The role of pharmacists in oncology has undergone a dramatic transformation with the introduction of advanced cancer therapies, moving far beyond traditional medication dispensing to become integral members of multidisciplinary care teams. This evolution is particularly pronounced in the management of chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, where pharmacists now play crucial roles in patient selection, toxicity management, and care coordination.
From Dispensing to Comprehensive Patient Management
Eileen Peng, PharmD, vice president, chief administrator, and pharmacy officer at Astera Cancer Care, emphasized the fundamental shift in pharmacist responsibilities. "The pharmacist and the pharmacy team role has evolved tremendously with CAR T and bispecifics, because we move from dispensing—pure dispensing—to managing patient selection, managing side effects, [and] providing education," Peng explained.
This transformation reflects the complexity of modern cancer therapeutics, where successful treatment outcomes depend not only on drug efficacy but also on careful patient selection, proactive monitoring, and coordinated care delivery. Pharmacists have emerged as key stakeholders in ensuring these sophisticated therapies reach the right patients at the optimal time.
Critical Role in Patient Selection
Patient selection has become one of the most critical aspects of the pharmacist's expanded role. With multiple treatment options available for cancer patients, determining eligibility for advanced therapies like CAR-T cells and bispecific antibodies requires specialized knowledge and careful evaluation.
"Not every patient is qualified or appropriate for CAR T and bispecifics. There are many, many treatments [a] patient can go through now," Peng noted. "The right patient selection is very, very important. We need to know when and when is the right time and what type of patient could benefit from it."
This responsibility extends beyond simple eligibility criteria to encompass timing considerations, treatment sequencing, and individual patient factors that may influence therapy success. Pharmacists bring unique expertise in drug mechanisms, interactions, and patient-specific factors that inform these complex decisions.
Proactive Toxicity Management and Monitoring
One of the most significant contributions pharmacists make in novel cancer therapy management is their ability to proactively identify and manage treatment-related toxicities. Their proximity to patients and laboratory data positions them as early detection specialists for adverse events.
"Pharmacists are very close to patients and lab results. We are often the first one to realize their symptoms come up or a subtle change [in the labs]," Peng explained. "We can actually use our knowledge to adjust the dose or change treatment and even put some prophylaxis there to treat the side effect and keep patient on treatment longer."
This proactive approach to toxicity management is particularly valuable in the context of CAR-T therapy and bispecific antibodies, where side effects can be severe and require immediate intervention. By identifying issues early and implementing appropriate interventions, pharmacists help maintain treatment continuity and optimize patient outcomes.
Integration into Value-Based Care Models
The expanded role of pharmacists extends into value-based care models, where their expertise in medication selection and side effect management contributes directly to cost-effective care delivery. Peng highlighted this emerging responsibility: "We can choose the medication that's cost-effective and manage patient adherence to avoid a lot of hospitalization or ER [emergency room] visit[s]."
This capability is particularly relevant as healthcare systems increasingly focus on outcomes-based payment models. Pharmacists' ability to prevent complications, manage adherence, and coordinate care directly impacts both patient outcomes and healthcare costs.
Multidisciplinary Team Collaboration
The evolution of pharmacist roles has strengthened their integration into multidisciplinary cancer care teams. Physicians increasingly rely on pharmacist expertise for treatment decisions, with frequent consultations on dose adjustments and treatment modifications based on laboratory changes or patient-reported symptoms.
Collaboration extends beyond physicians to include nursing staff, particularly triage nurses who consult pharmacists for recommendations on managing patient symptoms at home. This collaborative approach helps avoid unnecessary emergency department visits while ensuring safe outpatient management.
Medication Adherence and Patient Monitoring
Pharmacists have developed sophisticated systems for monitoring medication adherence across different treatment modalities. For infusion treatments, Astera Cancer Care employs tracking systems that monitor scheduled infusions and follow up on missed appointments. For oral medications, pharmacists review physician notes, monitor prescription patterns, and conduct proactive patient outreach.
"If we identify a patient [is] not adherent, not only would we tell them how important it is to adhere to their treatment, we also will inform our physician and let them know, 'Maybe set up [an] appointment and ask [the] patient to come in,'" Peng explained.
This comprehensive approach to adherence monitoring combines technology, clinical oversight, and patient engagement to ensure optimal treatment outcomes.
Future Implications for Cancer Care
The transformation of pharmacist roles in cancer care reflects broader changes in healthcare delivery, where specialized knowledge and proactive patient management are increasingly valued. As novel cancer therapies continue to emerge and become more complex, the pharmacist's role is likely to expand further.
The integration of pharmacists into value-based care models, their expertise in managing complex drug regimens, and their ability to coordinate care across multiple providers position them as essential contributors to the future of cancer treatment. This evolution represents not just a change in job responsibilities but a fundamental shift toward more collaborative, patient-centered care delivery in oncology.
