Leaders in Pharmacy Come Together to Discuss and Debate Oncology-Related Developments

Chris Fausel, PharmD, clinical manager, Oncology Pharmacy, Indiana University Health, Val R Adams, PharmD, associate professor, University of Kentucky, Kirollos Hanna, PharmD, oncology pharmacy manager, M Health Fairview—Maple Grove, and assistant professor of Pharmacy, Mayo Clinic College of Medicine, and Lisa Holle, PharmD, associate clinical professor, UConn School of Pharmacy, UConn Health Carole and Ray Neag Comprehensive Cancer Center, come together to discuss a new CPE event—Great Debates & Updates Oncology Pharmacy—aimed at educating pharmacists interested in oncology developments. Together in this video, the four meeting cochairs break down the various clinical and potentially controversial topics that will be discussed during these 3-day events. 

Learn more about the meeting and how to register for the event. 

Read the full transcript:

Dr Chris Fausel:  Hello, my name is Chris Fausel. I'm an oncology pharmacist that practices in precision medicine at the Indiana University Siteman Cancer Center in Indianapolis, Indiana. I have the privilege of being a cochair of the program for Great Debates in Oncology Pharmacy that's going to be upcoming in the next couple of weeks.

What I'd like to do now is to introduce my cochairs that are a part of this program with me. Dr Adams?

Dr Val Adams:  Hey, thanks, Chris. It's my pleasure to be part of this program as a cochair. What a fantastic program we've got coming up.

I'm an associate professor at the University of Kentucky and have a practice site over at the Markey Cancer Center, where I work with a lot of research protocols and things like that and a protocol review and monitoring committee, as well as the clinicians and the docs and see some of the patients. I think we've got a great program planned for us today.

I'll stop my introduction there and turn this over to Lisa.

Dr Lisa Holle:  Thank you. I am also very excited to be a part of this, cochairing this new oncology pharmacy program.

I am Lisa Holle. I'm a clinical associate professor at the University of Connecticut School of Pharmacy, and I practice at our UConn Health Carole and Ray Neag Comprehensive Cancer Center. I'm in a team-based practice focusing mostly on GI and GU malignancies.

I'll hand it over to Dr Hanna.

Dr Kirollos Hanna:  Hi, everyone. I'm extremely honored and excited for this new upcoming program, certainly honored to serve with my other colleagues as a cochair of this program as well as oncology pharmacy. I think many of you will find this very interactive in terms of the debate format that we have lined up for you.

My name is Kirollos Hanna. I'm currently the oncology pharmacy manager at M Health Fairview in Minneapolis, Minnesota. I also serve as assistant professor of pharmacy at the Mayo Clinic College of Medicine. I certainly hope that you all find our program very beneficial to you on clinical practice and operations.

Dr Fausel:  Thank you very much, folks. For those of you that haven't participated in this great debates-type format before, we feel we owe you a little bit of an explanation about how this is all going to work. To get that off the ground, we're going to have our esteemed colleague, Dr Holle, explain a little bit about how that's going to work.

Dr Holle:  We're very excited about this new program called Great Debates in Oncology Pharmacy. It is a new program, as we mentioned, and it is including nationally recognized oncology pharmacists who'll be both debating, as well as having clinical panels on current clinical and controversial topics that are really shaping how we're caring for our patients with cancer.

We will also provide some up-to-date information about new advances in oncology pharmacy as well as patient practice management guidelines. Although this is a virtual event, we really hope that we can have an engagement with our audience.

We have several opportunities to do that, both engaging discussions at the end of our debates and clinical practice updates, as well as a live Q&A session between the attendees, as well as the faculty members, and several networking events throughout the program.

Dr Fausel:  Thank you very much, Dr Holle. Dr Adams, who should attend this meeting? Should it be any pharmacy practice? Obviously, there's going to be clinical pharmacy education credits that are going to be provided. Who do you think will provide the most benefit in terms of education, from an audience standpoint?

Dr Adams:  I would say all pharmacists clearly need to participate. One of the beautiful things in oncology right now is we're getting new drugs all the time. The standard of care is changing rapidly and improving. The vast majority of these new drugs, we don't know the best sequence always.

