Administration of Dual HER2-Targeted Therapy in BC

Mark Pegram, MD: Next, I’d like to describe some of the issues surrounding administration of dual HER2 [human epidermal growth factor receptor 2] therapy in the neoadjuvant or adjuvant settings and the need for more convenient and equally effective approaches.

You both know that being a patient can be very challenging. For example, just obtaining appointments for our clinical visits can be difficult. You have to listen to Muzak or leave voice mails and wait for returned phone calls. Then you have to schedule appointments for the infusion visits in addition to the clinic visits, laboratory tests, imaging tests, port placement, echocardiography, etc. All of this can be daunting.

At Stanford Women’s Cancer Center a few years ago, we put up all these things on a whiteboard just to walk our way through what a patient actually goes through in our clinic for a diagnosis of early stage breast cancer. At the end of the session, the board is completely filled with sticky notes. It is absolutely incredible what we ask patients to go through.

Even for regimens given every 3 weeks, though this may not sound like often, but consider the patients may have to travel great distances, particularly here in the West, and many face grueling commutes due to horrible traffic conditions in and around major metropolitan areas. When the patients finally get to our clinics, they have to battle for a parking space, queue up at the front desk, queue up in the lab, wait for test results, wait for the pharmacy that makes their medications, wait for the nurse to access their IV [intravenous], finally start an intravenous drip, and then finally—almost an anticlimax—they get the infusion of their medicine. Infusions can sometimes be lengthy. Many are just 30 or 60 minutes, but some can be 3 hours, and that’s for each drug. For a routine infusion with a multiagent regimen, this can easily take a half day, start to finish, or more. A faster process for treatment, like a subcutaneous treatment approach, would dramatically shorten the amount of time spent in the treatment centers.

Moreover, subcutaneous treatment has become a preferred route of administration that mitigates against theoretical transmission risks for the coronavirus. Medical clinics are of course considered high-risk spaces. In my own clinics, 4 of our staff became infected with the virus. Considering patient risk factors for COVID-19 [coronavirus disease 2019] mortality—age, diabetes, hypertension, use of immunosuppressive drugs—many of our patients are being comedicated with steroids, for example, chemotherapy is immunosuppressive, and MTOR inhibitors can be. The shorter amount of time spent in the infusion centers should theoretically reduce exposure risk and mitigate against viral transmission. Not to mention the fact that for reasons I mentioned earlier, it’s simply more convenient.

Transcript Edited for Clarity