Pharmacists can play a central role in identifying patients who may benefit from PARP inhibitors and in optimizing sequencing of PARPi therapy, according to Siddhartha Yadav, M.B.B.S., M.D. In many practices pharmacists lead precision oncology consults, review germline and tumor genetic testing reports, and recommend therapeutic options based on those results.
Because pharmacists often encounter prescriptions first, they are well positioned to question treatment choices — for example, asking “why not a PARP inhibitor right now?” when a patient with a BRCA mutation is steered toward chemotherapy. They can also prompt testing when it has not been performed and help reduce undertesting. The same approach applies to other actionable alterations such as PIK3CA and PTEN, where targeted therapies are emerging from clinical trials.
Interpreting real-world survival trends requires caution. Real-world data may be biased if patients who receive PARP inhibitors are healthier or younger, which could contribute to observed survival differences independent of drug effect.
Nonetheless, clinical trials show robust progression-free survival benefits for PARP inhibitors, and subgroup analyses from trials such as OlympiAD suggest that earlier use may confer overall survival advantages. Yadav said the study’s real-world findings are consistent with trial data but urged clinicians not to overinterpret observational results.
Yadav emphasized standardizing germline and tumor testing for patients with metastatic breast cancer and recommended closer collaboration between pharmacists and clinicians to identify biomarkers and ensure patients receive the most appropriate therapies based on test results.
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