Optimizing Management of Metastatic Colorectal Cancer: The Expanding Role of Oncology Pharmacists

The treatment landscape for metastatic colorectal cancer (mCRC) continues to evolve, especially in later lines of therapy where clinical decision-making must balance efficacy, tolerability, and individual patient goals. Patients often face challenges related to adverse effect (AE) management, access barriers, and quality of life (QOL). In a recent AJMC Peer Exchange moderated by Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy, cancer care services at Mayo Clinic, a panel of oncology pharmacists reviewed mCRC treatment options, including fruquintinib, regorafenib, and trifluridine-tipiracil with or without bevacizumab, highlighting how differences in safety profiles, patient performance status, and treatment goals shape sequencing decisions. The panel also examined the expanding role of oncology pharmacists in treatment optimization, adherence support, and access navigation. It offered actionable strategies to improve patient-centered care in this increasingly complex setting.

A Clinical Overview

Colorectal cancer is the third most common malignancy worldwide and the second leading cause of cancer-related mortality.¹ At diagnosis, 15% to 30% of patients present with metastatic disease, whereas 20% to 50% of those with initially localized disease later develop metastases.² The liver is the most common site of metastasis, followed by the lungs, peritoneum, and distant lymph nodes.² Despite advances in treatment, the 5-year relative overall survival (OS) rate for individuals with mCRC is approximately 15%.³

Management of mCRC requires a multimodal approach, incorporating sequential chemotherapy, targeted therapy, surgery, locoregional interventions, treatment breaks, and supportive care.⁴ For patients with disease progression despite standard therapies, treatment options include regorafenib, a multikinase inhibitor that blocks signaling pathways involved in tumor growth and angiogenesis; trifluridine-tipiracil, a nucleoside analogue-based therapy that impairs DNA synthesis and stability; and, most recently, fruquintinib, a selective VEGFR1-3 inhibitor that suppresses tumor angiogenesis.^5-8 Although the optimal sequencing of these agents remains uncertain, the increasing number of patients with mCRC receiving multiple lines of therapy highlights their utility in managing heavily pretreated disease.^4,5

Regorafenib demonstrated a survival benefit in the phase 3 CORRECT trial (NCT01103323), with an OS of 6.4 months vs 5.0 months with placebo (HR, 0.77; P = .005), along with a modest improvement in progression-free survival (PFS) in patients with mCRC who progressed on standard therapies.⁶ Common grade 3 or higher AEs included hand-foot skin reaction, fatigue, hypertension, diarrhea, and rash.⁶

In a similar patient cohort, the phase 3 RECOURSE trial (NCT01607957) showed that trifluridine-tipiracil (also known as TAS-102) improved OS to 7.1 months compared with 5.3 months with placebo (HR, 0.68; P < .001).⁷ The most common AEs were neutropenia (grade ≥ 3, 38%), leukopenia, and febrile neutropenia.⁷ More recently, the phase 3 SUNLIGHT trial (NCT04737187) showed that adding bevacizumab to trifluridine-tipiracil further improved OS (10.8 vs 7.5 months; HR, 0.61; P < .001) and PFS (5.6 vs 2.4 months; HR, 0.44; P < .001) compared with trifluridine-tipiracil alone.⁹ However, the addition of bevacizumab increased the incidence of hypertension and neutropenia.⁹

Fruquintinib, a newer treatment option, demonstrated efficacy in the phase 3 FRESCO and FRESCO-2 trials.^8,10 FRESCO (NCT02314819), conducted in China among patients previously treated with at least 2 chemotherapy regimens and no prior VEGFR inhibitors, showed significant improvements in OS (9.3 vs 6.6 months; HR, 0.65; P < .001) and PFS (3.7 vs 1.8 months; HR, 0.26; P < .001).⁸ The global FRESCO-2 trial (NCT04322539) enrolled 691 patients with extensive prior treatment—most had received VEGF inhibitors, and nearly half were previously treated with both trifluridine-tipiracil and regorafenib. Fruquintinib again demonstrated an OS benefit in this heavily pretreated population (7.4 vs 4.8 months; HR, 0.66; P < .0001). Fruquintinib was well tolerated, with common grade 3 or higher AEs including hypertension (14%), asthenia (8%), and hand-foot syndrome (6%).¹⁰

