Patient Preference Supports Subcutaneous Trastuzumab For Metastatic HER2-Positive Breast Cancer

Patients with metastatic HER2-positive breast cancer using trastuzumab may prefer subcutaneous over intravenous administration

medwireNews: MetaspHer study findings suggest that patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer prefer subcutaneous (SC) administration of trastuzumab to intravenous (iv) delivery.

The results follow findings from the HannaH and PrefHer trials demonstrating sc trastuzumab to be as effective and well tolerated as iv trastuzumab in the early breast cancer setting, as well as preferred by this patient population, the investigators report in the European Journal of Cancer.

“Based on data from HannaH, PrefHer and MetaspHer, [sc trastuzumab] is a validated and a preferred option over [iv trastuzumab] for improving patients' care in early and metastatic HER2-positive breast cancer”, they conclude.

Xavier Pivot, from CHU Jean Minjoz in Besançon, France, and co-authors recruited 113 patients with HER2-positve metastatic breast cancer who had completed first-line chemotherapy with trastuzumab and had maintained a response for at least 3 years.

The patients were randomly assigned to receive three cycles of fixed-dose sc trastuzumab 600 mg followed by three cycles of standard iv trastuzumab 6 mg/kg over 30–90 minutes, or to receive treatment in the reverse sequence.

Of the 92 patients who completed all six cycles, 85.9% stated a preference for the sc trastuzumab using the Patient Preference Questionnaire, while 14.1% said they preferred the iv regimen. This preference was also noted for 88.5% of the 52 patients who had stated they did not have a preferred method of administration before beginning the study, the researchers observe.

The Quality of Life Questionnaire Core30 responses showed no differences in overall health status or physical, cognitive or social functioning scores over the study period, although the researchers point out “the high level of [quality of life] observed in this selected population of patients with metastatic disease controlled by trastuzumab.”

Side effects were reported by 67.6% of patients during sc treatment and 44.1% of patients during iv therapy. But while “[n]umerous low grade toxicities were reported due to the extensive capture of events”, the team emphasizes that “no impact in terms of compliance was detected.”

Grade 3 or more severe events occurred in 6.5% and 3.6% of patients during sc and iv therapy, respectively, and serious events in 2.8% and 1.8%. Overall, the researchers describe sc trastuzumab as well tolerated and say there were no new safety signals compared with the iv formulation.

Results from the ongoing SafeHer study will further assess the safety and tolerability of sc trastuzumab using a handheld injection or by assisted or self-administered single-use injection device in patients with early HER2-positive breast cancer, they add.

Reference

Pivot X, Spano JP, Espie M, et al. Patients’ preference of trastuzumab administration (subcutaneous versus intravenous) in HER2-positive metastatic breast cancer: Results of the randomised MetaspHer study. Eur J Cancer; Advance online publication 23 June 2017. https://doi.org/10.1016/j.ejca.2017.05.009

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