Oncology Care Pharmacy Has Promising Trends on the Horizon

As the coronavirus disease 2019 (COVID-19) pandemic persists through 2021, it is important to recognize that adults at any age with cancer are at an increased risk of severe COVID-19.¹ With 2 vaccines receiving emergency use authorization in the United States, pharmacists can play an important role to ensure oncology patients have access.¹

Additionally, there are a variety of oncology pipeline drugs to watch for in 2021. Pharmacists may also have expanded roles in oncology patient care management as part of the health care team.

Expanded Pharmacist Roles in Oncology

Pharmacists should ensure that patients have at least a 30-day supply of their oncology medications and continue to emphasize the importance of wearing a mask, frequent hand washing, social distancing, and avoiding travel during the pandemic.¹ In an interview with Pharmacy Times®, Bisni Narayanan, PharmD, MS, specialty clinical pharmacist at Outpatient Pharmacy Services, Yale New Haven Health System in Connecticut, discussed telehealth opportunities during COVID-19.

“Pharmacists can provide initial chemotherapy education, check for medication adherence, and reassessments all through telehealth,” said Narayanan. “I expect some of these changes to continue after the pandemic.”

According to a McKinsey report, the use of telehealth has dramatically increased from 11% in 2019 to 46% in 2020.² “The Centers for Medicare & Medicaid Services has relaxed some telehealth restrictions to enhance patient access to care,” Narayanan said. “Pharmacists do not have to be at the same site as the supervising physician, and direct supervision can be performed remotely as well. Patients are being switched to oral chemotherapy agents to reduce trips to infusion centers.”

One study examined trends in oncology care with a focus on the training and skills necessary for oncology pharmacists.³ Interviews were performed with oncology pharmacists with at least 5 years of experience. The study revealed that 85% of those surveyed reported that they expect changes in technology over the next 2 to 5 years, including enhancements to patient care, pharmacy automation, barcode administration, electronic health records, inventory, and analytics. Additionally, the study predicted more pharmacist involvement for immunotherapy (80%) and oral oncolytic therapy (90%). With the increasing demand for oncology pharmacists, there is a growing need for more postgraduate year 2 oncology residency programs and other advanced training opportunities.³

COVID-19 Vaccinations in 2021 for Patients With Cancer

The Pfizer-BioNTech and Moderna COVID-19 vaccines are currently available, and the CDC has issued recommendations for vaccine priority through phases, including⁴:

• 1a: health care personnel and long-term care facility residents;
• 1b: frontline essential workers and individuals 75 years and older; and
• 1c: individuals 65 to 74 years, those 16 to 64 years with underlying medical conditions, and other essential workers.

Ultimately, it is up to the states to decide vaccine priority, making it difficult for patients with cancer who are not in the current phase to get vaccinated. On January 12, 2021, members of Operation Warp Speed recommended that states expand access to COVID-19 vaccines to individuals 65 years and older and to any adults with underlying health conditions that increase the risk of severe COVID-19.⁵

Individuals who are currently receiving treatment for cancer or have advanced cancer that may increase the risk of complications from COVID-19 should be prioritized for vaccination.⁶ Patients with hematologic malignancies and lung cancers are especially at high risk of severe COVID-19. As more doses become available during 2021, patients with cancer will have greater access to COVID-19 vaccines.⁶

Oncology Pipeline Drugs for 2021

A variety of promising oncology medications are on the horizon for 2021. The FDA accepted a biologics license application (BLA) for idecabtagene vicleucel for priority review, which could be the first anti- BCMA chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma under development jointly by Bristol Myers Squibb and bluebird bio, Inc.⁷ The BLA is based on the phase 2 KarMMa study (NCT03361748), which revealed positive safety and efficacy results.⁷

Additionally, there is a rolling submission for ciltacabtagene autoleucel, a BCMA CAR T-cell therapy for the treatment of relapsed and/or refractory multiple myeloma based on positive results from the phase 1b/2 CARTITUDE-1 study (NCT03548207). The drug is under development by Legend Biotech in partnership with Janssen Biotech.⁸

Jennifer Gershman, PharmD, CPh, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

REFERENCES

1. People with certain medical conditions. Centers for Disease Control and Prevention. Updated December 29, 2020. Accessed January 10, 2021. https://www.cdc.gov/coronavirus/2019-ncov/ need-extra-precautions/people-with-medical-conditions.html
2. Telehealth: a quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. May 29, 2020. Accessed January 11, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality#
3. Ignoffo RJ, Knapp KK, Seung A, et al. Trends in the delivery of care to oncology patients in the United States: emphasis on the role pharmacists on the healthcare team. J Oncol Pharm Pract. 2021;27(1):5-13. doi:10.1177/1078155220907674
4. COVID-19 vaccines. Centers for Disease Control and Prevention. Updated January 11, 2021. Accessed January 11, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
5. Edwards E. In a push to get more vaccines into arms, officials recommend states give to anyone 65 and up. NBC News. January 12, 2021. Accessed January 12, 2021. https://www.nbcnews.com/health/ health-news/cdc-recommend-states-give-covid-vaccine-anyone-65-older-n1253887
6. Ribas A, Sengupta R, Locke T, et al. Priority COVID-19 vaccination for patients with cancer while vaccine supply is limited. Cancer Discov. Published Online December 19, 2020. doi:10.1158/2159- 8290.CD-20-1817
7. U.S. Food and Drug Administration (FDA) accepts for priority review Bristol Myers Squibb and bluebird bio application for Anti-BCMA CAR T cell therapy idecabtagene vicleucel (Ide-cel, bb2121). News Release. Bristol Myers Squibb. September 22, 2020. Accessed January 13, 2021. https://news.bms.com/news/details/2020/U.S.-Food-and-Drug-Administration-FDA-Accepts-for-Priority-Review-Bristol-Myers-Squibb-and-bluebird-bio-Application-for-Anti-BCMA-CAR-T-Cell-Therapy-Idecabtagene-Vicleucel-Ide-cel-bb2121/default.aspx
8. Legend Biotech announces initiation of rolling submission of biologics license application to U.S. FDA seeking approval of BCMA CAR-T therapy cilta-cel for the treatment of relapsed and/or refractory multiple myeloma. Legend Biotech. December 21, 2020. Accessed January 13, 2021. https://www.legendbiotech.com/pdf/LEGN_PR_12212020.pdf