Stakeholder Insights

Frank Scimeca, PharmD, MBA, BCOP, vice president of pharmacy services at Florida Cancer Specialists & Research Institute, provided an overview of treatment options for mCRC in patients with disease progression after all available regimens, focusing on therapies recommended by the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN guidelines) for this heavily pretreated population: fruquintinib; regorafenib; and trifluridine-tipiracil with or without bevacizumab. Scimeca explained that the treatment landscape for mCRC continues to evolve, particularly for patients who have progressed despite FOLFOX, FOLFIRI, oxaliplatin, and irinotecan-based therapies. As Scimeca noted, “There [are] a lot of data that demonstrate, within this unique subset, the overall survival benefit when we look at the CORRECT trial as well as the FRESCO trial [and] FRESCO-2.” He further explained that fruquintinib, regorafenib, and trifluridine-tipiracil all received approval based on phase 3 trials, offering alternative treatment options for patients in the late-line setting. He emphasized, “When we look at the clinical trial design, all 3 of these [agents] give patients a potential overall survival benefit when compared to best supportive care.” Scimeca added that therapy selection is guided by a formulary developed through a pharmacy and therapeutics committee review of efficacy and safety data, whereas clinicians tailor therapy based on individual patient factors such as comorbidities and adherence risk. In contrast, Nicholas Bouchard, PharmD, director of pharmacy for Hematology-Oncology Associates of Central New York, noted that he does not have pathways but must “stay within a certain concordance level with NCCN guidelines.”

Melody Chang, MBA, RPh, BCOP, vice president of pharmacy operations at American Oncology Network, highlighted the importance of toxicity profiles in therapy selection for mCRC, noting that “each of these regimens has a distinct [adverse] effect profile, which can really impact the tolerability and the patient’s adherence.” Chang explained that fruquintinib “is a highly selective VEGFR inhibitor, so the main toxicity we see is hypertension, proteinuria, [and] diarrhea. And the [adverse] effect profile tends to be more manageable compared to regorafenib, especially regarding the skin toxicity and the fatigue.” She added regorafenib has a higher toxicity burden, most notably hand-foot syndrome, fatigue, and diarrhea, often prompting a dose escalation strategy. Trifluridine-tipiracil is commonly associated with neutropenia and gastrointestinal adverse effects, sometimes requiring supportive measures such as granulocyte colony-stimulating factors or antiemetics; the addition of bevacizumab further increases the risk of hypertension. Chang emphasized the importance of considering a patient’s overall health and prior toxicities when selecting therapy, stating that “ultimately, the choice comes down to balancing efficacy with the patient’s ability to tolerate treatment. We want to keep them on therapy as long as possible while maintaining their quality of life.”

Pharmacists’ Evolving Role and Overcoming Access Challenges

The Expanding Role of Oncology Pharmacists

Oncology pharmacists have long been essential members of multidisciplinary cancer care teams, and their roles continue to expand with growing evidence of their clinical and economic value.^11,12 Given the complexity of cancer care and the nature of modern treatments, pharmacist involvement is increasingly indispensable.¹² Recent studies highlight their contributions to reducing drug-related problems, improving QOL, increasing adherence, and delivering cost-effective care.^11-14 As their responsibilities evolve, oncology pharmacists emphasize patient-centered care through counseling, education, and proactive patient engagement.¹¹ These efforts help prevent adverse drug reactions and support continued treatment, as evidenced by studies showing improved adherence following pharmacist-led education.¹¹

A recent scoping review further defined 4 key areas where oncology pharmacists enhance cancer care: patient education, adherence monitoring, management of adverse effects and drug interactions, and QOL.¹¹ By educating patients on medications, adverse effects, and lifestyle factors, pharmacists improve patient satisfaction and understanding.¹¹ They support adherence through ongoing counseling, tools such as calendars or pill organizers, and structured monitoring.¹¹ Pharmacists also help identify and resolve drug-related problems, ranging from drug interactions to inappropriate dosing, thereby reducing adverse events and optimizing treatment.¹¹ Taken together, these interventions contribute to a better quality of life.¹¹

As outlined by Holle et al, oncology pharmacists have transitioned from traditional dispensing roles to providing direct patient care across inpatient, ambulatory, infusion, specialty, and investigational settings.¹⁵ With advanced training, they contribute to supportive care management, staff and patient education, clinical pathway development, and institutional and national guidelines.¹⁵ Numerous studies confirm their value in improving clinical outcomes, ensuring medication safety, reducing costs, and alleviating the burden on providers.¹⁵

