The Role of Oncology Pharmacists Is Evolving in Early-Stage Breast Cancer Treatment Optimization

Pharmacy Times interviewed Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services and clinical pharmacy specialist, Allegheny Health Network, on her presentation at the Hematology/Oncology Pharmacy Association (HOPA) Annual Conference 2024 in Tampa, Florida titled “Advancements in Early-Stage Breast Cancer: The Role of Oncology Pharmacists in Treatment Optimization.” Roman discusses how the role of the oncology pharmacist has changed in recent years within this space, as well as some of the advancements in early-stage breast cancer treatment.

Pharmacy Times: How has the role of the oncology pharmacist in determining optimal treatment sequencing of targeted systemic therapies for patients with early-stage breast cancer changed in recent years?

Danielle Roman, PharmD, BCOP: I think one of the biggest changes with the role of pharmacists is just the abundance of therapies that are available now. So we have a lot more to select from, and they each have very specific criteria for which patients to use them in, and each have very unique adverse effect profiles and just kind of overall management. So I think pharmacists have a huge role in helping with that therapy selection, as well as also helping, once patients are on therapy, helping to manage those therapies.

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Pharmacy Times: What are some of the advancements in targeted systemic therapies in early-stage breast cancer, and how have these updates changed the treatment landscape?

Roman: One of the biggest advancements we've seen is the use of CDK4/6 inhibitors in combination with endocrine therapy for patients that are hormone receptor (HR) positive HER2 negative, that have high risk early stage breast cancer. So, it's been really exciting that we have great data with the use of abemaciclib [Verzenio; Lilly USA, LLC] for 2 years in combination with endocrine therapy, and some newer data coming out with ribociclib [Kisqali; Novartis] for 3 years. That I think is still very new data, so hasn't hit guidelines yet or received an FDA approval, but really could expand the use of the CDK4/6 inhibitors.

Then we have targeted therapies with PD1 inhibitor pembrolizumab [Keytruda; Merck], and using that for triple negative breast cancer in combination with chemotherapy, and also the use of olaparib [Lynparza; AstraZeneca and Merck], a PARP inhibitor for patients that have germline BRCA1 or BRCA2 pathologic variants.

Pharmacy Times: With current advancements in early-stage breast cancer treatments, what is your experience with the awareness level of other care team members on some of these updates, and has education of colleagues been an important role for you?

Roman: Yeah, I think that with the field changing as rapidly as it is, it can be very difficult to keep up with the data. So, I think there's certainly a role for all of us in clinical pharmacy and just pharmacy in general to be advocates for our patients and in helping to educate the health care team. I think, in particular, it may be difficult in regular practice to be that primary educator for everyone. But I think really being aware of where the resources lie, and helping to direct colleagues to places where they can go for those resources is great. Also just, I think in a pharmacy role, really focusing in on some of the key aspects of therapy selection and then also the adverse effects, and just being a part of the care team and sharing that information is important.

Pharmacy Times: What are some education points you would recommend pharmacists focus on when educating providers and other colleagues on care teams about current advancements in early-stage breast cancer treatments?

Roman: I think the kind of the key education points will probably be along the lines of identifying the appropriate patients for each therapies. I think one of the complex things is that it is not a one size fits all. So with a lot of these newer targeted therapies, there's very specific criteria that should be used in selecting patients, and it's based on the way that the clinical trials were done—and they differ between all of these trials. So there's a lot to keep track of. So I think really identifying or helping to identify all that criteria with therapy selection.

Then as I mentioned, adverse effects and being able to appropriately monitor these therapies is a huge part of this, because we want our patients to be successful on therapy. So helping to be a part of identifying when adverse effects may necessitate holding, dose reducing a drug, or important supportive care strategies that can be used to help to improve the patient experience.

Pharmacy Times: What are some key areas where pharmacists should focus their counseling for patients with early-stage breast cancer?

Roman: I think in terms of patient counseling, in addition to just kind of what it is, what to expect from it, I think the pharmacists also play a huge role in just the logistics of it. Some of these therapies we're talking about adding to other therapies, so the treatment can be very complicated for patients. They may have drugs that have different schedules at different frequencies that they need to take, with different instructions on taking it with food or without food, and sequencing of all of this. So I think pharmacists can be really important for helping patients to navigate the overall treatment plan and what they need to do and when they need to do it and being a resource to them for questions, as well as drug-drug interactions, that becomes a very important thing, especially with some of the oral therapies. And then side effects, so being a resource to patients that they can reach out to when they have particular side effects, and then helping them to navigate what's going on and being an intermediary between the patient and the care team to develop the best plan.