This was a Moroccan multicentre study which evaluated the cost minimisation of administering trastuzumab via intravenous versus subcutaneous route in patients with HER2 positive breast cancer. Given that breast cancer is the most prevalent cancer among women in Morocco, to roughly around 40%, the study aimed to determine which administration route is more cost effective and logistically efficient in the local healthcare setting.
What was the study design?
This was a prospective observational multicentre study in which around 747 patients with histologically confirmed HER2 positive breast cancer were enrolled. The primary endpoint of the study was to compare the average total cost, which included the drug cost, consumables, as well as consultation costs per patient, for intravenous versus subcut trastuzumab. Secondary endpoints of the study were to evaluate the time spent in the oncology unit and management of drug related adverse events.
What were the results of this study?
In total 747 patients from three sites in Morocco were enrolled between a period of March 2021 to July 2023. 379 patients received IV trastuzumab and 368 received subcutaneous trastuzumab. Both the groups were similar in terms of average age, weight and cancer histology.
Subcutaneous trastuzumab was preferred in EBC patients or early breast cancer patients and as monotherapy while there was no clear trend for IV transtuzumab. Subcutaneous trastuzumab was costing significantly more as compared to IV trastuzumab, to be precise around 53%. It was majorly driven by the drug cost.
The total time which was spent in hospital, which includes for trastuzumab all chemotherapy administration, at CP time, as well as the admin time which is spent by the patient. In the IV group it was more compared to the subcutaneous group – 220 minutes versus 163 minutes – while at CP time among patients where chemotherapy was given along with the trastuzumab it was more with the subcutaneous group as compared to IV.
Now, there was no significant difference in terms of quality of life as was measured by EQD-5 and treatment satisfaction questionnaires for medication.
To conclude, we can say that IV trastuzumab was more cost effective with similar quality of life outcomes, making it a viable strategy for resource-limited or constrained settings like Morocco.
What is the significance of these results?
IV trastuzumab is more cost effective in the Moroccan setting as is seen in this study. Moreover, it gives freedom of adjusting the dose per patient as per the bodyweight. Vial sharing is also something which is possible and weekly dosing is also feasible with IV trastuzumab.
Subcutaneous trastuzumab definitely offers time savings but at a higher cost. Both the routes offer comparable quality of life. This data supports budgetary planning and therapeutic strategy optimisation for national cancer programmes in favour of IV trastuzumab.
Is there anything else you would like to add?
There are certain questions which we need to ask or the clinicians need to ask from themselves. They are like how important is the shorter duration of subcutaneous trastuzumab in the real-life setting? Will you prefer subcutaneous versus IV trastuzumab for administration with concomitant chemotherapy when the IV line is already there? Does vial sharing, which is possible with IV, does it matter in your setting or hospital? Do you prefer giving a weekly regime of trastuzumab in some of your patients? And do you see any safety which is majorly the injection site reactions or immunogenicity which can be more of anti-trastuzumab antibodies or against high [??]. Any such differences between subcutaneous and IV trastuzumab formulations?
