Practice Pearl 4: Future Implications of Subcutaneous Dosing

Concluding the discussion, the panel considers future directions for subcutaneous dosing.

Adam M. Brufsky, MD, PhD: This has been extremely informative, and before we end this discussion, I'd like our 2 panelists to make any final comments.

Matthew J. Matasar, MD: I would close just by highlighting the fact that we're at this point of change right now where we have emergence of formulations that may be more patient friendly and more schedule friendly. And at the same time, we have the emergence of biosimilars that have different value propositions in that we as a discipline, pharmacists and oncologists together, have a lot of work to do to unravel the various pros and cons of these different formulations int he guiding of our patients.

Adam M. Brufsky, MD, PhD: Tim?

Tim Peterson, PharmD, BCOP: So definitely with these new subcutaneous formulations coming out for all sorts of different antibody therapies—daratumumab is likely coming out in the near future—it's definitely going to be a moving target in the conversation that needs to be had with patients, right? They need to be aware of the potential positives and negatives of each therapy and different, particular clinical scenarios, right? In a maintenance setting for multiple myeloma or the maintenance setting after having received dose-dense A/C [adjuvant chemotherapy] for breast cancer and going on to trastuzumab, it might be more appropriate for those sorts of situations. So it's always going to be a conversation that needs to be had between the oncologist and the patient.

Adam M. Brufsky, MD, PhD: No, and I agree. I think as someone who just has not used a lot of subcutaneous formulations yet, because it's just started in the breast cancer field, this has been really informative for me. I would worry about the giant lump, which clearly is not going to happen. I think I would worry about the infusion site reactions, which don't seem to happen. I worry about patient pain, which doesn't seem to happen.

The real question for us, as for you in the lymphoma world, is really what the value proposition is going to be, and I think it's a lot more than I thought of. Before I came into this discussion, I really thought that, oh, it's just another way of giving it; it's not going to be that big a deal. It's going to be 30% more at cost. But to be honest with you, patients are wanting it 90% of the time. I think that's a cost that you can really see.

You can't really actually physically measure it. But on the other hand, that's a big deal. You have a patient come in and out of a clinic in 5 to 10 minutes; that's a big deal. Especially on their days when they're not seeing any of us, that's a big deal.

Thank you. And thank you all for your contributions to this discussion. And on behalf of our panel, we thank you for joining us, and we hope you found this Pharmacy Times® Practice Pearls discussion to be useful and informative. Thank you.