Pharmacist Involvement in mCRC: Optimizing Sequencing and Support for Optimal QOL

The introduction of new therapies is expected to add complexity to the treatment landscape of mCRC, especially in later lines of therapy.⁴ Additional data are needed to determine the optimal sequencing of regorafenib, trifluridine-tipiracil, and fruquintinib.⁵ This remains an area of active investigation, particularly with the introduction of fruquintinib alongside established agents like regorafenib and trifluridine-tipiracil.⁴ A real-world, multicenter observational study (NCT05993702) is under way to assess the efficacy and safety of combining trifluridine-tipiracil with either regorafenib or fruquintinib in the third-line setting and beyond.⁴ Meanwhile, multiple clinical trials are exploring the use of fruquintinib earlier in treatment, including combinations with FOLFOX, FOLFIRI, or capecitabine in first- and second-line settings, as well as in maintenance therapy.⁴ These studies aim to clarify optimal sequencing strategies and improve outcomes in mCRC.⁴ Among available treatment options for mCRC, trifluridine-tipiracil and regorafenib remain appropriate choices, with no clear advantage in efficacy.¹⁶ Selection typically depends on patient performance status, safety and tolerability profiles, and QOL considerations.¹⁶ Real-world data suggest that trifluridine-tipiracil may offer superior adherence and persistence compared with regorafenib.¹⁷ Patients who began treatment with trifluridine-tipiracil before switching to regorafenib also had better adherence than those who initiated therapy with regorafenib, indicating a potential sequencing benefit.¹⁷ However, whereas regorafenib is associated with more grade 3 or higher adverse events, dose escalation strategies such as those from the phase 2 ReDOS trial (NCT02368886) can improve tolerability.^16,18 Close monitoring, effective toxicity management, and patient communication remain essential to sustaining adherence and maximizing treatment benefit in this setting.¹⁶ Given the narrow risk-benefit margin of later-line mCRC therapies, clinical expertise is crucial for appropriate treatment selection.¹⁶

As treatment advances extend survival for patients with mCRC, preserving QOL becomes increasingly central to care. Although clinical outcomes such as OS and PFS remain critical, they may not fully reflect the patient’s lived experience.¹⁹ Understanding patients’ fears, behaviors, and goals is essential to providing individualized, patient-centered care.¹⁹ Pharmacists play a key role in this multidisciplinary effort by managing toxicity and optimizing adherence, supporting informed decision-making, and helping patients navigate complex regimens.¹⁹ As part of coordinated care teams, such as multidisciplinary tumor boards, pharmacists can ensure treatment strategies are evidence-based and tailored to individual preferences.¹⁹ Their active involvement is especially important in later-line settings where the risk-benefit margin is narrow and treatment sequencing is less defined.¹⁶ Pharmacists can help select therapies that align with patient goals while reducing preventable discontinuation through toxicity mitigation and education.^11,14,15

Stakeholder Insights

Quality of Life and Patient Outcomes in mCRC Treatment

Bouchard emphasized the key role of pharmacists in managing toxicities across agents. For fruquintinib, strategies include home blood pressure monitoring, nonalcoholic mouth rinses for oral sores, and urea-based creams or diclofenac gel for hand-foot syndrome. Trifluridine-tipiracil often requires dose modifications or adjusted schedules to manage neutropenia and thrombocytopenia. Regorafenib is typically started with dose escalation to improve tolerability, alongside proactive management of diarrhea and skin toxicities and dose reduction for fatigue when needed. Bouchard added that when adverse effects are optimally managed, these agents have contributed to “an improvement [in patients' QOL]. It’s given them an additional option that they didn’t have before…[with] a PFS improvement.” He added that specifically for the fruquintinib FRESCO trial, “they looked at a [QOL] comparison…. I think that’s a positive thing that you can discuss with the patients…. They showed an improvement in emotional and social functioning, [a decrease] in fatigue, and a decrease in insomnia and those [QOL] factors.”

