HOPA 2018 | A new role for pharmacists in the personalized treatment of cancer patients?

I think the first thing that we, as pharmacists, need to do, is embrace our background teaching or our background knowledge base of cancer biology, and how it relates to the pharmacology of the drugs. We get very pigeon-holed sometimes into looking at a very clear algorithms of “we do this” and this really opens up the art of medicine, of really supporting independent thought and looking at the literature on cancer biology and leveraging all of our drug knowledge.

We may get an instance where we have a brain tumor that we genetically profile and Drug A may be a really really great drug, crizotinib, for example, if we have a patient that has an ALK or a ROS1 alteration, but we, from the pharmacy side, that the drug isn’t going to cross that blood-brain barrier. The testing company on their front page under the results may recommend crizotinib but we know that that is not going to be the best option. So, what my team really tries to do, and I think where a pharmacist can really fit into this, is taking the recommendations that come back and matching not just the drug to the target but looking at all the patient characteristics: do they have a history of cardiac problems? Do they have renal insufficiency? Have they already received this drug? Do they have another mutation that may make this drug not work? Putting together the results and everything we know about the patient, and that’s what we do as pharmacists every day. This is just a different input of knowledge. I think that’s where we can make a big impact, and we’re also very good at talking to patients and trying to take complex mechanisms of action and turning it into something that they can understand. Now it’s taking a different pathway and helping patients to understand that.

I see a lot of my background as a pharmacist really lending itself well to what translating molecular results into the clinic really requires. One other thing that I will say though is that knowing the piece that I play in this role and being able to reach out and collaborate with colleagues to fill in those other pieces. So, being very close with our molecular pathologist, having a very close collaboration with them in our service has been absolutely essential, and I think for people who are starting up a service, not thinking that I need to do everything, it’s who do I need on my team, this is the role that I will play and building a workflow so that it complements everyone’s background and their expertise.

I was hoping that after the session, that people would: become aware of the opportunities that the profession has for delving into these complex molecular profiles and the need for it. I think it’s a great opportunity for pharmacy to take ownership of this, because the physicians can do it, but we’re all strapped with time and if someone really has a love for cancer biology and putting all of these things together, like the puzzle of each patient and kinda the story that comes out, you can make a huge difference in that patient’s life and you can also show the other medical professionals that we have the skill sets too, we have this knowledge base too that can be utilised in a different way. So, I really hope that people became aware and got more excited about this as an opportunity and also that we can start thinking about what types of training would be the most helpful for people who are participating in molecular tumor boards or working in a lung clinic and starting to see these somatic mutation reports coming in a standard of practice.

I think each meeting we build on where we are at that time, what we kinda learned and so my hope is that this is the beginning of helping people in this profession who are practicing as clinical oncology pharmacists to think about: “this is the future, this is here, I need to learn about this. What are the tools that will be the most useful for me to learn about and how can HOPA provide some of that?”