Advantages of Subcutaneous Immuno-Oncology for Patients

Experts discuss the patient-centered advantages of subcutaneous immunotherapy for melanoma, including reduced treatment time and greater flexibility in care delivery.

Dronca (00:11): Good evening, everyone. Thank you for joining us on our next topic, advantages of subcutaneous immunotherapy for patients. As we have discussed previously and based on the recent data, we appreciate that one of the strongest patient-level advantage for subcutaneous immunotherapy is that it reduces one of the maybe least appreciated burdens for patients, and that is the time spent receiving treatment.

For both subcutaneous nivolumab and subcutaneous pembrolizumab, the time required to administer this therapy is significantly less compared to IV. For nivolumab and hyaluronidase, the time is approximately 3 to 5 minutes for subcutaneous injection versus 30 minutes for IV nivolumab and for pembrolizumab, and berahyaluronidase alfa, it is one minute for the dose given every 3 weeks and 2 minutes for the dose given every 6 weeks, again, administered by a healthcare provider.

Sam, I will turn it over to you to maybe guide us as to what this means from a patient perspective.

Guild (01:26): Thank you so much. So there are certainly several benefits to these new treatment options. And actually, Jen, I'm going to reach out to you for a little bit of help on the first one, and that is the time that it takes to receive these treatments. Generally speaking, IVs take about 30 minutes to receive that treatment. For the SubQs, it's up to 5 minutes.

One of the examples that I'm going to use to explain how we highly value our time is the TSA precheck. Many of us purchase TSA prechecks so that when we get to the airport, we save 20 to 25 minutes. Well, we do that because we don't want to be standing in line and waiting. Well, think about yourself as a patient and you've traveled 2, 3 hours from home, you have left behind your responsibilities, your work, your family, other things that you need to do to have a somewhat normal life as best as you can. Well, that 20 to 25 minutes is an enormous amount of time. Now thinking about you doing that every 2, 3, 4 or 6 weeks over a 2 plus year period, that quickly adds up. And so, that is one of the huge benefits of these new treatment options.

Now, Jen, I'm going to turn it over to you, because it's not just about administering the actual drugs. It's the entire time it takes to actually receive it, the prep time. And you have the most experience, so I'm going to ask you to share your thoughts.

Hunze (03:11): Yeah, I completely agree with you. The importance of giving time back to the patient is just so important, and we need to always think about that moving forward in this field. When it was IV, often patients would come in, it would take time to get an IV started. Pharmacy, dependent upon the size of the organization, it could take anywhere from 30, to 60, to 90 minutes to prepare that medication and get it ready. Then the infusion itself was at least 30 minutes. You also have to consider the fact that these patients are waiting for the chair, and if patients before them had any delay, now they're also delayed. This appointment that maybe was supposed to be at noon, and the patient before them maybe had a drug reaction or had something else go on, now that patient's noon appointment is one. Then let's say the pharmacy had a delay. You can see where I'm going with this is a, let's say, 90-minute appointment often turns into 2 hours, maybe even longer.

When it's SubQ, we can fast track that. I think I mentioned that a lot of infusion centers are starting to get creative on how they can get those injection patients in and out quicker. These patients have really, really loved it. They've loved being able to come in, get their shot and be on their way back to their normal life. Especially those patients that still work, maybe have children that have to travel to the treatment center with them, it's life-changing.

Guild (04:56): Thank you for that. I was speaking with a family member of a patient very recently and they were saying that it took up to 4 hours, some of their treatments, and they live close to home. Can you imagine somebody who lives 2, 3 hours away? It's an entire day out of their lives and that of their loved one who is traveling with them. Something like this can be a game changer, and really makes it easier for patients whose lives are already being disrupted to make sure that they adhere to their treatment.

There's also, in some cases, less pain. Nobody likes having a needle put into them. Somebody like me has very thin veins, and so when I have to have blood removed or anything else, this would be a very difficult thing to accomplish. There are a number of different things. In some cases, there are individuals who can be closer to home to have the SubQ. There are people who do need to travel to their cancer center, for their labs, and their scans and everything else, and so they might choose just to continue with the IV. But what's nice is, is that there are now choices out there for patients. That's really what we want to be able to do, is to offer them choices so that they can make decisions that are best for them.

Maybe, Jen, I'm going to kick it back to you because you've seen patients experience pain when it comes to receiving the IV versus the SubQ, and maybe you can share some of the things you've witnessed.

Hunze (06:34): Yeah, absolutely. I guess to start, repetitive IV starts and then infusing medications through them, patients' veins get very fragile. Scar tissue builds up. Maybe they're not feeling great from their treatment and so they get dehydrated. There's so many reasons why IVs can get tricky for this patient population. Going to the SubQ route was huge. It was a little uncomfortable getting a shot in the belly or the arm. Patients, it was foreign to them at first, to many of them anyway. However, they welcomed it when they had their first injection versus having to have an IV start. Especially, like you mentioned, you have small veins. There's a lot of patients that do, and it takes multiple sticks, where you can't really screw up a SubQ injection. That's why a lot of times patients can do certain types of medications and they can inject it themselves. It's definitely been a satisfier for the patients that I've dealt with.

Guild (07:48): I think it is important, though, to also address some of the disadvantages that patients may experience. Some patients do enjoy the ability to actually interact with others who are going through the same journey. Patients who have cancer can often feel alone or a burden to their family. And so, having the ability to talk to others who are going through a similar experience and can relate to what they are dealing with. I also think many patients, I'm sure, enjoy talking to the staff while they're getting their treatments. They're bonding with these individuals, they develop relationships, and I assume their nurses and PAs develop a relationship. And so, it's an opportunity for them, if they're getting an IV, to spend more time catching up with people and feeling as if they can build that relationship with somebody over the next couple of years, making them feel more comfortable each and every time they come.

I think I've covered it all. I may have missed a couple, but again, I think in the end, what it really comes down to is it needs to be a decision that patients have the opportunity to think about and ask questions. Ultimately, patients do go to their doctors and other providers for guidance on the best treatments, and so I hope that providers are prepared to share with them all of the options that are available to them.

Dronca (09:22): Thank you very much and thank you all for listening. We invite you to join us for our next chapter, how to implement subcutaneous immunotherapy options for providers.