Pharmacists Poised to Lead Precision Oncology, But Barriers Hinder Progress

In a presentation at the 2025 Oncology Pharmacists Connect (OPC) meeting, Mya Tran, PharmD, BCOP, highlighted a critical paradox in modern cancer care: while oncology has rapidly shifted toward genomics and personalized treatments, the vital role of pharmacists in this evolution remains significantly underutilized. Tran argued that despite their unique skill set, pharmacists are often on the sidelines due to a number of systemic and institutional barriers.

From Homogeneous to Molecularly Targeted Care

Precision oncology has fundamentally transformed cancer treatment over the past two decades. Historically, cancer was viewed through a broad lens, with therapy decisions driven primarily by tumor type. Today, the focus has shifted to understanding the molecular blueprint of each individual tumor. This has led to the development of highly effective targeted therapies, a change that has made cancer care more complex but also more personalized and effective.

To navigate this complexity, precision oncology relies on three key testing strategies: somatic (tumor) testing, germline testing, and pharmacogenomic assessments. The most crucial of these is Next-Generation Sequencing (NGS), which allows for comprehensive analysis of a tumor’s genetic mutations and biomarkers.

The Challenges of Integration

Despite the clear benefits of this new approach, pharmacists face significant obstacles to becoming fully integrated into precision oncology programs. A survey presented at the 2025 Hematology/Oncology Pharmacy Association Annual Meeting revealed that up to 70% of pharmacists were unaware of their institution’s precision medicine initiatives. Cited barriers included:

Lack of specialized training and genomic knowledge
Insufficient institutional support
Time constraints in already demanding roles

Operational challenges within the healthcare system also contribute to the problem. Tissue limitation from small biopsies and long turnaround times for NGS results (up to 2-3 weeks) can delay biomarker-driven treatment decisions. Furthermore, the financial burden of these expensive tests can hinder patient access without a robust financial assistance program.

A Pharmacist’s Essential Role

Tran emphasized that pharmacists are uniquely positioned to address these challenges and serve as leaders in precision oncology. She drew an analogy to antimicrobial stewardship, where pharmacists are central to interpreting complex data and optimizing drug selection. In a well-structured program, a pharmacist can:

Interpret genomic data and molecular pathology reports
Provide clinical validation of test results
Document findings in electronic medical records
Counsel patients on treatment options and potential side effects
Assist in navigating prior authorizations and financial assistance

Tran shared a powerful case study of a patient with metastatic lung cancer who was initially given a poor prognosis. After a pharmacist-led review of a liquid biopsy revealed a rare EGFR::RAD51 fusion, the patient was started on an off-label drug and experienced a dramatic, life-changing response.

This case, and others like it, highlights the immense impact pharmacists can have by applying their expertise to the nuances of genomic data. Tran concluded with a vision for the future, calling for more pharmacists to become deeply embedded in precision medicine to unlock its full potential for patients.