Pharmacist Contributions to Patient Care in Cervical and Endometrial Cancers: From Prevention to Metastatic Disease

PTCE would like to acknowledge Merck Sharp & Dohme Corp. and Eisai Inc. for their generous support of pharmacist education.

In a live 2020 Directions in Oncology Pharmacy^® conference session titled Cervical and Endometrial Cancers: A Pharmacist’s Review of the New and Emerging Treatment Paradigm for Patients With Advanced or Metastatic Disease, Judith A. Smith, PharmD, BCOP, CPHQ, FCCP, FHOPA, FISOPP, provided an update on the management of cervical and endometrial cancers.

The educational session began with a review of cervical and endometrial cancers, with an emphasis on the role of molecular testing, such as microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR). Recommendations from the National Comprehensive Cancer Network (NCCN) on surgery, radiation, and chemotherapy in the management of cervical and endometrial cancers were also reviewed.

Dr Smith highlighted the role of immune checkpoint inhibitors (ICIs) in the management of advanced cervical and endometrial cancers. She described the clinical trials leading to FDA approval of bevacizumab and pembrolizumab in cervical cancers, as well as the data supporting use of trastuzumab, pembrolizumab with or without lenvatinib, and bevacizumab in advanced endometrial cancer.

Specifically for advanced cervical cancer, the data for use of bevacizumab in combination with paclitaxel based on the GOG 240 trial were reviewed, as well as the KEYNOTE-158 trial with pembrolizumab in the treatment of recurrent or metastatic cervical cancer for patients who have at least 1% programmed death-ligand 1 (PD-L1) positive tumor cells. For advanced endometrial cancers, the phase 2 data to support the use of trastuzumab in combination with chemotherapy were discussed, as well as the phase 2 data of pembrolizumab with or without lenvatinib in specific patient populations. The phase 1/2 data showing the role of bevacizumab plus chemotherapy in advanced endometrial cancer were also reviewed.

Dr Smith reviewed the pharmacist’s role in disease prevention based on risk factors for cervical and endometrial cancers. The human papillomavirus (HPV) vaccination is recommended in male and female patients aged 11 to 12 years and is also approved in adult patients to prevent cervical cancer. Pharmacists can assist in offering vaccinations and providing recommendations on other lifestyle modifications, such as weight management support and smoking cessation.

The session concluded with an emphasis on the role of pharmacists in caring for patients with cervical or endometrial cancer, with a brief review of adverse effects associated with radiation or drug therapies. Specifically, strategies to prevent and manage adverse effects associated with immune checkpoint inhibitors and targeted therapies were emphasized, as well as immune-related adverse events (irAEs), including diarrhea, colitis, pneumonitis, and thyroiditis. Additionally, counseling points for patients, plans for monitoring adverse effects, and safe handling of antineoplastic agents were highlighted. Dr Smith emphasized the value pharmacists provide by assisting in coordination of care and potentially facilitating patient access to medications through insurance approvals and enrollment in patient assistance programs.