Oversight, Dose Management, and Improving Therapy Continuation with Oral HMAs

This segment focuses on physician oversight, practical dose management, and strategies to reduce early discontinuation of oral HMAs. Dr. Fazal is asked how he supervises the therapy process when patients are seen only monthly, relying heavily on the care team for day-to-day monitoring.

Dr. Fazal explains that oral therapies require a fundamentally different approach compared to intravenous treatment. His institution uses specialized oral therapy nurses who ensure patients have the medication in hand, perform necessary blood tests, and educate patients on proper administration and antiemetic use. Dose modifications are simpler with oral therapy: instead of navigating multiple pill strengths, adjustments can be made by changing the number of pills per day or dosing frequency, which allows timely responses to blood count changes. The system also addresses absorption concerns related to food intake and enhances convenience, reducing scheduling barriers common with IV therapy.

The discussion then transitions to therapy adherence and early discontinuation. Patients typically need 4–6 cycles to see maximum clinical benefit, but many discontinue therapy within two cycles in real-world settings. Dr. Shastri highlights that early discontinuation is more common outside clinical trials, especially among women, nonwhite patients, nursing home residents, and those with multiple comorbidities. Oral HMAs offer flexibility to mitigate these challenges: doses can be adjusted, telehealth visits can monitor patients remotely, and overall treatment burden can be reduced, potentially improving therapy continuation.

Overall, this segment emphasizes the importance of structured oversight, patient education, and practical strategies to maintain adherence, demonstrating how oral HMAs can be integrated effectively into both academic and community oncology settings.