Optimizing Treatment Sequencing in Advanced Colorectal Cancer

Chang explained that sequencing treatment in mCRC is individualized and guided by prior therapies and tolerability, performance status, comorbidities, and patient preference. For example, she noted, “Some people don’t like [intravenous (IV)]; they prefer oral. In that case, you probably don’t want to start with TAS-102 plus bevacizumab.” Chang emphasized that “treatment sequencing is about balancing efficacy, toxicity, and prior treatment exposure, and the patient’s comorbidity, as well as the patient’s preference.” She noted that financial toxicity is a key consideration in treatment decisions—particularly for non-Medicare patients—and highlighted the role of pharmacists in identifying assistance programs, vouchers, or foundation support to help reduce the burden. Scimeca added that data guiding optimal sequencing in later-line mCRC therapy are limited, highlighting the value of real-world evidence for informing treatment strategies and “utilizing that real-world data to mitigate [adverse] effects.” Bouchard echoed, “We [don’t] have concrete data on the appropriate way to sequence these [agents],” adding, “I’ve seen [the sequencing of the 3 done] all different ways. Sometimes, it could be a payer initiative; maybe there’s a step therapy…. We see all 3 as far as where to start and where to end. I think that’s up for debate.” Other panelists shared similar experiences, noting that sequencing is shaped by payers, clinician judgment, and patient preference, with pharmacists helping tailor treatment to individual needs.

The Patient Journey: Mapping the Pharmacist’s Role in mCRC Management

Bouchard described the typical mCRC patient journey, which begins with IV chemotherapy regimens like FOLFOX or FOLFIRI with or without targeted agents, followed by oral therapies in later lines. He emphasized that pharmacists are integrated throughout the care continuum—reviewing regimens for dosing, safety, interactions, and guideline alignment; supporting prior authorizations; securing financial assistance; and providing ongoing patient follow-up and adherence monitoring. Bouchard emphasized that “communication is key” to pharmacist collaboration with oncologists and advanced practice staff, noting, “We share the office with the physicians and the advanced practice provider staff. So, there’s always a line of communication.” Pharmacists regularly assist with care plan development, including off-guideline regimens based on emerging data, and help support payer appeals by gathering relevant clinical evidence. He added that “the shared EMR [electronic medical record] is very beneficial too because we can see everything they’re seeing and vice versa. I think that really enhances our relationship with the prescribers.”

The role of oncology pharmacists in mCRC care has expanded significantly, particularly within medically integrated practices, as Scimeca noted. With EMR access, pharmacists act as extensions of the care team—reviewing labs, comorbidities, and chart notes to guide patient-specific medication management. They also develop drug-level clinical programs and proactively reach out to patients at key points, such as around the expected onset of toxicity, to address adverse effects early and improve outcomes.

Building on this evolution, Soefje shared that Mayo Clinic has embedded pharmacists directly into clinic workflows, allowing them to practice alongside providers. “[mCRC] is a perfect disease state where there are certain cycles of treatment that the pharmacists can actually manage themselves,” he explained. Through collaborative practice, pharmacists at Mayo conduct toxicity and lab assessments and, when appropriate, are authorized to sign off on chemotherapy refills—often allowing patients to bypass provider visits during routine treatment cycles. Chang welcomed the model, noting that patients often value their interactions with pharmacists. “A lot of times, the patients prefer to talk to the pharmacist more than they talk to their physicians,” she said. “Pharmacists tend to be down to earth, holding their hand, [listening] to their story, and then want to hear what [adverse] effect they actually experience and then can do something for them.” Scimeca expanded on the meaningful impact pharmacists have on patient care, noting that pharmacist-led, drug-specific outreach has improved adherence and patient-reported outcomes. He added, “We evaluate survival benefit—whether it’s [PFS], time to treatment, or any type of failures—manage that at the drug level, [comparing] it to clinical trial benchmarks [to assess whether] our team is able to keep patients on therapy for extended periods.” Scimeca emphasized the importance of continuous learning, external partnerships, and initiatives like custom starter kits to help pharmacists operate “at the top of their license while simultaneously giving patients more affordable and safe options.”

Treatment Adherence in mCRC

Managing adverse events is a central role for pharmacists in mCRC care, particularly through early education and dose optimization, Chang explained. She added, “Another very important strategy is optimizing the dosing. Start with a lower dose, ramp up to the full dose, and that could alleviate some of the [adverse] effects significantly.” In addition to toxicity management, Chang highlighted the pharmacist’s role in helping patients stay on therapy by simplifying complex regimens and addressing cost concerns. She explained, “Adherence is influenced by [adherence] effects, dosing complexity, financial barriers, and patient motivation. As pharmacists, we improve adherence by providing education [and] symptom management.” She added that for patients experiencing treatment fatigue, “if they understand their treatment goals, it is much more likely they’re going to stay engaged and adhere with the treatment.” Bouchard reinforced the importance of adherence, highlighting regular patient check-ins and comparing remaining medication with dispensing records as key strategies to identify and address nonadherence.

