Lung Cancer

Elizabeth Briand

Each year in the United States, approximately 230,000 people are diagnosed with non-small cell lung cancer (NSCLC), accounting for more than 80% of all lung cancer cases. Lung cancer overall remains one of the leading causes of cancer-related deaths in America, both for women and for men.

However, new medications have come to market to treat NSCLC—with many approvals seen in 2024 alone. In August 2024, FDA approved the use of two new targeted therapy drug combinations for the treatment of NSCLC. The combinations—lazertinib with amivantamab-vmjw and amivantamab-vmjw with carboplatin and pemetrexed—can both be used as first-line treatments for certain types of locally advanced or metastatic NSCLC.

These two therapies are part of a growing number of treatments that have become available for NSCLC in recent years.

“Non-small cell lung cancer treatments have seen a huge surge of approvals in recent years,” said Whitney Lewis, PharmD, clinical pharmacy specialist at the University of Texas MD Anderson Cancer Center. “When I started in clinical practice a decade ago, approvals were fewer and much further between. I would estimate we have had approximately one approval per quarter for the last few years, sometimes more frequently, which has been so incredible to watch and so impactful for patient care.”

Amivantamab and lazertinib, said Lewis, both work on the epidermal growth factor receptor (EGFR). He noted that lazertinib is a small molecule tyrosine kinase inhibitor that is able to work intracellularly to inhibit the MAP kinase pathway from EGFR.

“Amivantamab is a novel bispecific antibody that works extracellularly to inhibit not only EGFR but also another receptor called MET, which is a common way that cancer cells exposed to EGFR inhibition develop resistance and grow despite treatment,” said Lewis.

Partnering in care

With each new medication that reaches the market, pharmacists have an opportunity to support patients even more. This includes helping patients as part of a clinical care team, advising them on the complexities of these treatments, and letting patients know what to expect with the use of the medications, including adverse effects.

“NSCLC is such a nuanced disease, and the patient population can vary from otherwise healthy patients in their 20s, to more fragile or complex elderly patients,” said Lewis. “There is absolutely a role for a clinical pharmacist on any multidisciplinary medical oncology team to care for patients across the entire spectrum.”

For example, she added, “Younger patients may have more concerns about fertility preservation and a lower threshold for toxicity, while older patients often have complex drug and disease interactions.”

As part of the care team, pharmacists can have a significant impact on facilitating treatment and ensuring safety.

“Pharmacists serve an integral role in helping acquire the medication for patients by aiding providers with prior authorizations, helping patients navigate patient assistance programs, and being aware of when the new drugs will be available,” said Lewis. “Pharmacists can help providers by providing detailed patient education, assisting with approvals and coordinating patient care, checking for drug–drug interactions, and assisting with adverse effect management and toxicity checks.”

Direct guidance for patients

As is so often the case, community pharmacists may have a closer relationship with patients and see them more frequently than any other health care provider.

“When a community pharmacist is aware of the types of treatment patients may be taking and has a general understanding of side effects and drug interactions, it can be so impactful,” said Lewis. “If the community pharmacist is aware of the treatment[s] the patient is receiving, that’s much safer when it comes time to dispense and counsel on any new medications.”

In addition, pharmacists may be able to advise on other potential interactions, such as when a patient is considering taking vitamin supplements, which can have significant effects with certain medications.

Knowing about potential safety issues with cancer treatments can make a significant difference in the coordination of care for this specific patient population, Lewis noted. Sharing this knowledge also has an empowering effect on the patients themselves, helping them make safer and more informed decisions. ■