Specialty pharmacy services for patients receiving oral medications for solid tumors.

PURPOSE - Currently available oral oncology therapies are reviewed, and specialty pharmacy services for patients receiving these drugs are described.

SUMMARY - Market introductions of new oral oncology drugs have increased substantially over the past decade, and 25-30% of all oncology agents in development are oral medications.

Oral agents for treatment of breast cancer include capecitabine, lafatinib, and palbociclib. Several oral agents are used in treating patients with lung cancer driven by mutations of genes coding for anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR); currently available agents include the ALK inhibitors certinib and crizotinib and the EGFR inhibitors afatinib, erlotinib, and gefitinib. Four oral targeted therapies are used in the treatment of melanoma associated with the B-Raf proto-oncogene, BRAF: cobimetinib, dabrafenib, trametinib, and vemurafenib. Oral agents for treatment of prostate cancer include abiraterone acetate and enzalutamide. Oral agents for treatment of renal cell carcinoma include axitinib, everolimus, pazopanib, sorafenib, and sunitinib. Specialty pharmacy services for patients receiving oral oncology agents can include (1) providing patient counseling and education on adverse effects and self-management strategies, (2) processing prior-authorization requests and helping patients navigate copayment assistance programs, and (3) monitoring for medication toxicities and recommending dose adjustments as appropriate.

CONCLUSIONS - Many oral oncology medications have been introduced over the past 10-15 years, with many others in clinical development. Due to the complexity of initiating and monitoring patients receiving these oral therapies, specialty pharmacy services are an essential component of many patients' cancer care.

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2016 Apr 28 [Epub ahead of print]

Jill Stein, Janelle Mann

Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA. St. Louis College of Pharmacy, St. Louis, MO, and Department of Pharmacy Practice, Division of Specialty Care Pharmacy, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO.