Research indicates that the administration of HER2-targeted therapies via injection is as safe and effective as traditional intravenous infusions, streamlining the treatment process for breast cancer patients. While the advantages of subcutaneous delivery are recognized in leading medical facilities, access to this method remains inconsistent throughout India”s diverse healthcare landscape.
In December 2021, when Vrinda Thakker was diagnosed with metastatic HER2-positive breast cancer, her treatment began with intravenous therapy, which involved a lengthy process of infusion through a chemoport. She described each session as taking hours, including necessary precautions to prevent blockages. After enduring the lengthy regimen for several months, she opted to discuss the possibility of switching to a subcutaneous delivery method with her oncologist. This alternative involves a quick injection, which, while initially uncomfortable, greatly reduces the time spent in the hospital.
Another patient echoed Thakker”s sentiments, noting that the subcutaneous injection is significantly faster, taking only a few minutes compared to the lengthy intravenous process. This shift not only minimizes hospital time but also mitigates risks associated with chemoports, such as infections and blood clots.
The science behind this transition involves trastuzumab, a monoclonal antibody used for over twenty years to treat HER2-positive breast cancer. Traditionally administered intravenously every three weeks, trastuzumab can now be delivered subcutaneously thanks to a formulation that uses recombinant human hyaluronidase (rHuPH20). Clinical trials, including the HannaH and FeDeriCa studies, have demonstrated that this fixed-dose subcutaneous version of trastuzumab maintains the same safety and efficacy as intravenous infusions.
In India, a real-world evaluation of the subcutaneous treatment, known as PHESGO, showed comparable outcomes for patients with both early-stage and metastatic disease. Most participants reported fewer hospital visits and expressed a preference for the subcutaneous method, citing its convenience.
Time efficiency is a crucial factor in breast cancer treatment. The ADEPT study revealed that the average duration in the treatment chair decreased from approximately 85 minutes with intravenous administration to about 20 minutes with the subcutaneous method. This reduction in hospital time can significantly impact patients and their families, as Meenu Walia, a senior oncologist, highlighted the burdens that long hospital stays impose on those who are daily wage earners or responsible for caregiving.
Shorter treatment sessions also benefit healthcare providers by optimizing patient flow within oncology units. Niti Raizada, a director at Fortis Cancer Institute, noted that more efficient procedures allow for better management of patient care without overcrowding infusion units.
Despite the established benefits of subcutaneous therapy, access remains uneven across India”s healthcare system. Dr. Raja emphasized that while urban centers have advanced facilities, smaller towns often lack the necessary infrastructure and trained staff, complicating treatment for patients who must frequently travel for care.
For oncologists, the shift to simpler treatment modalities not only enhances efficiency but also improves the overall patient experience. Dr. Shona Nag explained that traditional infusion processes can be exhausting and emotionally taxing for patients, particularly those balancing work and family responsibilities. The ability to receive treatment quickly and with less intrusion into daily life has proven beneficial, especially during the COVID-19 pandemic, when home-based subcutaneous treatments became necessary.
Thakker continues her targeted therapy and advocates for the subcutaneous option, noting its cost-effectiveness compared to intravenous methods. The focus of modern oncology is not only on treating the disease but also on ensuring a more comfortable and less disruptive experience for patients.
