Kirollos Hanna, PharmD, BCPS, BCOP: We talked about a lot of exciting things. Dr. Perissinotti, because she does not show us what the role of the pharmacist is in the management of LLC [chronic lymphocytic leukemia]? We talked about selection and treatment strategies. But what can pharmacists do or how can pharmacists be more involved in the care of these CLL patients?
Anthony Perissinotti, PharmD, BCOP: Obviously, when we think of pharmacists, we think of our traditional role of ensuring that patients adhere to therapy, that there are no drug interactions, that there are no contraindications, that we are selecting the right therapies based on comorbidities and how much other. Surely you think of the pharmacist in helping with access, especially when it comes to combinations. When you now add 2 medications, oral therapies costing around $ 15,000 per month each, copay care will be incredibly difficult. Getting funding for these: We will run out of funds, so we try to develop strategic strategies for obtaining patient therapy. Now logon, I don’t think a pharmacist should do that. I think we should really argue that the support staff are able to do this. In this way, we can free our pharmacists to really advance our practice. I think the most important thing we really need to push ourselves to do is read the data. Read all the literature. We have done so many studies, and this was mostly an ASH study [American Society of Hematology 2021 Annual Meeting]. There are so many other studios out there. Keeping up with this is incredibly daunting and challenging. Just reading this information took hours to prepare. So you have to apply this data to your patients, so this also takes a huge amount of time. And then you have to educate your fellow doctors and your fellow nurses. I really think the pharmacist’s role should be to critically evaluate all of this literature and identify how we should treat our patients in the clinical arena. And this is not just developing clinical pathways for the 80% of patients this fits, but also for those individual patients for whom stencil medicine doesn’t work so you can think outside the box about which therapy is best for certain patients. I think these are some of the things we should be doing as pharmacists. We should really push ourselves further and really advance our profession by continuing to read, learn and know everything about all the little nuances of literature.
Kirollos Hanna, PharmD, BCPS, BCOP: I couldn’t agree more with you, Dr. Perissinotti. A couple of other things that I think would be very important for our pharmacists to consider, as you said, drug-drug interactions. Those are key. Almost all patients who will be treated with CLL therapy, 3A / 3A4 inhibition; it will be fundamental. BTK [Bruton tyrosine kinase]BCL2 [B-cell lymphoma 2]PI3K [phosphoinositide 3-kinase], really all of the above. Another thing is infectious prophylaxis. So sometimes our pharmacists may have key interventions in terms of making sure they make recommendations for certain patients who may be at high risk of developing infectious complications. We have previously mentioned COVID-19 vaccinations and what the implications are, especially in those patients receiving anti-CD20 monoclonal antibodies. It will be very important. Another thing, Dr. Perissinotti, you mentioned earlier is the absorption of these drugs. All of our BTK inhibitors can be taken with or without food. But outside of acid suppression etc, high fat, high calorie meals actually impact ibrutinib [Imbruvica] and acalabrutinib [Calquence] absorption. So these are also things that, although we can take with or without food, we need to be aware of and be aware of in terms of clinical practice. Some patients may require growth factor prophylaxis. Pharmacists can play a role in terms of developing institutional pathways; being part of that team, as he evaluates the data that Dr. Perissinotti had just cited, once again, outside of ASH; and incorporating it into your clinical practice and developing guidelines, your model of care, your value-based care; and trying to move that needle forward. Whether it is indefinite treatment with BTK, finished treatment with BCL2 anti-CD20. Whether you break it down by subsets of patients. All of these will be critical strategies for your patients. And again, the amount of evolution that we are seeing, that amount of combinations, the sequence of therapy will be very, very critical to the success of these patients.
Anthony Perissinotti, PharmD, BCOP: Well, it was a really good discussion. I want to thank Dr. Hanna for all of her comments. I was about to say, “Let’s open this up for further discussion to see what other unmet needs we have,” but we really talked about it. I just want to thank the audience, everyone watching this, for your undivided attention. And I hope you’ve learned something from me and Dr. Hanna. It was a pleasure. Hope you found this Times® PharmacyInsight to be rich and informative. And with that, good evening.
Transcription modified for clarity.