Checkpoint Change: Rethinking How PD-1/PD-L1 Inhibitors Are Delivered

Описание: Immune checkpoint inhibitors targeting PD-1 and PD-L1 have transformed the treatment landscape across a wide variety of cancers, becoming foundational therapies in oncology. Dr. Stacey Sobocinski and Dr. Michele Rice join host Dr. Kerry Schwarz to discuss what the new subcutaneous PD-1/PD-L1 immune checkpoint inhibitors could mean for oncology practice. They cover the three agents that have become available in subcutaneous formulations, their advantages and disadvantages, other important operational, financial, clinical, and safety issues for health systems to consider.



 



Guest speaker:  



 



Stacey Sobocinski, Pharm.D., BCPS



Associate Director, Pharmacy Medication Management & Informatics



MD Anderson Cancer Center 



 



Michele Rice, Pharm.D., BCOP



Senior Consulting Solutions Director



Vizient Pharmacy Enterprise Solutions



Host:  



Kerry Schwarz, Pharm.D., MPH



Senior Clinical Manager, Evidence-Based Medicine and Outcomes



Vizient Center for Pharmacy Practice Excellence  



 



Show Notes:

00:05 — Introduction



• Announcer welcomes listeners to VerifiedRx, produced by the Vizient Center for Pharmacy Practice Excellence.






00:14 — Episode Overview



• Host Kerry introduces the topic: new subcutaneous formulations of PD-1 and PD-L1 immune checkpoint inhibitors.


• These therapies have traditionally been administered intravenously (IV) in infusion centers.


• Recently approved subcutaneous versions include:



• Pembrolizumab (Keytruda Qlex)


• Nivolumab (Opdivo Qvantig)


• Atezolizumab (Tecentriq Hybreza)





• Potential benefits include shorter administration times and relief for infusion centers operating at capacity.


• Guests:



• Stacy Sobacinski, Associate Director of Pharmacy Medication Management and Informatics, MD Anderson Cancer Center


• Michelle Rice, Senior Pharmacy Enterprise Solutions Director, Vizient





01:39 — Clinical Data: Efficacy, Safety & Pharmacokinetics



• Subcutaneous formulations were approved in combination with hyaluronidase, allowing full-dose subcutaneous administration.


• Clinical studies demonstrated:



• Comparable pharmacokinetics


• Similar efficacy


• Similar safety profiles compared to IV formulations





• The main difference observed was local injection site reactions, expected with subcutaneous administration.


02:32 — Confidence in Clinical Comparisons



• Although direct head-to-head trials are limited, extensive experience with IV formulations supports confidence in safety and efficacy.


• Differences largely relate to administration method, not drug activity.


03:11 — Operational Impact: Changes to Workflow



• Subcutaneous administration introduces new operational considerations.


• Shorter injection times may appear advantageous, but real-world workflow impact is still being evaluated


• Much of a patient’s visit still involves:



• Waiting room time


• Laboratory testing


• Provider visits


• Care coordination







 

04:06 — Chair Time vs Total Visit Time



• For therapies previously requiring longer infusions, switching to subcutaneous injections can significantly reduce chair time.


• For therapies previously infused over 30 minutes, the difference between IV and subcutaneous administration time may be less impactful.




 

04:24 — Administration Challenges



• Subcutaneous doses are not small-volume injections.


• Injection volumes may reach 10–15 mL


• Nursing considerations include:



• Patient tolerance for larger-volume injections.


• IV infusions allow nurses to start the infusion and attend to other tasks.


• Subcutaneous injections require continuous nursing presence during administration.


• This may increase direct nursing time.







 



 



 

05:05 — Equipment Considerations



• Some centers may use syringe pumps to administer subcutaneous injections.


• Many adult infusion centers do not currently have pumps since chemotherapy is typically delivered via IV using infusion pumps.


• Implementing syringe pumps could ...