[MP Test] Subcutaneous atezolizumab favoured over intravenous infusion

Nonsmall cell lung cancer (NSCLC) patients with high PD-L1 expression appear to show a strong preference for receiving atezolizumab subcutaneously rather than intravenously.

Results of the IMscin002 trial presented at ELCC 2024 showed that out of the 123 patients surveyed, 70.7 percent opted for the subcutaneous delivery of atezolizumab while only 21.1 percent were partial to the intravenous route. The remaining 8.1 percent expressed no preference. [Cappuzzo F, et al, ELCC 2024]

The strong preference for subcutaneous treatment was driven by the convenience of shorter clinic visits (64.4 percent), greater comfort during administration (46.0 percent), and reduced emotional distress (29.9 percent).

Following the positive experience, a significant proportion of patients (79.4 percent) went for the subcutaneous route of administration during the extended treatment period.

“All patients who preferred subcutaneous atezolizumab chose [the same] for the continuation period,” noted lead study author Prof Federico Cappuzzo of IRCCS Regina Elena National Cancer Institute in Rome, Italy.

Satisfaction scores reflected the treatment preference, with 85.8 percent of patients reporting to be satisfied/very satisfied with subcutaneous atezolizumab versus 75.2 percent of those reporting the same with the intravenous infusion.

Beyond patient preference, subcutaneous atezolizumab offered additional benefits for the healthcare system. Unlike intravenous administration, the subcutaneous route often eliminates the need for specialized sterile preparation and allows administration in ward settings (following local regulations), according to Cappuzzo.

Moreover, subcutaneous administration shortens preparation time, he continued. Nurses on the ward can prepare subcutaneous atezolizumab roughly three times faster than pharmacists in the pharmacy setting.

In other words, subcutaneous atezolizumab presents a potential for more efficient use of hospital resources, particularly when local regulations permit out-of-pharmacy preparation, Cappuzzo said.

No safety concerns

IMscin002 included 179 patients (median age 67 years, 67 percent male, 83 percent White) with PD-L1–positive NSCLC who had prior chemotherapy and no evidence of recurrence. Of these, 117 had stage IV NSCLC and 62 had resected NSCLC. The patients were randomly assigned to receive atezolizumab either subcutaneously (1,875 mg; n=90) or intravenously (1,200 mg; n=89) once every 3 weeks.

After the third cycle of treatment, patients were switched to the alternative route of administration. Then after cycle 6, patients were asked to select how they wanted the treatment delivered for the continuation period. Treatment continued for ≤16 cycles for those with resected NSCLC or until investigator-determined loss of clinical benefit for those with advanced NSCLC.

“The overall safety profile was consistent with the well-established atezolizumab profile, and there were no safety concerns identified in relation to switching between formulations,” Cappuzzo noted. [Ann Oncol 2023;34:693-702; https://www.ema.europa.eu/en/documents/product-information/tecentriq-epar-product-information_en.pdf; https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761034s042lbl.pdf]

“The likelihood of a patient experiencing an injection-site reaction or infusion-related reaction event did not increase when switching between atezolizumab subcutaneously and intravenously, or vice versa,” he added.

There were 69.1 percent of patients who had adverse events (AEs) and 46.3 percent who had treatment-related AEs. Serious AEs occurred in 16.0 percent of patients, while grade 3-4 AEs occurred in 19.4 percent. AEs led to treatment interruption in 13.7 percent of patients and to death in 2.9 percent.

“These results support previous findings that subcutaneous atezolizumab is an equivalent alternative to [the intravenous infusion] and has the potential of reducing burden on hospitals and for all patients who are eligible for treatment with atezolizumab, including lung cancer and other approved indications,” Cappuzzo said.