Bhavesh Shah Previews AMCP Nexus 2022 Session on Oncology Pipeline

Bhavesh Shah, RPh, BCOP, chief pharmacy officer and director of specialty and hematology/oncology pharmacy at Boston Medical Center, goes over his session to be presented at the fall meeting of AMCP Nexus 2022.

Transcript

What can attendees of AMCP Nexus 2022 look forward to learning at your session on the oncology pipeline?

I'm actually presenting with a colleague from [MassHealth] Massachusetts Medicaid, and we're both tag-teaming this pipeline presentation. Essentially, Kaelyn Boss[, PharmD,] is going to be talking about the currently approved agents and also looking at some of the unique mechanisms of emerging drugs in the oncology pipeline.

My focus is: of course, there are so many pipeline agents you can talk about, but what can we really highlight for managed care and providers, [and] what's evolving in the next few years.

My main themes are looking at tumor-agnostic therapies. We've seen a increase in approvals for tumor-agnostic therapies in oncology. Currently, we have a BRAF inhibitor, and we have PD-1 agent, NTRK inhibitor, and recently RET inhibitor was approved. So, really thinking about how this pipeline is going to expand. We've seen even in lung cancer where there's patients with HER2 mutation—not expression—are now able to get trastuzumab deruxtecan, which is unique, and we'll see that evolve into other malignancies where you see HER2 mutations. So, really kind of this expansion of tumor-agnostic biomarker-driven treatments.

Focusing on the next [theme]: People have been talking about checkpoint inhibitors, right? What is going on with checkpoint inhibitors? We know there are multiple agents that are approved in the market, and there are these disruptors that we've been all waiting for. So, thinking about what is going to be impacting the disruption, how that disruption is going to be impacted with these new PD-1 inhibitors.

In the PD-1 space, for the existing branded agents that have the market share, really how are they looking at expanding or protecting that class? Expansion of the indications, combinations, really talking about those implications that may actually put a damper on the PD-1 disruption that we were thinking, because PD-1 agents are probably the biggest cost drivers; for many of the managed care payers, it is the No. 1, probably, top 10 item. So really talking through some of the implications of these new PD-1s and what the current agents' manufacturers are doing around PD-1.

In the hematology pipeline, we're going to be seeing a significant number of BCMA bispecifics being approved for myeloma. We've seen a bispecific BCMA CAR T approved. There's going to be a BCMA bispecific, which is really important because there's multiple ones coming out, and then patients would actually go on to receiving BCMA CAR T after bispecific or vice versa, or they could get BCMA antibody-specific drug conjugate. So really, how is that going to evolve and what are the considerations for managed care providers?

Obviously, we've seen more and more radiopharmaceuticals being approved—very highly efficacious ones for prostate cancer were approved—so we're going to see more of those radiopharmaceuticals, which seem to be very attractive just because you have a finite number of doses that you give. So you're talking about fixed duration of therapy and then looking at these agents where we've seen expansion of the footprint in more earlier settings of prostate cancer, where patients [have] hormone-sensitive prostate cancer; currently we're seeing them in patients who are progressed on chemotherapy. So it will be interesting to see that.

We've already seen the trials that are looking at some of these radiopharmaceuticals on the front end, so really also talking about the reach of those, because radiopharmaceuticals have always been limited in terms of access for patients, but these PSMA radioligands have been able to provide more access for patients because of being accessible in in the community.

The last aspect was the CD47 immune checkpoint inhibitors. We've seen some positive data from the CD47 molecules, and then really expanding the pipeline for CD47 coverage beyond just hematologic malignancies. But I think that there's going to be combinations in other malignancies beyond [hematology], so looking at bifunctional CD47 agents.

So really exciting to see innovation and impacts on managed care that I think we need to be aware of.

Transcript edited lightly for clarity.