The input of a pharmacist is crucial to proper therapy selection for the treatment of patients with chronic myeloid leukemia (CML), as they can provide patient education to improve treatment adherence and aid oncologists with frontline treatment choices, especially as new agents continue to emerge, according to Jose Tinajero, PharmD, BCOP.
“Pharmacists are uniquely equipped to not only counsel and educate patients on the importance of adherence to therapy, but [we can] also help identify and mitigate toxicities associated with these agents,” Tinajero, a bone marrow transplant and hematology clinical pharmacist at City of Hope in Duarte, California, said in an interview with OncLive®. “Additionally, we provide valuable support and collaboration with advanced practice providers and visiting teams regarding sequencing, selection, and even switching therapies.”
In the interview, Tinajero discussed his approach to frontline TKI selection, strategies to enhance patient treatment adherence, how pharmacists aid in the implementation of new agents and formulations, and the importance of the pharmacist-oncologist relationship in treating patients with CML.
OncLive: Within the CML space, there are several TKIs approved across the spectrum, with other potentially on the way. With all these options, how do you approach selecting the right agent for the right patient?
Tinajero: CML management has evolved since the development of the first-generation TKI, imatinib [Gleevec].1 Now we have second-generation options such as dasatinib [Sprycel] and nilotinib [Tasigna], third-generation options like ponatinib [Iclusig], and allosteric inhibitors such as asciminib [Scemblix].2-5
The current treatment landscape focuses on frontline TKI selection, considering factors such as patient risk scores, age, and comorbidities, like cardiovascular risk. We also account for drug-drug and drug-food interactions, as well as [treatment] adherence.
What strategies help to ensure patient adherence, and how do you adjust when patients struggle to stay on treatment?
Our role is to educate and empower patients about the importance of consistent medication use. If patients struggle due to interactions, toxicities, or adverse effects, we counsel them and work to mitigate these issues. When toxicities become burdensome, we may switch patients to more tolerable options. Ongoing follow-up and communication between patients and the care team are key to maintaining adherence.
In terms of dose optimization and adjustments—keeping patients on effective therapy while minimizing toxicity—how do you approach this, and how do you work with oncologists and patients to achieve the right balance?
Pharmacists in CML Treatment Planning and Management: Key Takeaways
- Pharmacists play a vital role in CML management—supporting oncologists with frontline TKI selection based on patient-specific factors such as comorbidities, drug interactions, and adherence considerations.
- Education and adherence monitoring are central to pharmacist involvement, as they counsel patients on proper medication use, manage toxicities, and coordinate therapy adjustments to maintain treatment continuity and tolerability.
- Collaboration across the multidisciplinary team enhances outcomes, with pharmacists contributing to dose optimization, new agent implementation, and ongoing education for providers in both academic and community settings.
Dose optimization is critical. We aim to minimize therapy interruptions and manage interactions. Some TKIs have meal-related requirements—for example, some are best taken on an empty stomach, while others should be taken with food for proper absorption.
Drug-drug interactions are also important, particularly since many patients with CML are older and often on multiple medications. Pharmacists help screen for interactions to prevent overdosing or underdosing. Many factors contribute to maintaining optimal dosing.
How important is the multidisciplinary team in ensuring effective treatment planning and patient management from diagnosis through treatment completion?
This is a long journey. We assess milestones at [approximately] 3, 6, and 12 months. Having a multidisciplinary team is essential—pharmacists counsel patients and provide expertise on drug therapies, and advanced practice providers, physicians, nurses, and other health care [team] members reinforce these concepts. An all-hands-on-deck approach ensures optimal outcomes, as shown across various studies.
Although the role of TKIs has been established in CML, new approvals continue to emerge and shake up the treatment paradigm. When new agents become available, what role do you play in education and implementation?
When new agents reach the market, we’re involved in onboarding and ensuring their safe and appropriate use. This includes educating nursing staff, specialty pharmacists, physicians, and advanced practice providers through in-services and training sessions. We also participate in pharmacy and therapeutics committees to evaluate new agents and place them appropriately in treatment pathways based on clinical trial data.
I encourage my colleagues to stay equally involved in these efforts, as education and collaboration are key.
For community oncologists who may not have the same level of daily interaction with pharmacists as those in academic centers, what is the importance of that relationship?
Community oncologists can greatly benefit from pharmacy support. Many centers are now incorporating clinical pharmacists into decision-making, counseling, and education. Pharmacists can assist with prior authorizations for newer agents, identify and manage drug interactions, and help address toxicities.
Having a strong pharmacist-oncologist relationship enhances patient safety and outcomes, and there’s significant opportunity for growth in this area within community settings.
References
- Cohen MH, Williams G, Johnson JR, et al. Approval summary for imatinib mesylate capsules in the treatment of chronic myelogenous leukemia. Clin Cancer Res. 2002;8(5):935-942
- Sprycel. Prescribing information. Bristol Myers Squibb. 2024. Accessed November 7, 2025. https://packageinserts.bms.com/pi/pi_sprycel.pdf
- Tasigna. Prescribing information. Novartis. 2024. Accessed November 7, 2025. https://www.novartis.com/us-en/sites/novartis_us/files/tasigna.pdf
- Iclusig. Prescribing information. Takeda. 2024. Accessed November 7, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/203469s037lbl.pdf
- Scemblix. Prescribing information. Novartis. 2024. Accessed November 7, 2025. https://www.novartis.com/us-en/sites/novartis_us/files/scemblix.pdf
