Expert: The Role of Pharmacists in Optimizing Prostate Cancer Care

Scott Soefje, PharmD, BCOP, FCCP, FHOPA, MBA, director of pharmacy cancer care at Mayo Clinic, discusses the evolving treatment landscape for prostate cancer and the role that pharmacists can play in optimizing patient care and outcomes. He outlines several new second-generation androgen receptor antagonists and other emerging therapies that are helping to extend life expectancy and progression-free survival. However, he notes that the high costs of these medications often lead to financial toxicity and issues with non-adherence for patients.

Q: What are some of the novel therapies for prostate cancer that are currently in the pipeline?

Scott Soefje: Over the last several years, we've seen an increase in the second generation androgen receptor antagonists. We've seen the PARP inhibitors start showing up as treatments for prostate cancer. The newest one is the radioligand, and that's combined with a PSA targeted therapy. It's becoming fairly popular in some areas. We suspect down the line immunotherapy is going to be given a try. I know there's some clinical trials out there looking at bispecifics-target and PSA and then trying to pull the T cells into close. I'm sure someone's working on a CAR-T somewhere for it. So I think those are some of the things that are going to be interesting down the line is how do we use that PSA marker as a targeting function? Then are there other biomarkers that we can start taking advantage of BRACA1 and BRACA2? What can we do to help target that? Then I think the last thing will be are there ways to overcome resistance to prevent that castrate-sensitive disease to turn into castrate-resistant disease? And I'm sure there's there's a lot of work out there looking at that kind of research.

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Q: How can these novel therapies help to address gaps in care and improve outcomes for patients with prostate cancer?

Scott Soefje: Well, the the the new second generation, anti-androgens have made a significant leap forward over the first generation; they're more effective, hey have fewer side effects, they work better, and they're starting to find their place in therapy. They're actually kind of moving up into earlier lines of therapy as well, and we also look as we start combining them with chemotherapy and a few other things. How do we develop the best therapy for patients? The idea is to extend that life expectancy, the progression free survival, reduce the time to something becoming castrate resistant, you put all that together, and you really begin to affect the outcomes of these patients.

Q: What are some financial considerations for novel medications in prostate cancer?

Scott Soefje: Now these drugs aren't cheap. That's one of the problems, and so what we're seeing is a lot of financial toxicity with patients. The financial burden that these patients get under, and then what happens is it leads to nonadherence. What we know is a drug that the patient doesn't take isn't going to work, and as I teach my students from a cost effectiveness perspective, the most costly drug is the one that doesn't work, and so we're trying to make sure patients stay adherent, but then these added costs are a significant problem. When you look at the few cost effectiveness studies that have been done out there, we see some of the second generations are not cost effective at any level that we're willing to pay for it. So the question is, how do we improve all of that process? There's some generic drugs that are coming down the pipe, I think as the generics come out, that will help significantly, and anything we can do to help lower the financial burden will be a benefit to patients.

Q: What role can pharmacists play in educating patients about novel medications for prostate cancer?

Scott Soefje: Pharmacists are an important part of the care team now. When you look at a prostate cancer patient, as I said in the talk, they're dealing with up to 18 different health care providers across the continuum of care, we can help be that coordinating body, that coordinating group, that makes sure the patient's therapies are maximize and optimize. Then you also start looking at some of the complexities of these treatments. You have the androgen deprivation therapies that are some times long acting, so every 3 or 4 month type therapy, that they may be getting every 3 weeks chemotherapy, or daily or twice daily oral therapy. So helping a patient work through that complexity is something a pharmacist can be very, very helpful with. We're taught to deal with chemotherapy, we're taught to deal with the drug interactions and the adverse events, and help patients manage those processes to get the best outcomes we can.

Q: How can pharmacists best collaborate with other health care providers to optimize care and improve outcomes for patients with prostate cancer?

Scott Soefje: It's about communication. It's about making sure everybody knows what this patient's at therapy is, and then serving as that medication expert to help everyone in the care team understand what that patient is getting, and provide that comprehensive medication management, and by doing that, then we become sort of that linchpin that keeps all of the care teams together and helps the patient get through their entire their entire process.

Q: What are some unmet needs for prostate cancer, and what areas should be in focus for the future of treatment?

Scott Soefje: I think the financial burden is still a significant concern. These are elderly patients, most have Medicare. So there's a lot of out of pocket, it's going to be interesting to see as the rules for the oral out-of-pockets change with the inflation Reduction Act going into effect soon how that impacts some of these patients. But again, reducing that financial burden is something we have to look out and figure out how to do, and then on the research side is how do we identify the tumors earlier, so that we can treat them earlier and we always more effective if we get them earlier? And then once they evolve, what can we do to keep them castrate sensitive and prevent that resistance developing? And then how do we improve the patient's quality of life? What are those kinds of things that we can do to reduce the fatigue reduce the brain fog reduce the other things we see with these drugs and help the patients in you know live out their life and in a quality manner as much as lengthening it at the same time?