Pharmacists Essential to Expanding CAR T, Bispecific Access: David Awad, PharmD, BCOP

As chimeric antigen receptor (CAR) T-cell and bispecific therapies become more widely available, pharmacists are essential in navigating patient-specific complexities, insurance approvals, and more. According to David Awad, PharmD, BCOP, oncology pharmacy manager, Robert Wood Johnson University Hospital, their expertise in evaluating toxicities, managing adverse effects, and conducting comprehensive medication reviews supports safer, more effective cancer care within value-based models.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How has the role of pharmacists and pharmacy teams evolved in the delivery of CAR T and bispecifics?

As more and more CAR T products and bispecific medications are approved, more patients are becoming eligible to receive these products, which means that more patients are going to be receiving them.

Pharmacists are integral members, of part of the oncology team, and it's necessary to set up these patients. They might be sicker patients or have more comorbidities than those who were studied in the clinical trials, so adjustments might need to be made or you might need to get other consults prior to giving them these medications to understand how to mitigate some of the unique toxicities that this specific patient might receive.

Additionally, there's REMS [risk evaluation and mitigation strategy] requirements that need to be leveraged, and ensuring that these patients can get approved perhaps earlier line or in combination with other medications that might not be FDA-approved in those settings. Pharmacists are going to be necessary to be able to work with insurers [and] with the clinical teams to be able to get insurance approval and be able to give that medication to those patients.

What is the role of pharmacy-led toxicity management in value-based cancer care?

Pharmacists are valuable in understanding if this is a true toxicity, is it from the medication, and then what do we need to do next? Is this a true toxicity? Do they meet all the criteria or is this a unique toxicity that might have been published in a case report for example? How do we manage the toxicity is also going to be useful for the pharmacist to chime in on because, if it's first-line toxicity, great. If this is the third time they're having it, what do we do now? If we've exhausted all of our first-line agents for management of, for example, cytokine release syndrome, what can we now use next? The pharmacist can be useful in helping determine that.

And the last thing is, was it actually from the medication or was it a comorbidity, or was it from another medication that they're on? Pharmacists provide, and can provide, comprehensive medication reviews to ensure that they're not having side effects from another medication, or if there is a possible drug interaction or is another medication clouding the picture, which can all help to make sure that the patient continues on the therapy, if it's fully appropriate to.