop. So, we'll pre-med just to make sure that nothing happens. And then we go over all the supportive care medications that they would receive while they're in the hospital. So, a lot of that has to do with antibiotics because they are at an infection risk, and then anti-seizure medications as well.
Pharmacy Times: How importance is the CAR T-cell therapy team at Ochsner?
Peyton-Thomas: So besides educating the patient on the side effects of the chemotherapy and just the side effects of CAR T in general, a lot of what I did was—we didn't have these treatment plans built into EPIC yet, and so I had to hand build these plans for both of our first patients, hoping that the next one that comes along, the plans will be in production and ready for use. But that's the world of oncology: If something new and exciting comes out, we may not always have something built. So, I had to build order by order all the communications, all the instructions to the nurses if something happened, obviously the drugs, and then all the supportive care medications in there as well.
Pharmacy Times: Do you have to be ready to pivot at any moment?
Key Takeaways
- Pharmacist's Critical Role in CAR T-cell Therapy: Peyton-Thomas emphasizes her responsibilities as a bone marrow transplant pharmacist, including adjusting doses based on liver and kidney function, educating patients about medications, managing supportive care, and pre-medicating to prevent adverse effects. Her role is central to ensuring patient safety and optimizing therapeutic outcomes.
- Collaborative Multidisciplinary Team: She highlights the importance of teamwork in CAR T-cell therapy, where pharmacists, physicians, and nurses collaborate to build treatment plans and adapt them as new information becomes available. For example, Peyton-Thomas quickly incorporated steroids into a patient’s plan to mitigate potential adverse effects, demonstrating the need for flexibility and quick decision-making in oncology.
- Excitement About CAR T-cell Therapy's Future: Peyton-Thomas expresses enthusiasm about the potential for CAR T-cell therapy to revolutionize cancer treatment, potentially replacing traditional bone marrow transplants. She reflects on the reduced infection risk and better patient outcomes as key advantages, seeing the therapy as a transformative step in oncology.
Peyton-Thomas: When our first patient admitted 24 hours beforehand, we actually got information about using steroids up front to prevent a lot of the side effects of the chemotherapy or the CAR T and so [Leonard Alsfeld, MD] actually talked to me about 24 hours before this patient admitted and was like, I think I want to add some steroids to his plan. So I did, and I'm very happy that we did, because he didn't have as many side effects that could have happened because of those steroids. So yes, pivoting at any moment.
Pharmacy Times: What is it like to work with such a robust team?
Peyton-Thomas: I absolutely enjoy it, because everyone kind of brings something to the table that's their specialty. So obviously, working with the physicians, they're very pharmacy friendly, and they rely on us a lot for treatment plan builds, and the patients just enjoy having us to walk them through some of these really scary side effects. Because they could hear things about chemotherapy, and all they have are the stories. So when they come and meet with us, I can kind of make it a little bit easier and more fun, or not as scary for them.
Pharmacy Times: What do you love most about what you do?
Peyton-Thomas: The patients. I enjoy seeing the patients and being that person [who] calms them down about a side effect, such as nausea. Nausea is kind of my passion. So, all they've heard are stories of how other people that they have known have gone through chemotherapy, and they'll always say, like back in the old days, Oh, I got so nauseated I would never do chemotherapy ever again. But we now have new drugs that have come out that most patients don't know about. So being that person to get to tell the patient that we are using this new medication, it has a really long half life, which means it's going to cover you for a couple of days. Just being able to walk them through that, and seeing them go from scared to feeling more comfortable—I love that part of my job.
Pharmacy Times: How was the transition into CAR T-cell therapy, and what are the advantages you’re already seeing?
Peyton-Thomas: So, for 10 years, I've been a bone marrow transplant pharmacist. Immunosuppression, tacrolimus—that's been my jam. So now, not needing that anymore with CAR T and seeing these incredible responses, and the patient not having to be on something that prolongs their infection risk, or just not having the same infection risk in general as transplant, it's absolutely amazing for me to see. It's been an incredible journey for me to get to witness this firsthand.
Pharmacy Times: How excited are you about the future of CAR T-cell therapy and how it’s going to evolve?
Peyton-Thomas: I always joke that CAR T's probably going to take over. Will we have any more transplants in the future? So, everything that I've been doing for the past decade might not—not that it doesn't matter anymore—but we're moving on to bigger and better things, and it's just very exciting.
