Clinical Trials Update Showcase Regimen That Increased Survival in Patients with High-Risk Types of Early-Stage Breast Cancer

Jordan Hill, PharmD, BCOP, Clinical Pharmacy Specialist – Oncology, West Virginia University Medicine, Morgantown, West Virginia, joined Pharmacy Times at HOPA Conference 2023 to discuss updates in the treatment of early-stage breast cancer (ESBC), discussing expanded drug approvals and the role of the oncology pharmacist for managing physical and financial toxicities.

PT Staff: What is the expanding role of the oncology pharmacist for early-stage breast cancer (ESBC)?

Jordan Hill, PharmD, BCOP: I think there is an ever-expanding role of the pharmacy oncologist in early-stage breast cancer.First and foremost is probably identifying patients that are appropriate candidates for the newer targeted therapies that are being used in early-stage breast cancer. These are patients that historically may have only received endocrine therapy alone. And now, we have a lot more options for them. And so keeping that in the back of your mind and being able to help our providers identify the most appropriate patients for these newer targeted therapies.

And then of course, helping to monitor any appropriate lab work that needs done, assessing for side effects is extremely important, adherence can be difficult with these medications due to the side effects—and so early assessment of side effects is really important to try to catch those side effects early, help start [patients] on appropriate supportive care medications which can help prevent the toxicities from getting more severe and help keep them on the medications longer. The newer targeted therapies are also very expensive. And so patients are very at risk for financial toxicity. So, helping to appropriately identify patients who might be at risk for financial toxicity, working with your colleagues to find resources that could be available to mitigate that.

PT Staff: Could you describe some recent clinical trial data; how could it shape the ESBC treatment landscape?

Jordan Hill, PharmD, BCOP: There were a few recent trials with exciting updates. A couple of them weren't necessarily with novel drugs, 1 of them was just helping to identify more patients who have just as good of outcomes without chemotherapy in the adjuvant setting, which is really exciting. So it's not a novel medication, it's more that you do just as well without chemo, which is something that's really exciting that they've been looking more at recently. And breast cancer is actually decreasing the amount of therapy that patients need to kind of minimize side effects in patients that maybe aren't benefiting from medications that are very toxic. And so, the RxPONDER trial really helped identify patients that clinically seemed high risk, but genomically weren't and so [they] didn't necessarily benefit from chemotherapy. That was a very exciting update in the last couple of years.

Another update without a (technically) novel drug was the KEYNOTE-522 regimen in neoadjuvant triple-negative (TNBC) that helped incorporate immunotherapy into our neoadjuvant treatment of TNBC patients to prolong event-free survival (EFS) and decreased distant recurrences. So even though pembrolizumab has been around for like 10 years now, it's new to breast cancer, and so that was exciting.

As far as more novel agents are targeted therapies, like abemaciclib and olaparib, have just recently been introduced into the early stage setting of breast cancer from the MONARCH and OlympiA trials. And so those medications, although they have been being used in the metastatic setting, are brand new to the early stage setting and really have helped identify ways to improve with OlympiA and the addition of olaparib in people with BRCA mutations that actually prolongs overall survival (OS), which is very exciting to see this early with a high-risk patient population of BRCA-mutated patients. And then with abemaciclib, we don't have long enough follow-up for OS to know for sure, but we definitely see decreases in recurrences and significant decreases also in distant recurrences, which are the non-curative recurrences. So that's really exciting to see some of those newer targeted therapies being used in earlier settings and improving outcomes.