Weighing Logistics and Time Savings of Subcutaneous Drug Delivery

In an interview with Targeted Oncology^TM, J. Thaddeus Beck, MD, medical oncologist at Highlands Oncology, discussed how the move from intravenous (IV) to subcutaneous drug formulations is affecting oncology practice. He covered the logistical demands of subcutaneous administration, patient preferences, and the outlook for on-body delivery systems.

Targeted Oncology: What does the current landscape of subcutaneous drug delivery look like in oncology today?

J. Thaddeus Beck, MD: There are quite a few subcutaneous delivery systems, both simple injections and wearable devices, that have been around for at least a decade. There has also been a transition from IV drugs to subcutaneous formulations over the past decade or so.

What challenges have you experienced integrating subcutaneous delivery into your practice or treatment regimens?

There are some logistical issues. Patients have to unbutton their shirt, for example, to receive an injection into the abdominal wall. That requires more privacy and space than having an IV placed in your arm, so we have to design spaces for subcutaneous delivery. That’s the main issue. Sometimes the materials are refrigerated and have to be warmed up, so you need to time things so the drug and the proper mixing solution are ready when the patient arrives.

Because subcutaneous formulations are different from IV formulations, there is some risk of allergy, although the rate of allergic events is relatively small.

Have patients generally been more receptive, or have you seen subcutaneous delivery become a patient preference?

Every patient is different, and they have different preferences. They may have more or fewer demands on their time. They may not like to take their shirt off or expose their belly in public. That being said, the time savings often overcome those barriers. Some of the first drugs that went into subcutaneous formulations saved 8 hours of infusion time and a full day in the office. Everyone was very eager to transition to those subcutaneous versions.

How do you see subcutaneous drugs expanding over the next 5 years, especially with more novel delivery mechanisms like on-body applicators?

I think it’s going to happen more and more. That’s the way the trend has been going. We haven’t used on-body systems much, though we have in the past. They carry more risk of unexpected failure compared with direct injection in the office. But newer and more convenient techniques are coming out, and for medications given subcutaneously over a longer period, on-body programs would be more feasible.

Are there other developments in this field that you’re particularly excited about?

I think any conversion from IV to subcutaneous is exciting.