Soefje and Scimeca acknowledged that payer restrictions could limit in-house dispensing, noting that when medications can be filled internally, treatment selection is often influenced by insurance-preferred sequencing, even though no single agent is universally preferred. Scimeca emphasized the importance of having a process in place to support patients even when medications are dispensed externally, ensuring coordination among the specialty pharmacy, patient, and care team until the medication is in hand.

Access Challenges and Strategies in Managing Colorectal Cancer

Pharmacy benefit managers (PBMs) are intermediaries that manage prescription drug benefits for insurers and other entities.²⁰ They significantly impact oncology care, especially as more cancer treatments involve oral therapies.²⁰ PBMs influence drug coverage, patient costs, and pharmacy access while affecting provider workflows and care delivery.²⁰ As a result, these practices can create significant barriers to timely cancer treatment.²⁰ Utilization management strategies, such as prior authorization, step therapy, and restrictive formularies, can delay access, increase patient stress, and negatively impact clinical outcomes.²⁰ These policies may require patients to start on less preferred drugs or switch medications for nonmedical reasons, undermining personalized cancer care.²⁰ PBM requirements often restrict in-office dispensing, limiting timely access and disrupting continuity of care. Mandatory mail-order pharmacies can also result in medication waste and hinder adherence.²⁰ Patients may be at greater risk of adherence-related challenges when specialty pharmacy services are fragmented or external to the care team.¹³ Integrated pharmacy models, particularly those involving embedded oncology pharmacists, may help streamline coordination, reduce delays, and improve satisfaction.¹³ These models highlight the value of cohesive pharmacy support as oral cancer therapies become increasingly complex and resource-intensive.¹³

Prior authorization, originally intended to promote evidence-based and cost-effective care, has increasingly created barriers in oncology by delaying access to essential treatments and adding administrative burden for providers.²¹ Step therapy is frequently built into the prior authorization process to prioritize lower-cost options, often requiring patients to try and fail alternative therapies before receiving approval for the prescribed treatment.²¹ These requirements can result in patients receiving suboptimal or less tolerable therapies or facing financial toxicity due to increased out-of-pocket costs.²¹ In a 2022 American Medical Association survey, 82% of physicians reported treatment abandonment following a prior authorization denial, and one-third reported serious adverse events as a result of prior authorization–related delays, including hospitalization and life-threatening outcomes.^21,22 Nearly all oncologists surveyed by American Society of Clinical Oncology reported harm to patients caused by prior authorization, including treatment delays, forced use of second-choice therapies, disease progression, and even loss of life.^21,23

Pharmacist-led prior authorization clinics and centralized prior authorization teams can streamline the prior authorization process by shifting administrative tasks away from physicians.²⁴ Pharmacists bring key advantages, including access to prescription history and electronic health records and greater availability to patients.²⁴ These models improve efficiency, with pharmacy-led interventions shown to reduce time to prior authorization approval, medication dispensing, and pickup.²⁴ When a prior authorization is denied, pharmacists support continuity of care by recommending alternative therapies or connecting patients with assistance programs, vouchers, or coupons.²⁴

Stakeholder Insights

Barriers to Access and Delayed Therapy Initiation

Chang outlined several key access challenges, including prior authorization delays, step therapy requirements, and persistent PBM pushback—even when complete clinical documentation is submitted. She warned that these barriers could postpone care, emphasizing, “One of the biggest challenges is the consistent, persistent pushback from PBM by imposing formulary restrictions and the step therapy…. This can delay care and expose patients to unnecessary toxicities…[and] in the meantime, patients may experience disease progression. So, the time is important.” She stressed the need for early intervention, financial support, and persistent advocacy to help minimize delays and improve access to life-extending therapies.

