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Pharmacists are poised to play an increasingly vital role in breast cancer treatment as advancements in precision medicine adn biomarker-driven therapy selection reshape patient care. Experts at the San Antonio Breast Cancer Symposium (SABCS) emphasized the need for careful patient selection and toxicity management as new therapies emerge, highlighting the pharmacist’s critical position in coordinating these complex regimens.
The Expanding Role of Biomarkers
The increasing availability of treatment options necessitates a more refined approach to identifying patients who will most benefit from – and tolerate – specific therapies.”Having more and more therapy options is great, but we need to do a better job…at identifying patients who are most likely to benefit from and tolerate those therapies,” one oncology expert stated.
Recent data presented at the symposium focused on giredestrant, a third oral selective estrogen receptor degrader (SERD) showing promise. This builds on the approvals of elacestrant and imlunestrant for patients with metastatic hormone receptor-positive breast cancer harboring the ESR1 mutation. A key distinction with giredestrant lies in its study within the adjuvant population, where ESR1 mutations are rare. This underscores the importance of understanding nuanced differences in indications and toxicities,even within a drug class.
“That’s a realy good example of needing to be aware of how biomarkers impact the indication for a class of drugs,” the expert explained.
Minimizing toxicity Through Proactive Pharmacy Coordination
Alongside advancements in targeted therapies,reducing treatment-related toxicities without compromising efficacy remains a central focus. Pharmacy coordination is proving essential in this effort.
A new ramp-up dosing strategy for abemaciclib, supported by data presented at SABCS, exemplifies this approach. Implementing this strategy requires meticulous attention to prescription ordering and patient education, as manufacturers currently do not offer pre-packaged dose escalation kits. “That requires quite a bit of coordination in terms of making sure the prescription is ordered appropriately and making sure that it will get filled,” the expert noted. Data from the conference confirms the effectiveness of this ramp-up approach.
Managing Metabolic Complications with PI3K and AKT Inhibitors
Pharmacists are also taking a leading role in managing the side effects of newer therapies, particularly hyperglycemia associated with PI3K and AKT inhibitors. These drugs, while effective, can disrupt insulin signaling, leading to elevated blood sugar levels. Close monitoring of glucose levels and proactive interventions, such as diabetes management education and medication adjustments, are crucial.
Why: Precision medicine is evolving breast cancer treatment,requiring more tailored approaches to therapy selection and toxicity management.
Who: Pharmacists are becoming increasingly vital in this process, coordinating complex regimens and managing side effects. Oncology experts at the San Antonio Breast Cancer Symposium (SABCS) highlighted this shift.
What: New therapies like giredestrant, elacestrant, and imlunestrant (targeting ESR1 mutations) and abemaciclib (with a new ramp-up dosing strategy) are emerging. Pharmacists are key to implementing these effectively and safely.
How did it end?: The article concludes by emphasizing the pharmacist’s role in managing hyperglycemia associated with PI3K and AKT inhibitors, highlighting the ongoing need for proactive monitoring and intervention as new therapies are introduced. The SABCS presentations underscored the importance of these evolving roles.