The other thing, as care becomes more fractured, what we tend to see is with some of the oral drugs, somebody's filling, in a specialty pharmacy, perhaps filling the anticancer drug, but the side effects may be treated at Kroger's.

Even community pharmacists, I would argue, should participate, but pharmacists I think, in all realms, because we're talking about gray areas where it's not always the most clear. We're also providing some updates for some of the more current drugs that were more recently approved.

I think everybody will benefit from participating, at least pharmacy. This is all really driven around drugs, and the questions evolving around that.

Dr Fausel:  Thank you, Dr Adams. Just to highlight what you just said, this past Friday, we had two new drugs approved by the FDA. First off, sotorasib, the first ever KRAS-directed therapy approved for cancer, and secondly, infigratinib for FGFR-mutated cholangiocarcinoma.

It seems like, every other week, we're getting new agents that are really important agents approved by the FDA, which is wonderful news for our patients. For us, as pharmacists, it's tough to keep track of all this stuff. All of us have been doing this for a number of years. Some of us, more than others. We wouldn't really get into how many years, but it's tough to keep up.

What we've tried to do with organizing this program is to provide a format with getting you the most up-to-date informations and providing state of the art practice of oncology pharmacy in some of the most fast moving topics.

For example, the way that we have this program set up. There's a three-day program. Day one, we're primarily focusing on hematologic malignancies. We're going to be talking about chronic lymphocytic leukemia, and we're going to have a debate about that.

As anyone that is practicing in hematologic malignancies knows the drugs are coming fast and furious for chronic lymphocytic leukemia. The sequencing of drugs and the combination of drugs, of how they're to be applied, keeps changing almost by the minute in chronic lymphocytic leukemia, so it's a hard disease to keep up with. We're going to spend some time on that.

Multiple myeloma actually preceded chronic lymphocytic leukemia is one of the first hematologic malignancies. There was a sea change in how that disease was managed over the last decade, and it's not slowing down.

You have a disease that started off with basically three or four drugs. A little over a decade ago, in some patients, that could go to hematopoietic stem cell transplant. Now, where there's over 10 drugs, the median survival of the disease has improved from 3 to 5 years to 8 to 10, sometimes even more.

We've had patients that have made it out 20 years with multiple myeloma, which was unheard of. We're going to talk about that. We're going to talk about acute myeloid leukemia, which again there is a disease where nothing changed for 30 years. All of a sudden, in the last 3 or 4 years, we have a plethora of new drugs. I'm actually going to be talking about that at the end of day one.

Day two, we're going to switch gears, and we're going to talk about women's cancers. We're going to talk a bit about breast cancer. We're going to talk about targeted therapy in breast cancer. We're going to talk about HER2.

We're going to talk about GYN oncology malignancies, which is a really important group of patients. Sometimes, quite frankly, it just doesn't get discussed enough, so we thought it was really important to include that patient group as a focus of what we're going to be describing.

On day three, our main focus is going to be with genitourinary malignancies and gastrointestinal malignancies. We're going to highlight some of the newer agents.

As you know, for bladder cancer, for the gastrointestinal malignancies, many new agents to discuss, many new applications of these agents, many toxicities that we need to be mindful of some of the new oral TKIs that are being used in these diseases.

There's a lot to chew on in these three days. Then, we're going to wrap it up. We're going to have a very interesting conversation about financial toxicity.

If you work in the community setting, whether you work in specialty pharmacy, whether you work in an ambulatory clinic in a hospital, you know that's a real pain in the neck to try and get drugs for our patients. There's a huge financial burden for our patients in terms of copays and insurance caps and all these things that our patients run into.

Now that genomic sequencing really is starting to take hold of oncology in many different disease states, trying to obtain drugs off label for our patients is very difficult. We're going to talk about all that, and we're going to try to give you some best practices of how it can help you at your institutions to serve more patients.

That's what we're trying to do with our agenda. We hope that it's going to make the time that you invest in this education well worth it. Is there anything else that I didn't highlight, Dr Hanna, that the folks that would sign up for this should be excited about?

Dr Hanna:  I appreciate that, Dr Fausel. Not only to everything that you guys have said there, I echo all of that.