Scimeca noted that payer requirements often impact treatment sequencing and can delay therapy initiation by up to 60 days. To address this, he emphasized the value of manufacturer partnerships, explaining, “We work a lot with manufacturers to offer voucher programs, quick-start programs…to get [the] patient on expeditious therapy initiation.” Bouchard added that although adverse events can add to the total cost of care—such as growth factor support or transfusions with trifluridine-tipiracil—they do not typically influence prescribing decisions in his practice. He added, “It’d be kind of neat to see a real-world comparison between the 3 medications…to compare and contrast what that total cost of care is.” Bouchard emphasized that total cost of care is a major concern in value-based care models, noting that “it’s easier to just look at the drug purchasing price, but it’s very hard to assess the cost triggered by the adverse event management.” Soefje agreed that a better understanding of the full cost of care in mCRC is needed, remarking, “From the moment a [patient with] colorectal cancer walks [through] our door, to the time, some point in the future, where either they walk away cured or they’ve passed away, what is that total cost? And to my knowledge, no one knows that.” He suggested that breaking down costs by treatment line could provide valuable insight into how sequencing, adverse event management, and other factors interrelate.

Streamlining Prior Authorization and Appeals

Scimeca shared that their internal, medically integrated specialty pharmacy model streamlines access by leveraging EMR data and a dedicated prior authorization team. He noted that this approach enables faster approvals and improves outcomes, explaining, “Having that dedicated team of subject matter expertise compiled with access to our EMR allows us to readily expedite prior authorizations, [giving us] an extremely high approval rate…[of] around 93%.”

Chang and Bouchard emphasized the importance of submitting thorough, well-prepared prior authorizations up front to avoid delays. Chang highlighted the need to anticipate payer policies, act quickly and persistently on appeals, and escalate to peer-to-peer reviews when needed. Bouchard added that their pharmacists bundle complete documentation, including circled NCCN guidelines and studies, to strengthen submissions but still face denials. He explained, “We try to give as much information as possible up front so that we don’t get the denial…but the appeal process just puts you in quicksand.” Bouchard also stressed the importance of ensuring peer-to-peer reviews involve true clinical peers, such as oncologists, and recommended marking authorizations as urgent to help expedite turnaround.

Financial Support and Stakeholder Collaboration

Financial assistance models vary across institutions; some use the same team for prior authorizations and support programs. In contrast, others rely on separate but coordinated teams to ensure timely access and continuity of care. Scimeca shared that, at his organization, a specialized patient advocacy team manages financial support, enrolling patients in co-pay cards, voucher programs, and foundation assistance, emphasizing the value of “a dedicated team of true subject matter experts to help alleviate that financial toxicity for patients.”

Chang emphasized the importance of proactively addressing payer-related barriers such as prior authorization, step therapy, and restricted formulary by selecting therapies aligned with payer policies and preparing supporting financial and clinical documentation in advance. She advised, “Getting ahead of these challenges is the key…. No. 1 is choosing the therapy with the payer requirements in mind…[that's] important, otherwise…it’s going to be denied because it’s not on their formulary, it’s not on their policy.”

Scimeca stressed the need for collaboration across stakeholders to improve patient access, particularly through education about formulary restrictions and utilization policies. He noted, “When we look at this specific topic, it’s a little complex with sequencing and NCCN guidelines. Partnership would be more focused on education and understanding formulary, as well as utilization management for the unique drugs.” He added that collaboration with manufacturers through voucher or quick-start programs can also help expedite therapy when prior authorization or appeals delay treatment initiation.

Key Takeaways: Pharmacists as Drivers of mCRC Care

Within the evolving treatment landscape in mCRC, Bouchard highlighted the critical role of in-house dispensing. He also emphasized the value of access to limited-distribution drugs, which are medications that manufacturers have not made available through PBM-owned pharmacies.

Bouchard noted that internal pharmacies enable faster dose adjustments and more comprehensive support. “We can be nimble with dose changes…and manage these patients from the start all the way through their therapy.”

Scimeca reiterated the expanding role of pharmacists in optimizing patient care and the importance of collaboration across the care continuum. He highlighted the need for cohesive teamwork within EMRs and with external stakeholders to support timely treatment access.

Chang and Soefje highlighted the integral contribution of pharmacists across the entire care continuum for patients with mCRC—from clinic-based support to dispensing and adherence monitoring. Soefje concluded, “Pharmacists play a vital role, and this disease state is a great opportunity to utilize the skill pharmacists have to manage patients, to optimize their therapy, and to improve the best outcomes.” •

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