Breast cancer treatment continues to evolve, yet clinicians still face unanswered questions about how best to arrange new therapeutic options for patients.
Unresolved issues in sequencing antibody‑drug conjugates
Oncologists have observed that antibody‑drug conjugates (ADCs) can produce strong responses in breast cancer, but there is no consensus on which ADC to use first. Megan May, a clinical pharmacy specialist at Baptist Health Systems, said the field lacks data on whether a second ADC remains effective after the first, or if chemotherapy should be inserted between them.
She noted that “there are still a lot of unanswered questions about the appropriate sequencing of ADCs.”
Beyond ADCs, patients often present with multiple actionable mutations. In early‑stage hormone‑receptor‑positive, HER2‑negative disease, a tumor may carry both an ESR1 alteration and a PIK3CA change. May explained that clinicians do not yet know which target to address first, emphasizing the need for more evidence on sequencing to achieve the “most robust efficacy” for each individual.
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Pharmacists’ role in personalized testing and medication safety
According to the report, oncology pharmacists can help bridge these gaps by ensuring that proper molecular testing occurs as the disease progresses. For metastatic hormone‑receptor‑positive, HER2‑negative cancer, she recommends sending tissue or circulating tumor DNA (ctDNA) for analysis at the first sign of progression.
“Pharmacists can help ensure that we use the most appropriate agent and conduct all appropriate molecular testing,” she said, highlighting the link between testing and matching the right drug to the right mutation.
May also stressed the importance of reviewing patients’ full medication lists, including over‑the‑counter products and supplements. She routinely asks patients to disclose every substance they take and offers a direct phone line for quick safety checks.
“If you start any new medication, whether it’s an over‑the‑counter medication or a new prescription, just give me a quick call,” she advises, aiming to avoid drug interactions that could undermine therapy.
What could happen next?
While the current evidence base is limited, the growing use of ADCs and targeted agents suggests that future guidelines may incorporate clearer pathways for sequencing. As more real‑world data emerge, pharmacists are likely to take on expanded responsibilities in interpreting molecular results and coordinating multidisciplinary care.
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This could reduce delays in therapy selection and improve outcomes, provided that health systems invest in the necessary testing infrastructure.
Patient concerns and pharmacist interventions
Beyond technical issues, patients often express anxiety about supplements and herbal remedies. May reports that many patients do not realize that such products can interfere with chemotherapy or targeted drugs.
By conducting thorough medication reviews, pharmacists can identify potential conflicts early and counsel patients on safe use. She also emphasizes proactive communication, offering patients a direct line to discuss any new medication they consider.
In practice, this approach means that a patient starting a new hormone therapy will have their existing prescriptions, vitamins, and even teas cross‑checked for compatibility. If a conflict is found, the pharmacist can recommend alternatives or adjust dosing, thereby protecting the efficacy of the primary cancer regimen.