Challenges in IV Administration of Immune Checkpoint Inhibitors and Interest in SubQ

Challenges in IV Administration and Interest in SubQ

IV administration of immune checkpoint inhibitors presents significant operational challenges for oncology practices. As cancer diagnoses increase and patients live longer, requiring sequential treatments, infusion units face mounting constraints, including chair bottlenecks, complex scheduling around laboratory tests and imaging, safety requirements for acute reactions, line management, and medication stability concerns. These operational inefficiencies affect both practice workflow and pharmacy operations, creating systemwide challenges that limit patient access and throughput.

From the patient perspective, IV checkpoint inhibitor therapy imposes substantial time toxicity. Patients face multiple multihour clinic visits, requiring coordination across outpatient areas, laboratory facilities, and infusion centers. Travel logistics prove particularly burdensome for those with limited venous access or those requiring caregiver accompaniment. Over extended treatment courses spanning 1 to 2 years, venous access deteriorates significantly, often necessitating port placement. However, even ports require painful needle access through the septum every 2 weeks, adding to patient discomfort despite topical anesthetics.

The interest in subcutaneous formulations stems from their potential to address these multifaceted challenges. Subcutaneous administration eliminates the need for IV access, particularly beneficial for patients with difficult venous access or movement disorders. From an operational standpoint, subcutaneous injections can potentially be administered in examination rooms or dedicated injection bays rather than traditional infusion centers, streamlining workflow. The medication may come premixed in vials for chairside withdrawal and administration, eliminating pharmacy compounding steps. Some institutions are exploring home infusion services for appropriate patients, though this requires careful consideration of resource availability and economic implications for practices without established home infusion capabilities.