Utilizing a Multidisciplinary Team Approach to Bladder Cancer Treatment
Oncology pharmacists are important to the oncology care team, as they can bring a unique perspective to treatment planning, according to Kirollos S. Hanna, PharmD, BCPS, BCOP, FACC.
Working within a care team is important to help the patient receive the best possible care. The knowledge and education that pharmacists bring to the table can help through a myriad of situations.
Kirollos S. Hanna, PharmD, BCPS, BCOP, FACC, director of pharmacy at Minnesota Oncology and assistant professor of pharmacy at the Mayo Clinic College of Medicine and Science, discussed how to integrate pharmacists into the care team.
He highlighted the recent FDA approval of enofrtumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) for patients with locally advanced or metastatic urothelial carcinoma, and how pharmacists can be used to monitor adverse effects (AEs) and operationalizing costs.1
Hanna mentioned the pivotal phase 3 EV-302 trial (NCT04223856) which led to the approval of the agent, and how to better leverage pharmacists in ongoing trials in the bladder cancer space.2
Transcript:
Oncology pharmacists play a critical role across the board, whether we’re talking about large academic or community practice. It just depends on how that pharmacist is plugged into the model within the practice. Education is something that pharmacists excel at. Whether it’s education around the therapy, the supportive care, pharmacists can certainly help their AE monitoring and support when AEs do come up. In addition to that, when these patients are coming into that infusion center and not seeing a provider, the clinical pharmacist can certainly be there to help with lab evaluation, counseling, or addressing things with our nursing colleagues as well.
The other component of it is [the enfortumab vedotin plus pembrolizumab] regimen and how it’s going to shift the disease paradigm. If pharmacists are functioning on a pharmacy and therapeutics committee and doing the analysis of how the organization wants to operationalize this, this regimen certainly does come with a cost. You’re combining 2 expensive therapeutics that are going to increase the total cost of care for patients, particularly in the frontline setting.
Even when you look at the 2 or 3 lines of therapy for bladder cancer, these patients are still going to be exposed to these therapeutics at one point in time, whether you leverage this on the front line, or whether you do platinum[-based] therapy, then they go on immunotherapy, then they go on enfortumab vedotin. From a bladder cancer perspective in total, it doesn’t increase the cost of care, but it shifts the cost of care to that frontline setting, given the clinical efficacy of the profile of the EV-302 study. I would encourage people to still leverage the pharmacy for awareness that clinical trials are still strongly encouraged in bladder cancer, and metastatic bladder cancer across all lines of therapy because we still have a significant way to go in terms of making an impact. We’ve seen a lot of novel therapeutics within this space. When you look at the 5-year survival [rate], it’s only about 8% to 10%. It’s still a far way from where we would like to be for this patient population.
References
- FDA approves enfortumab vedotin-ejfv with pembrolizumab for locally advanced or metastatic urothelial cancer. News release. FDA. December 15, 2023. Accessed March 28, 2024. https://bit.ly/48ls9bi
- Hoimes CJ, Flaig TW, Milowsky MI, et al. Enfortumab vedotin plus pembrolizumab in previously untreated advanced urothelial cancer. J Clin Oncol. 2023;41(1):22-31. doi:10.1200/JCO.22.01643
