Pharmacist tailored monitoring for patients initiating encorafenib and binimetinib combination therapy.

Introduction

Combination therapy with protein kinase B-raf (BRAF) inhibitor, encorafenib, and mitogen-activated extracellular kinase (MEK) inhibitor, binimetinib, is associated with adverse events (AEs) that can lead to therapy changes early in treatment. This study assessed the impact of pharmacist tailored monitoring on therapy changes during the first 90 days after initiation.

Methods

This single center, pre-post intervention study included adult patients initiating encorafenib and binimetinib for unresectable or metastatic melanoma, with prescriptions filled through the center's specialty pharmacy or manufacturer's assistance program from July 2018 to December 2019 and April 2021 to December 2022. Beginning April 2021, a tailored monitoring program was implemented. Patients received counseling and a welcome kit at therapy initiation, followed by 6 monitoring calls over the first 90 days aligned with expected AE onset.

Results

The number of patients in the pre-intervention (n = 18) and post-intervention (n = 19) cohorts was similar. Fewer patients in the pre-intervention cohort had treatment interruptions (pre 44%, post 58%), dose reductions (pre 39%, post 47%), and discontinuations (pre 11%, post 26%) compared to the post-intervention arm. Most patients reported at least 1 AE within 14 days of initiating therapy (pre 78%, post 95%). The most reported AEs pre- and post-intervention were fatigue (pre 56%, post 68%), nausea (pre 44%, post 74%), and diarrhea (pre 17%, post 47%). Post-intervention, all patients (n = 19) received pharmacist interventions, with patient education (95%) and supportive therapy (68%) being the most frequent.

Conclusions

This study supports the HOPA recommendation to follow-up with patients 7-14 days after oral anticancer medication initiation. More studies are needed to evaluate the benefit of increased pharmacist monitoring after the first 2 weeks of therapy.