The Impact of Subcutaneous Formulation of Atezolizumab on Treatment for Patients with Non-Small Cell Lung Cancer

Federico Cappuzzo, MD, National Cancer Institute Regina Elena, Rome, Italy, discusses the benefits of the subcutaneous formulation of atezolizumab compared with atezolizumab intravenous. Dr Cappuzzo reviews data from both IMscin001 and IMscin002 to cover both efficacy outcomes as well as patient- and health care professional-reported outcomes.

Dr Cappuzzo concluded, “I really hope…the health authorities will allow using these agents outside of the hospital. This is, I think, the most important point for the patients.”

Transcript:

I am Federico Cappuzzo. I'm medical oncologist and I'm the Director of Medical Oncology at the National Cancer Institute Regina Elena, in Rome, Italy.

Please discuss the current treatment option of intravenous atezolizumab.

Atezolizumab is an agent that is approved for the treatment of metastatic advanced non-small cell lung cancer in patients with high levels of PD-L1 expression. And the clinical trials that were so far conducted are showing that this agent is effective in the treatment of this disease. We have clear evidence that atezolizumab as an anti PD-L1 agent is very effective in the treatment of patients with advanced disease. Also, we have evidence that atezolizumab is effective in early stage, because we have also positive data of atezolizumab specifically in patients with resected tumors, so in what we call the adjuvant setting.

How does the efficacy of subcutaneous atezolizumab compare to intravenous?

We have different studies that were conducted with atezolizumab subcutaneous, and all of these trials are showing that there is no difference in terms of efficacy between the subcutaneous and the intravenous. But in terms of compliance of the patient, compliance is much better for patients receiving the subcutaneous administration. Also, the subcutaneous administration gives many other potential advantages also for the hospital using the subcutaneous, the timing for preparing the drug, the timing for administering the drug is much lower. This is an important advantage. And of course, we save also resources of the hospital. In terms of the general cost of the drug, it is lower by using the subcutaneous. The other advantage, of course, is for the patients because it's much easier for the patient to receive the drug, it's much quicker.

Also there is another important potential advantage, that is represented by the fact that, if it's allowed by the different countries’ rules, potentially we could give the drug even outside of the hospital. Potentially the patient could receive the drug even at home, or at the office of the family doctor. It's much more easy to deliver the drug, meaning that the patient does not necessarily need to go to the hospital. This is very important at the present time, particularly because we know that unfortunately, we have a lot of patients referring to the hospital and we have not enough resources for managing all the patients going to the hospital. It's very important if we can find also a way in which we can deliver the drug, if we can deliver the drug even outside of the hospital.

Please discuss the results of the IMscin002 trial.

The IMscin002 trial specifically explored the patient preference for atezolizumab subcutaneous or intravenous. The design of the trial was based on the fact that the patient was allowed to decide what kind of route of administration was used. And the data coming from this clinical trial clearly showed that the majority of patients preferred usage of subcutaneous atezolizumab. And the reasons were, the reason that we already discussed: less time in the clinic, usage was more comfortable, treatment was less emotionally distressing. And for that reason, it is not a surprise that the vast majority of patients preferred to use the subcutaneous specifically in the continuation period, when they continue the treatment with atezolizumab. Also, the satisfaction for the therapy was very high with the intravenous, and no difference in terms of toxicity at all was observed between subcutaneous and intravenous. We have a lot of evidence coming from this clinical trial supporting the usage of subcutaneous as also the preferred method of delivery by the patients.

How does the approval of subcutaneous atezolizumab impact real-world practice?

The impact will be very high because the possibility of delivering a drug in a very easy way is very important for the patient. It is extremely important because we need, particularly in cancer patients and particularly in patients with advanced disease, where the duration of life unfortunately is limited, we have to reduce the time they spend in the hospital. In this way, we can certainly reduce the negative impact in terms of quality of life for the patient. This is a great advantage for the patient and also is a great advantage for the hospital, and I think for the health system in general. It is a great advantage for everybody with the usage of the subcutaneous.

Also giving the possibility of using at home potentially. Many patients, unfortunately, with lung cancer are elderly patients. Even facilitating the therapy for the patient is very relevant. Not only for the patient, but also for all the other caregivers. Because in general, elderly patients also require somebody helping them going to the hospital. Generally cancer is not a problem only for the patient, it's a problem for the whole family. Atezollizumab subcutaneous certainly represents a way in which we can facilitate the management of patients with cancer in general.

Now we have data with atezolizumab, but there are many other drugs, many other companies, also working in this space for developing the subcutaneous administration. I think this is a very important progress and very important advantage for everybody and of course, for the patient particularly.

Are there any special considerations to keep in mind with subcutaneous atezolizumab?

Of course we need to remember that the usage of subcutaneous atezollizumab is a little bit different from other subcutaneous drugs. For example, people can imagine that this is similar to insulin, but it's not the same because the injection requires some minutes. We need to pay attention. Of course, when we administer the drug, even subcutaneously there is some risk of the, that are related to the subcutaneous infusion itself. But the tolerability is very, very favorable in general.

There is no particular requirement, there is no particular suggestion, and in my opinion, there is no specific group of patients in which this approach is not indicated. This is an approach for everybody. I can say that probably it's much more indicated, particularly for elderly, for people that want to reduce spending time in the hospital, for people without the caregivers. These are a group of patients in which specifically there is much more evidence of using the subcutaneous. But in general, this is an approach, this is a treatment that we can give to all patients. There is no group of patients that could be potentially excluded.

Is there anything else about subcutaneous atezolizumab that you would like to add?

The study findings are very favorable. The trials that we have are clearly showing the great advantages that we have with subcutaneous usage of anti-cancer agents in general, and in this case specifically with immunotherapy. I really hope that the other health authorities will very quickly approve and particularly the health authorities will allow using these agents outside of the hospital. This is I think the most important point for the patients. When we have other treatments, for example, oral drugs, patients are very happy that they can take the drug at home. So why should we confine that only to oral drugs? Now we have also other drugs that we need to in some way infuse it to the patient, but of course subcutaneous infusion is much more convenient than the intravenous.

Source:

Cappuzzo F. Primary results from IMscin002: A study to evaluate patient- and healthcare professional- reported preferences for atezolizumab subcutaneous vs intravenous for the treatment of non-small cell lung cancer. Presented at 2024 European Lung Cancer Congress; Match 20-23, 2024. Prague, Czech Republic.