Oral Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

Challenges with the Implementation into Clinical Practice of Subcutaneous Trastuzumab – A Pharmacist’s Perspective (#6)

Geeta Sandhu 1
  1. Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia

Subcutaneous trastuzumab has recently become available nationally on the Pharmaceutical Benefits Scheme for locally advanced and metastatic HER2-positive breast cancer. Its unique formulation with recombinant human hyaluronidase temporarily interrupts the extracellular matrix integrity of the body’s subcutaneous tissue, enabling painless and straightforward drug delivery. Studies suggest that the 600mg fixed dose 3-weekly, no requirement for intravenous access or loading doses, provides a convenient and timesaving alternative from the traditional weight based dosing of intravenous trastuzumab for patients and busy cancer day units alike.1,2 However, does this actually translate into a reduction in drug preparation time, patient chair time and drug wastage for the ‘real life’ Australian clinical setting? Clinical trials have demonstrated comparable pharmacokinetics, efficacy and tolerability between subcutaneous and intravenous trastuzumab.3,4 Does the one dose fits all approach with subcutaneous administration ensure long-term disease free survival rates and an adverse effect profile similar to that of intravenous trastuzumab at the extremes of population i.e. in obese or underweight patients?


  1. Pivot X, Gligorov J, Müller V. et al. Patientsʼ preferences for subcutaneous trastuzumab versus conventional intravenous infusion for the adjuvant treatment of HER2-positive early breast cancer: final analysis of 488 patients in the international, randomized, two-cohort PrefHer study. Ann Oncol. 2014;25:1979–1987.
  2. De Cock E, Semiglazov V, Lopez-Vivanco G. Time savings with trastuzumab subcutaneous vs. intravenous administration: a time and motion study. St. Gallen 2013, Abstr. P209.
  3. Jackisch C, Kim S, Semiglazov V. et al. Subcutaneous versus intravenous formulation of trastuzumab for HER2-positive early breast cancer: updated results from the phase III HannaH study. Ann Oncol. 2015;26:320–325.
  4. Gligorov J, De Laurentiis M, Verrill M. et al. Subcutaneous trastuzumab plus chemotherapy for early breast cancer: interim safety from SafeHer. Presented at the St Gallen International Breast Cancer Conference, Vienna, Austria, 18–21 March, 2015; Poster P103.