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Reinisch M, Untch M, Mahlberg R, Reimer T, Hitschold T, Marmé F, Aydogdu M, Schmatloch S, Lück HJ, Schmidt M, Ladda E, Sinn BV, Klare P, Janni W, Jackisch C, Denkert C, Seiler S, Göhler T, Michel L, Burchardi N, Stickeler E, Rey J, Klutinus N, Möbus V, Loibl S. Subcutaneous injection of trastuzumab into the thigh versus abdominal wall in patients with HER2-positive early breast cancer: Pharmacokinetic, safety and patients' preference - Substudy of the randomised phase III GAIN-2 study. Breast 2022; 66:110-117. [PMID: 36223695 PMCID: PMC9563210 DOI: 10.1016/j.breast.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Trastuzumab given intravenously in combination with chemotherapy is standard of care for patients with early HER2-positive breast cancer (BC). Different randomised studies have shown equivalent efficacy of a subcutaneous injection into the thigh compared to the intravenous formulation. Other body regions for injection have not been investigated but might be more convenient for patients. METHODS After surgery, patients were randomised to receive either subcutaneous trastuzumab into the thigh or into the abdominal wall (AW). Patient preferences were evaluated using validated questionnaires (PINT). Primary objectives of this multicentre, non-blinded, randomised substudy of the GAIN-2 study were to investigate pharmacokinetics of the injection into the thigh versus AW and to determine patients' preferences of either administration site versus the previously received intravenous application. RESULTS 226 patients were randomised and 219 patients (thigh: N = 110; AW: N = 109) formed the modified intent-to-treat (mITT). Overall, 83.5% (out of N = 182 with information about patients' preference) preferred subcutaneous over previous intravenous application or had no preference. Preference was similar between both administration sites (thigh: 80.6%; AW: 86.5; p = 0.322). Pharmacokinetic analysis included 30 patients. Geometric means of Cmax and AUC0-21d were higher in thigh than in AW group (geometric mean ratio with body weight adjustment: Cmax: 1.291, 90%-CI 1.052-1.584; AUC0-21d: 1.291, 90%-CI 1.026-1.626). Safety profile was in line with previous reports of subcutaneous trastuzumab. CONCLUSION Subcutaneous trastuzumab into the thigh showed an approximately 30% higher bioavailability. Injections were well tolerated and preferred over intravenous administration. The subcutaneous injection into the thigh should remain the standard of care.
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Affiliation(s)
- Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Michael Untch
- Department of Gynaecology and Obstetrics, Breast Cancer and Gynecologic Oncology Center, HELIOS Klinikum Berlin Buch, Germany
| | - Rolf Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik Am Klinikum Südstadt Rostock, Germany
| | | | - Frederik Marmé
- Department of Gynaecology and Obstetrics, University Hospital Mannheim, Germany
| | | | | | | | - Marcus Schmidt
- Department of Obstetrics and Gynaecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Peter Klare
- Praxisklinik Krebsheilkunde für Frauen Berlin, Germany
| | | | | | | | | | - Thomas Göhler
- Fachärzte für Innere Medizin, Hämatologie und Internistische Onkologie, Onkozentrum Dresden, Germany
| | - Laura Michel
- National Center for Tumour Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | | | - Julia Rey
- German Breast Group, Neu-Isenburg, Germany
| | - Nicole Klutinus
- HELIOS Klinikum Pforzheim GmbH Brustzentrum, Pforzheim, Germany
| | - Volker Möbus
- Department of Medicine II, Haematology & Oncology, University of Frankfurt, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany,Corresponding author. author. German Breast Group, GBG Forschungs GmbH, Martin-Behaim-Straße 12, 63263, Neu-Isenburg, Germany.
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Eisenberg S. Subcutaneous Administration: Evolution, Challenges, and the Role of Hyaluronidase. Clin J Oncol Nurs 2021; 25:663-671. [PMID: 34800095 DOI: 10.1188/21.cjon.663-671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The subcutaneous (SC) route has evolved significantly. More than two dozen chemotherapy and supportive therapies have been approved for use in the oncology setting. Several IV therapies have been approved for the SC route and require a significantly higher volume than historical maximum limits. Differences exist in how these drugs are administered as compared to older chemotherapy agents. OBJECTIVES The purpose of this article is to provide a brief history of the SC route and describe its role in cancer treatment. The use of recombinant hyaluronidase is reviewed within the context of SC monoclonal antibodies. Proper administration techniques and interventions for reducing patient discomfort are discussed. METHODS Sentinel medical texts, pharmacokinetic studies, manufacturer's recommendations, and peer-reviewed articles were examined. FINDINGS The SC route offers several advantages over the oral and IV routes. A clear understanding of anatomical site selection and injection techniques is beneficial for providing requisite patient education.
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Boudreau A. Practical considerations for the integration of subcutaneous targeted therapies into the oncology clinic. Can Oncol Nurs J 2019; 29:267-270. [PMID: 31966017 PMCID: PMC6970019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The oncology clinic is changing, with an increasing number of cancer therapies becoming available as formulations for subcutaneous (SC) injection. Using targeted therapies, such as alemtuzumab, bortezomib, rituximab or trastuzumab, via SC injection can be advantageous for patients, healthcare professionals, and healthcare systems. However, their use can also present challenges, and nurses have a unique opportunity to positively influence the integration of SC agents in the clinic. This article summarizes practical suggestions for optimal administration of SC targeted therapies, and provides pragmatic considerations for managing the change process related to their adoption.
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Affiliation(s)
- Angela Boudreau
- Advanced Practice Nurse, Department of Nursing, Sunnybrook Odette Cancer Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5,
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