Cancer drugs are numerous and the field is ever-expanding. In pharmacy school and as a pharmacist exposure to this group of drugs can be limited and in turn it is common to be intimidated the topic. Here, an experienced oncology pharmacist identifies 5 things for you to know about cancer drugs.
Authored By: Laura Bobolts, PharmD, BCOP
Don’t let cancer drugs be intimidating. Embrace their uniqueness and your eyes will be opened to a whole new world of opportunities as a pharmacist.
Here are 5 things for other pharmacists to know about cancer drugs, as seen through the eyes as an oncology pharmacist…
1. There are far more drugs to know about than just the chemotherapy
We have come a long way since chemotherapy with well over a hundred cancer drugs that are targeted therapy—aiming directly at the cancer cell itself.
If a cancer cell is overexpressing an abnormal signal, well hey, we might have a monoclonal antibody for that. For example, overexpression of HER2 can make breast and other cancers grow. Multiple drugs have been developed to target HER2 signaling such as trastuzumab (Herceptin). I had one HER2+ breast cancer patient I won’t forget—she had burning in her breast where the cancer was when trastuzumab was infusing. The patient asked me if that meant the drug was eating away the cancer in her breast. I was astonished and could only reply that almost anything was possible!
Another group of drugs we have is tyrosine kinase inhibitors. These are pills which target a specific signal inside the cancer cell that has gone array, telling it to keep growing. Oral cancer drugs are convenient and can allow the patient to stay at home with their family.
Immunotherapy is yet another group of drugs and is one of the hot topics right now in oncology. Cancer cells are sneaky and have learned how to hide from our immune system. Researchers have identified receptor signaling that makes the cancer cells invisible to the immune system. Immunotherapy drugs such as nivolumab (Opdivo), pembrolizumab (Keytruda), and atezolizumab (Tecentriq) block this signaling, shedding light on the cancer cells for destruction by the immune system almost as if we hit start to allow packman to gobble up the cancer cells!
With therapies like these, it is a very exciting time in oncology pharmacy.
2. The drug names get easier to pronounce in time, I promise!
Cancer drugs are notorious for tongue-twisting names. Pronounce them correctly and you look like a genius! Don’t let the crazy names scare you away though. We are very forgiving in the oncology world when it comes to this. Even experts can butcher the name of a new cancer drug.
I use tricks to help me remember how to pronounce drug names. For example, atezolizumab is a drug used to treat urothelial cancers like bladder cancer. The TEZ in atezolizumab reminds me of the cartoon character TAZ, the Tasmanian Devil. Swap the “a” in TAZ with an “e” and you’re a pro – aTEZolizumab.
You can also cheat—I promise it’s allowed! Search Google for the pronunciation of a cancer drug and many websites will sound it out for you. Also, continuing education companies post videos of expert oncologist talking about new drugs, how they use them in practice, and how they performed in clinical trials. Hearing it from the horse’s mouth is an easy way to get that name down pat!
3. Some drugs can make people live longer
We can’t say that about many drugs on the market, even for many of our cancer drugs. While we have great cancer drugs that can cure the disease or make patients live longer, many are sped through the FDA approval process based upon surrogate trial endpoints such as objective response rate, or merely shrinking of the tumor. Just because the tumor gets smaller, will the patient live longer or feel better? Not always.
We do need to applaud those drugs that add life to our patients, which means more time for them to spend with their family. For example, combining pertuzumab (Perjeta) plus docetaxel (Taxotere) plus trastuzumab can add nearly 16 months to a metastatic breast cancer patient’s life.
4. Oncology drugs can be really expensive!
Everything comes at a price. Certain cancer drugs are blowing our ballpark price of $10,000/month out of the water.
Adjuvant ipilimumab (Yervoy) for melanoma can run over $130,000/month for a 1 in 4 chance the cancer won’t come back and likely be incurable. Who can afford for this? Health insurance or drug company help is a must. Surprisingly, the drug company will supply this treatment for free if the patient meets assistance program requirements. I commend the company for aiding patients with this completely unrealistic cost of adjuvant ipilimumab that they set.
The cost of cancer drugs are spiraling out of control. The FDA does not take cost into consideration when evaluating for approval. The drug company is responsible for setting the base price, then Medicare and insurance payers must react and pay some form of a multiplier, usually above the Average Sales Price (ASP). Why does our government have no say in the base price of cancer drugs so we can make them affordable for our patients?
5. The co-pays are a mystery!
This is the worst! It’s the elephant in the room that no one wants to talk about. As clinicians, we actually have no idea what the co-pay is going to be!
Will a patient be able to afford their co-pay if prescribed dabrafenib (Tafinlar) plus trametinib (Mekinist) for metastatic melanoma at over $20,000/month of drug? Will a high co-pay affect the way a patient takes their medication? Will they sting out pills to make ends meet, running the risk of sub-therapeutic dosing?
With all our technology, why can’t we know a patient’s specific co-pay at the very time the oncologist prescribes treatment? I’ve watched an incurable cancer patient sit in an infusion center chair while expensive treatment ran throughout their veins, covered with bills all over their lap, trying to figure out how to make ends meet for their family—it’s heartbreaking! We need to do better for our patients!
Cancer drugs are very unique. I hope this article helped open your eyes to the many faces of these drugs that I take into consideration as an oncology pharmacists.
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