What are immune checkpoint inhibitors?
Immunotherapies work by increasing the ability of the body’s immune system to target and destroy cancer cells. Cancer is tricky, and it is often able to shut down our immune system’s ability to recognize it as a threat. These drugs reengage and reinvigorate our immune system so that it can recognize and kill cancer cells. Immune checkpoint inhibitors are a specific type of immunotherapy. Our immune system has built-in mechanisms called checkpoints that turn immune responses off or on. Normally, these checkpoints help prevent our immune systems from overreacting and attacking healthy cells. But cancer cells can use these checkpoints to prevent them from being identified as abnormal cells and destroyed. Immune checkpoint inhibitors stop the activation of these checkpoints and allow immune cells to fight cancer.
How are checkpoint inhibitor therapies administered?
Checkpoint inhibitor therapies are administered either intravenously or subcutaneously. Examples of intravenous checkpoint inhibitor therapies are ipilimumab (Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda). If administered subcutaneously, the drugs will have slightly different names, such as Keytruda Qlex versus Keytruda.
What is the process for intravenous administration?
Intravenous therapies are injected into a vein. They are often referred to as an “IV” or “infusion.” When you receive your therapy intravenously you sit in a chair and a healthcare provider will first clean your skin and insert a needle into a vein most often at the inside joint of your forearm. Then, a tube is attached to allow the medication to flow through the tube and into your vein. The infusion itself takes approximately 30 minutes, and the whole process can take 60 minutes or more, depending on the time it takes to set up your IV; to receive the medication from the pharmacy; and to monitor for a reaction.
What is the process for subcutaneous administration?
Intravenous therapies generally must be administered in a cancer center or hospital outpatient setting and the whole process takes 60 or more minutes, which can be burdensome to both patients and the healthcare system. Subcutaneous therapies may be administered in an office setting or clinic, and they are faster to administer, so there are benefits to patients and healthcare providers. Overall, subcutaneous therapies are easier to administer, take less time, and don’t require the outpatient setup that intravenous therapies require.
Are subcutaneous checkpoint inhibitors as effective as intravenous checkpoint inhibitors?
The immunotherapy medication in subcutaneous formulations is the same as what is used in intravenous therapies, and it includes an enzyme that helps the delivery and distribution of the immunotherapy in your body because it’s not going directly into a vein. In clinical studies, subcutaneous and intravenous therapies were shown to have similar and consistent efficacy (effectiveness).
Are the safety and side effects of subcutaneous checkpoint inhibitors the same as the intravenous formulations?
Results from clinical studies showed that the safety profile is similar for subcutaneous and intravenous checkpoint inhibitors. Injection site reactions can occur with subcutaneous administration. This involves redness, itching, and swelling. These complications are not severe and can be managed with a cold compress or with over-the-counter pain medications. With infusion delivery, pain at the IV site can occur and can be managed similarly. It is also possible for an IV site to get infected.
What are some reasons that subcutaneous checkpoint inhibitors may be right for me?
Subcutaneous therapies may be available at a location physically closer to you than a cancer center or hospital, so you may spend less time traveling to and from treatment appointments. Subcutaneous injections are beneficial if you experience anxiety or pain during IV infusions or if you have fragile veins or veins that are difficult to access. There is no need for venous access, so there is no need to repeatedly puncture your blood vessels. There may be less pain at the injections site at the injection site because the medication does not go into your vein. In addition, there may be fewer complications such as infection that can occur with IV therapies, and there is a choice of injection site, in the thigh or abdomen, which provides flexibility.
Why might subcutaneous checkpoint inhibitors not be a good choice for me?
If you also receive other IV treatments, it may not make sense to receive an additional treatment in a different way, as that would add more time to complete your treatment regimen. Similarly, if you have other reasons to travel to the cancer center, such as for lab work or healthcare provider appointments, you can combine visits with infusion. You may prefer intravenous administration if you experience anxiety about injections, if you are uncomfortable with the possibility of unintended injection into a muscle, if the location of the injection is not comfortable, or if you are uncomfortable with the possibility of redness, itching, and swelling at the injection site. Lastly, if you started your therapy as an infusion, your healthcare provider may prefer to keep you on infusion.
Can I switch from treatment with intravenous checkpoint inhibitors to subcutaneous checkpoint inhibitors?
Your healthcare provider can help you decide during your treatment if it makes sense to switch from intravenous to subcutaneous therapy.