The Challenge of Balancing Efficacy and Toxicity

A central theme at the San Antonio Breast Cancer symposium (SABCS) consistently revolves around minimizing treatment-related side effects without sacrificing the effectiveness of therapies. Pharmacists are playing an increasingly vital role in achieving this balance through targeted interventions and care coordination.

Abemaciclib Dose Escalation: A Pharmacy-Led Coordination Effort

One specific example highlighted by pharmacy experts is the implementation of a new ramp-up dosing strategy for abemaciclib, a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor used in hormone receptor-positive, HER2-negative breast cancer.Data presented at SABCS 2023 further supports the effectiveness of this approach.

Currently, abemaciclib is not available as a dose pack from the manufacturer, requiring pharmacists to proactively coordinate prescriptions and ensure patients understand the escalating dosage schedule.This involves clear communication about how to take the medication correctly during the ramp-up period. The ramp-up dosing strategy aims to mitigate common side effects like diarrhea,a frequent challenge with abemaciclib.

While the exact details of the ramp-up schedule can vary based on institutional protocols and individual patient needs, a typical approach involves starting with a lower dose (e.g., 50mg daily) for a period, then escalating to 100mg daily, and finally to 150mg daily, as tolerated.

Managing hyperglycemia with PI3K and AKT Inhibitors

Pharmacists are also taking a leading role in managing hyperglycemia, a significant side effect associated with phosphatidylinositol 3-kinase (PI3K) and AKT inhibitors.These drugs are increasingly used in breast cancer treatment, notably in more advanced settings.

PI3K/AKT inhibitors work by blocking signaling pathways involved in cell growth and survival, but they can also disrupt glucose metabolism, leading to elevated blood sugar levels. Pharmacists are involved in monitoring glucose levels, adjusting diabetes medications, and providing patient education on diet and lifestyle modifications to manage this side effect effectively.Further data presented at SABCS 2023 is expected to provide additional insights into optimal management strategies.

The Expanding Role of the Oncology Pharmacist

These examples demonstrate a clear trend: the oncology pharmacist is evolving from a traditional dispensing role to a critical member of the multidisciplinary care team. Their expertise in medication management, side effect mitigation, and patient education is essential for optimizing treatment outcomes and improving the quality of life for individuals with breast cancer.