A couple of other things that are very, very exciting about this great debates program that's coming up, this virtual world that we've started to live it since COVID began has made it very difficult for us to disseminate a lot of information.

One thing that I find most beneficial, whether we're doing live conferences or virtual programs, is the best way to disseminate information is to have key thought leaders and expert faculty having a debate, just like all of you said.

Oncology pharmacy practice is extremely complex nowadays. It's no longer just chemotherapy and you're done and then palliative care, for example. You look at, like you said, Dr Fausel, CLL. Is it BTK, is it BCL-2, or is it chemoimmunotherapy? What do you do?

Just in that session, I'm super excited about that. We have two key thought leaders, Doctors Duffy and Perissinotti, who are going to be battling it out on how you treat your patient in terms of various biomarkers, cytogenetics, and how you prioritize therapies. Do you keep your patient on BTK indefinitely? Do you get them on BCL-2 inhibition for a finite period of time or try to continue it?

I think these types of discussions are going to be very beneficial. I'm very, very excited for that, and our attendees should be as well.

Another thing too is not often can we have this type of platform where pharmacists who might be practicing in general areas and not subspecialize in key areas in hematology or solid malignancies, can they interact in such a way with these expert faculty of thought leaders? Not only the live Q&As, but also seeing that debate format is going to be very good.

Also one other thing, I know some people had said that they might not be able to attend during the various dates that we have highlighted for this, but this program is offered twice. One is going to be in July, and another time is going to be in August.

In addition to that, a lot of the programs that are coming out are also going to be available on demand. There are numerous things for us to be excited about from this program. I strongly encourage everybody to certainly sign up for these opportunities.

Dr Fausel:  Thank you very much, Dr Hanna. You really brought up an important point. We're just starting to emerge out of the pandemic, and that's had a huge implication for everything that we do in life, not to mention the education that we get in trying to take care of our patients.

We are going to have a section where we talk about the application of COVID vaccines to cancer patients, so we're actually going to bring in a couple of infectious diseases experts, who are going to provide some information on that for us, which I think will be a really, really outstanding session for the group as a whole, for anybody that's a pharmacist.

You're going to walk away with a wonderful knowledge based on that. What are some of the takeaways that we want the folks that attend these conferences to walk away from?

We're going to have a little mini debate now between Dr Adams and Dr Holle. They'll talk about what they think are the big take-home points for the attendees that come to this conference, either the one in July or the one in August. We'll start with Dr Holle.

Dr Holle:  One of our goals is that our attendees can come away having a better understanding of some of these controversial topics that we have mentioned, and that we'll be discussing during this programming.

I think that we all are struggling with how to consider a financial toxicity, as you've mentioned. Hopefully, people can come away with some tips from our panel about financial toxicity, about how to best apply the COVID vaccinations, as we move out of the pandemic and think about this as a possible long-term health care, public health need that we need to address and how it affects our cancer patients specifically.

There are several different topic areas, where you've already mentioned, like with CLL, multiple myeloma. Also, with breast cancer and HER2 positive breast cancer and sequencing of therapies and bladder cancer, are topics where hopefully our audience can come away with understanding how the new data that we have available can shape how we care for our patients.

What do you think, Dr Adams?

Dr Fausel:  Dr Holle, thank you very much.

Dr Adams:  The points that you make are certainly valid, but I see it from a very different perspective. Myself, it's pretty simple. We're pharmacists. We want to make sure we give the right drug at the right dose to the right patient. That's becoming increasingly complex, mostly because we've got so many new drugs, choosing the right one.

I think perhaps the most important take home is understanding, is this the right drug, and how do we monitor for toxicity and some of the drug interactions that we see? I think this goes across all borders.

When I think about things like our brand new KRAS inhibitor -- Chris just brought that up -- you can't get that with a PPI or an H2 receptor antagonist, or you're not going to get absorption, the AUC goes down by about 50%. Who needs to know that? Everybody needs to know that, if you're a pharmacist.

Again this is community pharmacists. There's a whole host of people. Again, the take home is really important, but my focus is more making sure that we get the right drugs at the right dose to the right patient and really dodging all the drug interaction stuff.

