Introduction The use of trastuzumab in the (neo)adjuvant setting for patients with her-2 positive early breast cancer is known to reduce the rate of disease recurrence by approximately 50%, and improve survival by approximately 30% 1,2 Subcutaneous administration of trastuzumab has been shown to be non- inferior to intravenous administration3 and is generally well tolerated and preferred by patients At royal united hospitals, bath, over ¾ of patients now receive trastuzumab via the subcutaneous route Manufacturer’s literature recommends an observation period of 6 hours after IV trastuzumab Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al.. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005;353:1659-1672 Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005;353:1673-16 3) Ismael G et al.. Subcutaneous versus intravenous administration of (neo)adjuvant trastuzumab in patients with HER2-positive, clinical stage I–III breast cancer (HannaH study) a phase 3, open-label, multicentre, randomised trial Lancet oncol. 2012; 13 (9) : 869 - 878

Medicines.org.uk “Administration-related reactions (ARRs) are known to occur with Herceptin subcutaneous formulation… Although serious ARRs, including dyspnoea, hypotension, wheezing, bronchospasm, tachycardia, reduced oxygen saturation and respiratory distress, were not reported in the clinical trial with the Herceptin subcutaneous formulation, caution should be exercised as these have been associated with the intravenous formulation. Patients should be observed for ARRs for six hours after the first injection and for two hours after subsequent injections.”

objectives To quantify the financial and time-saving benefits of the use of SC trastuzumab vs. IV trastuzumab To assess the rate of adverse events after administration of the first dose of sc trastuzumab in the adjuvant or neo-adjuvant setting

August 2015-July 2016 SC doses n = 755 IV doses n = 155 Total doses n = 910

Method Methods

Results

Summary of results Financial saving of almost £100,000 over a 1-year period Does not take into account financial benefits of saving staff time Significant savings in chair time, administration time and pharmacy time Frees up staff and increases availability of chair space for other patients Lack of adverse reactions to sc trastuzumab in 6-hour observation window Calculated time-savings above DO not include potential further chair-time savings if observation window were to be reduced

Conclusion

Thank you Any questions?