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Pharmacists Play Key Role in Managing Toxicity During Neoadjuvant Therapy for Melanoma
Christine Barrett, PharmD, BCOP, shares insights, challenges, and advice for oncology pharmacists navigating neoadjuvant therapy.
In a Pharmacy Times interview at the HOPA Annual Meeting 2025, Christine Barrett, PharmD, BCOP, clinical pharmacy specialist at West Virginia University, discussed the advantages of neoadjuvant therapy in melanoma, particularly the use of immunotherapy to leverage the tumor microenvironment and existing T-cell populations before surgery. Additionally, she shares insights into the critical role of oncology pharmacists in managing toxicities, ensuring adherence, and providing patient education.
Pharmacy Times: What advantages does neoadjuvant therapy offer specifically in melanoma, compared to its use in other tumor types?
Christine Barrett, PharmD, BCOP: So, we know that in melanoma specifically, there is an advantage to using immunotherapy based on the tumor microenvironment; and additionally, by using immunoadjuvant therapy, we're able to really utilize the existing T-cell population prior to surgical reception.
Pharmacy Times: Can you highlight some of the most influential or practice-changing trials that have shaped the current role of neoadjuvant therapy in melanoma?
Barrett: I think there have been a number of clinical trials in the neoadjuvant space in melanoma that are very exciting for current practice. And a couple of those that I would highlight would be the SWOG S1801 [NCT03698019] which looked at neoadjuvant and adjuvant pembrolizumab [Keytruda; Merck Sharp & Dohme LLC] in that setting, as well as the recent NADINA trial [NCT04949113], which looked at the role of neoadjuvant ipilimumab [Yervoy; Bristol Myers Squibb] and nivolumab [Opdivo; Bristol Myers Squibb]. So really exciting for us to see, especially in those patients who receive neoadjuvant therapy, the ability to provide a pathologic complete response and a sustained benefit.1,2
Pharmacy Times: What are some of the challenges clinicians and pharmacists face when integrating neoadjuvant regimens into practice for melanoma?
Barrett: Yeah, I think one of the challenges in incorporating new adjuvant therapy is that, of course, we need to identify those patients prior to seeing surgical oncology and undergoing surgical resection. And so, what I have found at my institution to be very helpful is ensuring that we are working very closely with our surgical oncology team to make sure that we are making an informed decision together on which patients may qualify for neoadjuvant therapy.
Pharmacy Times: Are there any particular regimens or drug combinations that have shown strong promise or raised specific safety concerns in the neoadjuvant setting?
Barrett: So, I think it's really interesting to look at the evolution of clinical trials in neoadjuvant immunotherapy in melanoma. We know that initially, a lot of those trials were looking at high dose ipilimumab in combination with nivolumab, which elicited very nice response rates, but also were associated with a pretty significant incidence of toxicity. And so, I think that over time, as we continue to kind of refine neoadjuvant strategies, we have been able to identify regimens that are still effective but more tolerable for patients.
Pharmacy Times: What role can oncology pharmacists play in managing toxicity, adherence, or patient education during neoadjuvant therapy for melanoma?
Barrett: I really enjoy working as an oncology pharmacy in the melanoma space, because we play such a critical role. So with immunotherapy, we know that these can cause specific and unique immune related adverse events, and I think as clinical pharmacists, we are really in a very good position to assist our physicians and our surgical oncologists, in identifying, monitoring for and mitigating those toxicities, to ensure that patients are able to complete therapy, go on to surgical resection, and also really be a resource for our providers.
