The pharmacist has a key role in the management of CAR-T therapies. Selection, ordering, reception, storage, preparation of the product for infusion, and dispensing of CAR-T therapies are some of the pharmacy service responsibilities (Black 2018; Moreno-Martínez et al. 2020; Booth et al. 2020). The pharmacist requires specific training, ensuring coordination with all the professionals in the multidisciplinary team who are involved in the management of these therapies, as summarized in Table 41.1.

Table 41.1 Pharmacist’s responsibilities
Full size table

The pharmacist must also know which types of CARs are available and can arrive in the future. CAR-T cells are currently indicated for the treatment of B-cell acute lymphoblastic leukaemia and diffuse large B-cell lymphoma, two haematological diseases that share expression of the CD-19 antigen, but the target antigens are potentially many; therefore, the pharmacist must receive training that takes into account new future possibilities. An example of other options is the advanced phase experimentation of CAR-T cells and anti-B-cell maturation antigen (BCMA) for multiple myeloma pathologies.

CAR-T cells are just the beginning, and CAR-Technology is being applied to other immune cells:

  • CAR natural killer (NK) cells: CAR-NK.

  • CAR macrophages (M): CAR–M.

Finally, CAR-T cells may be effective against solid tumours, and the main problem related to the accessibility of the antigen can be solved in patients suffering from glioblastoma and neuroblastoma with the injection of the cells on site.

The complexity of these therapies requires the intervention of the pharmacist whose training must include implementation and management of advanced biotechnological procedures; therefore, specific skills not only in the preparation of classic chemotherapies and monoclonal antibodies but also in how to handle, store, and manage novel therapies and the specific medical devices that could be required are needed.

One of the most important pharmacist interventions is patient follow-up, intended to monitor toxicities, adverse events, and concomitant and contraindicated drugs. Cytokine release syndrome is an extremely serious event that must be monitored by a multidisciplinary team in which the pharmacist is the reference figure for the management of rescue drugs and pharmacovigilance studies.

FormalPara Key Points

  • The pharmacist requires specific training in the management of CAR-T therapies, ensuring coordination with all the professionals in the multidisciplinary team.

  • The pharmacist must know the types of CARs available and what will arrive quite soon.

  • New skills are needed to handle and store CARs and to follow-up with patients.