For me one of the biggest pains of cancer treatment has been the IV. I have never had veins that are easy to find, so waiting to see if the nurse can find an accessible vein for an intravenous medicine has always been a source of anxiety. Many patients have a port which makes administration of IV solutions easier, but there is still the time in the treatment room that interferes with a normal day, and not everyone uses a port.
For patients taking trastuzumab (Herceptin) those sessions in the treatment room may extend for a year or more depending on the severity of their disease and how well it responds to the medicine. A typical schedule might include Herceptin treatments every three weeks for a year after the initial treatments are concluded. Each treatment involves time off work or away from family to sit waiting for the medicine to complete its slow drip into her veins over a 30 to 90 minute period.
A new study published in The Lancet suggests that patients’ doctors may be able to offer them Herceptin as a shot, not an IV drip, in the future. The study divided almost 600 women into two groups and randomly assigned them either IV or subcutaneous (a shot) doses of Herceptin. Treatment was equally effective for both groups. There was a slightly higher incidence of adverse effects with the subcutaneous group. The researchers seem to consider one death in the IV group versus three in the subcutaneous group within the statistical margin of error.
Cancer tumors that overexpress an oncogene called Her-2/neu tend to be more aggressive. Herceptin acts as an antibody that targets these genes. Unlike chemotherapy that is designed to kill cells, Herceptin targets the specific part of the cell that makes it more aggressive. That is why Herceptin and its new cousins are called targeted therapies. For most women, these treatments have fewer side effects than standard chemo.
The next phase of clinical trials should establish whether the difference in problems was a fluke in this research group or a potential problem. Herceptin has been a miracle drug for women who are positive for Her-2/neu. Although many women have fewer side effects with Herceptin than chemotherapy, its most significant side effect is that it can weaken the heart. Doctors routinely monitor heart functioning of women taking the drug and do not prescribe it for women with known heart problems. Therefore it is not surprising that there were problems during the trial. The question is whether there is a greater danger administering the drug as an injection.
Herceptin as a shot could not only lessen time in the doctors’ office for patients, but it offers the possibility of administration in any local doctor’s office or even at home for patients who live a long distance from their oncologist.
If you are on Herceptin and the pain of long sessions with your IV drip are getting you down, ask your doctor’s opinion about whether the injection form might be a possibility for you. You might decide you would like to participate in the next round of clinical trials for this medicine. It won’t be right for everyone, but it might be right for you.
Ismael G, Hegg R, Muehlbauer S, et al. Subcutaneous versus intravenous administration of (neo)adjuvant trastuzumab in patients with HER2-positive, clinical stage I—III breast cancer (HannaH study): a phase 3, open-label, multicentre, randomised trial. Lancet. Online 09 August 2012.