Dr Holle:  That's an incredibly important point. Even if you specialize in a particular area, certain tumor types, it's hard to keep up in that area because things are changing so rapidly. Also, being able to get exposure to different diseases that you might not see commonly, cholangiocarcinoma is a good one that we're having a discussion about. There's been a lot of new advances in that recently.

Being able to have that opportunity to learn about those specific things that are important for pharmacists. It's one of the great things about this programming that we have.

Dr Fausel:  Thank you both. Dr Hanna, how are you going to apply this information to your clinical practice up in the great state of Minnesota?

Dr Hanna:  Thanks, Dr Fausel. In applying what we learned from these types of debates to clinical practice is going to be really contingent on what type of pharmacy environment you practice in.

Are you inpatient? Are you outpatient? Are you someone who is focused just on a single malignancy within your institution such as the use of GU side or inside, or are you a community pharmacist?

Clearly, we can gauge so many different types of pharmacists throughout this program, not only to gain CE, etc., but also get a better understanding because we know that patients with cancer are going to see their community pharmacists at their local retail pharmacy. They are coming into our centers, whether you're practicing infusion side or chemotherapy side or admitted for some type of complication.

A lot of these learnings, based on what you do, you're going to be able to focus your...because we have so many different types of sessions and learning opportunities, you'll be able to take key sessions and apply them to what type of practice you have.

Dr Adams had mentioned that PPI interaction with BTK inhibitors, for example. How many times do we see a patient walk into a retail pharmacy, pick up their omeprazole right off the counter? The bottle says take it only for 14 days. You have no idea as the oncology pharmacist because it's not part of their EMR that they're even taking it, and there's an interaction there.

You could have been the pharmacist right there behind the counter, who the patient came to and said "I have GERD, and you made that recommendation on what I've resolved,” but you didn't know that they're on acalabrutinib, for example, so big, big interventions there in terms of all types of pharmacists and regardless of what type of hat you wear.

Those are some key takeaways and how you can apply some of the things we do in clinical practice, but also another thing that is going to be very, very important. Many of the disease states that we're discussing, whether it's breast cancer, multiple myeloma, CLL, urothelial carcinoma. It's extremely complex.

Understanding cytogenetics, understanding molecular testing, understanding sequences of therapies, just getting the idea of what are key drivers in each disease state. You don't even have to be an expert in that specific disease state.

Understanding key concepts such as the drivers, when you need to test, what you need to look for, those are going to be very, very important things especially to those pharmacists, where I think most oncology pharmacists actually practice in the general setting means they see all oncology patients that walk in through the door.

Because of the complexities of oncology nowadays, it's extremely difficult. What do you do in urothelial, for example, do you do platinum-based therapy? Even with the platinum-based therapy conversation, you do cis or carb?

Then, do you do immunotherapy maintenance, or do you wait till they progress? Do you do immunotherapy second line? Do you do EGFR, or do you do antibody drug conjugates?

Even in the antibody drug conjugates space, which has got to be a discussion of its own. Just in bladder cancer, we have two antibody drug conjugates that are approved in bladder cancer after progressing on platinum and IO therapy.

All these are going to be very, very important things that we need to get better understandings of. Then, seeing that debate format, having that conversation really helps solidify certain key concepts.

Dr Fausel:  Thank you very much, Dr Hanna. Really excellent comments, guys. One of the things that we've tried to do with organizing this is we have to try and meet folks where they are.

We know everybody is really busy with all the demands on our time and with everything that's going on over the last year and a half with a pandemic, so what we tried to do is build in some flexibility with providing this programming.

Like we talked about previously, it's going to be available twice. It's going to be available in July. Again, the same program is going to be repeated in August, but it's also going to be available for those folks that sign up on demand.

If you really want to go listen to Dr Adams speak a couple times a week to understand the mutation burden that is seen in non-small cell lung cancer and how to apply drug therapy based on that, you can do it.

The folks that are helping us provide this educational symposium are really working hard in the background to try and make it as easy as possible for the attendees to get this information and to be able to access when they're available. We thank them for that.

I want to thank everybody for joining us today, and we really look forward to seeing you in July and August and sharing this wonderful education. Thanks, again, for the time and the interest. Take care.