About the Editor in Chief
Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, succeeds Lisa E. Davis, PharmD, FCCP, BCPS, BCOP, as editor in chief of Pharmacy Practice in Focus: Oncology. Mahmoudjafari is a clinical pharmacy manager in the Blood and Marrow Transplant Program in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Cancer Center in Kansas City, Kansas. Mahmoudjafari is a board-certified oncology pharmacist involved in several oncology-pharmacy organizations, such as the Hematology/Oncology Pharmacy Association (HOPA), currently serving as secretary on the HOPA board of directors. She has also been the chair or cochair of conferences such as Advanced Topics for Oncology Pharmacy Professionals and Oncology Pharmacists Connect. In 2022, she was the recipient of the American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Lifetime Achievement Award and received the American Society of Clinical Oncology’s 40 Under 40 in Cancer Award.
Mahmoudjafari has presented nationally on her experience with managing high-cost therapies and on clinical topics such as cell and gene therapies, acute and chronic graft-vs-host disease, and the management of fungal infections in hematopoietic stem cell transplantation. Mahmoudjafari completed her pharmacy training at the University of Missouri-Kansas City (UMKC) and her PGY-1 pharmacy practice residency at The Ohio State University Wexner Medical Center. She completed her PGY-2 oncology residency at Huntsman Cancer Institute at the University of Utah and most recently received her MBA from Henry W. Bloch School of Management, which is affiliated with UMKC.
In the field of cancer care, it has been a jam-packed summer, with multiple key conferences shedding light on new data and developments in therapies, such as bispecific antibodies (BsAbs). In October, we now have the approval of 9 BsAbs in both hematology and oncology, and we anticipate more to come.
BsAbs are a class of immunotherapies designed to simultaneously bind 2 different antigens, typically one on the cancer cell and one on a component of the immune system. This dual-targeting mechanism allows BsAbs to direct T cells to the malignant cells, enhancing their ability to recognize and eliminate malignant cells.
Trispecific therapies are also in clinical development, and we have much to learn when it comes to optimizing these therapies. For this reason, pharmacists have emerged as a critical component in managing patients receiving these therapies operationally, financially, and clinically to enhance patient outcomes.
Pharmacists are often the catalyst for ensuring a new drug is operational within the health care system. This is a component of our role that we do not receive enough credit for, and we should do a better job of highlighting this as a profession. From working within the multidisciplinary care team and ensuring formulary inclusion to developing the electronic medical record entry, pharmacists are essential in developing institutional protocols outlining drug handling, compounding, and storage while also creating monitoring requirements and adverse event (AE) management strategies. AEs such as cytokine release syndrome (CRS) and neurotoxicity have mainly been limited to the administration of chimeric antigen receptor (CAR) T-cell therapies, but centers have been challenged to provide more comprehensive education to personnel on these unique toxicities. To support this training endeavor, pharmacists are well positioned to complete this education and share insights with the larger team.
Pharmacists are also aware of the financial ramifications of drug therapies and can serve a significant role in stewardship opportunities at their center by helping raise awareness of payer and reimbursement implications to ensure the financial sustainability of treatment for patients. Additionally, at least with the multiple myeloma products, there have been associated Risk Evaluation and Mitigation Strategy (REMS) programs requiring compliance prior to dispensing these therapies. Perhaps someday we can see the removal of the REMS program for BsAbs in the CAR T-cell setting, but for now, a component of REMS includes annual audits, which are completed by the pharmacy team.
Clinically, BsAbs require specialized dosing regimens, often involving step-up dosing to minimize the risk of CRS. Pharmacists play a key role in recognizing the early signs of CRS, educating patients and their caregivers on what to watch for, and ensuring prompt administration of treatments such as corticosteroids and tocilizumab (Actemra; Genentech). As frontline providers in many outpatient settings, pharmacists are well positioned to monitor patients and manage CRS severity, potentially preventing the need for hospitalization. Despite these acute toxicities, BsAbs can cause significant infections, and it’s imperative that a strong supportive care regimen be in place.
BsAbs are poised to become an essential part of the therapeutic arsenal for several disease states. Their unique mechanism of action, combined with their off-the-shelf availability, positions them as highly effective and accessible options for a broader patient population. With the emergence of these new therapies in cancer care also comes the opportunity for pharmacists to work internally and more broadly with other centers in research and reports of patient outcomes. We have much to learn when it comes to this drug class of therapies, and I encourage us to be curious and not shy away from making an important difference.
Additionally, as pharmacists, we are uniquely positioned to advocate for policies that impact the health and well-being of our patients and communities. Our profession gives us insight into critical issues such as medication access, health care reform, and public health initiatives. It is essential that we not only engage in clinical work but also take part in advocacy efforts, ensuring that our voices are heard at both local and national levels. With upcoming elections, now is the time for pharmacists to be proactive, informed, and involved in shaping the future of health care. I didn’t really appreciate the significance of this until recently during some of my MBA courses, and how critical advocacy is. Our participation in the democratic process can drive meaningful change for the profession and the patients we serve.
