SC vs IV Immune Checkpoint Inhibition in NSCLC: Is One Better Than the Other?

By: Julia Cipriano, MS
Posted: Monday, August 5, 2024

The demanding nature of intravenous (IV) immune checkpoint inhibitor administration has led to speculation as to whether a subcutaneous (SC) method may decompress infusion center resources and improve quality of life. Nithya Ramnath, MBBS, of the University of Michigan, Ann Arbor, and colleagues sought to answer this clinically relevant question in the context of the multicenter phase III IMscin001 trial of patients with non–small cell lung cancer (NSCLC). Their commentary on the pros and cons of each method of administration was published in the journal Translational Lung Cancer Research.

Briefly, in the IMscin001 trial, patients with previously treated locally advanced or metastatic NSCLC were randomly assigned in a 2:1 ratio to receive SC (1,875 mg; n = 247) or IV (1,200 mg; n = 124) atezolizumab every 3 weeks. The formulations of this monoclonal antibody seemed to demonstrate equivalent pharmacokinetic, efficacy, and adverse-event profiles. However, the median duration of follow-up was just 4.7 months, and the SC dose was 30% higher than that approved for IV administration.

Intravenous administration involves intricate sterile processes and equipment, whereas subcutaneous formulations can be drawn up at chairside with fewer materials. The authors compared the chair time between the methods of atezolizumab administration, using subcutaneous data from the IMscin001 trial. The subcutaneous method was not found to offer a benefit, given the required 30-minute observation period; however, with an implied shorter administration time in the IMscin001 trial, it was rolled out by the National Health Service in the maintenance setting.

Of the IMscin002 study population, 70.7% preferred SC atezolizumab, 21.1% preferred IV atezolizumab, and 8.1% had no preference. The authors noted that the costs associated with the preparation and administration of IV formulations may not be offset by those associated with the higher SC doses.

“It appears that the patient who is receiving prolonged immune checkpoint inhibition may have the final say in the choice of preparation,” the investigators concluded.

Disclosure: Dr. Ramnath reported no conflicts of interest. For full disclosures of the other authors, visit tlcr.amegroups.org.

Translational Lung Cancer Research