Subcutaneuous trastuzumab : any fears ? any new practices ?

Subcutaneous trastuzumab (SC) has been available since September 2014. This formulation is administered as a fixed dose (600mg for all patients). We compared fears and organization of several hospitals that have chosen the SC form.

Two quizzes have been created on internet. It enables a quick answer online. The first is for pharmacists in charge of chemotherapy’s preparation. The second is for nurses who administer chemotherapy. Links to these quizzes were sent to 10 hospitals where breast cancers are treated.

Eight hospitals answered. Five of these ones had patients treated with trastuzumab SC. Four out of 10 respondents expressed fears : confusion between subcutaneous and intravenous form, efficacy and toxicity modified by the fixed dose. Seven out of 10 noticed an impact on their daily activity (an average of 8.5 minutes of preparation time and 8.6 minutes of administration time is saved). New practices such as the reallocation of non administered trastuzumab syringes or delegation of their preparation for the nurses were highlighted. Advices given to patients are different : two nurses recommend massages of the injection site to improve trastuzumab absorption, 3 other nurses do not recommend massages. Nurses prefer SC form because it simplifies the aseptic administration.

With a difficult financial background, this change has a significant impact on budget and practices in hospital. However, biosimilar forms are going to be commercialized soon (announced in France by 2018 (Medicine Agency)). Is the commercialization of the SC form a marketing way to reduce the possibility of transition to biosimilar intravenous forms ?