Canadian Oncology Nursing Journal (Jul 2015)
Evaluating the benefits of transitioning from intravenous to subcutaneous Rituximab for Alberta cancer patients
Abstract
A novel approach to treating cancer in the settings of Non-Hodgkin’s Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL) is the use of a subcutaneous (SC) injection of Rituximab (in addition to standard combination chemotherapy). Alberta cancer patients can safely benefit from the administration of subcutaneous Rituximab in numerous ways while still ensuring efficacy and optimal treatment for their cancer. Review of the American literature revealed several studies indicating the benefits of SC Rituximab. The Spark Thera trial revealed pharmacokinetic results of Rituximab concentrations in NHL patients who were administered a fixed dose of 1,400 mg (625mg/m2) SC achieved non-inferior Ctrough and AUC levels compared to those patients administered the standard IV dose of 375mg/m2. The SABRINA study results reveal an ORR 54% (IV+ chemo) versus 57% (SC + chemo); CR 19% versus 29% respectively and PR 35% versus 37% respectively with comparable safety profiles. The Sawyer B025341 Phase 1b study shows non-inferior pharmacokinetics and comparable safety profiles using a fixed dose of 1,600 mg of Rituximab SC compared to Rituximab 500mg/m2 IV in patients with CLL receiving combination (FC) chemotherapy. Further American studies report relative reductions in mean chair time, reduced pharmacy preparation time and increased ability to improve the number of other patients that can be treated increasing a facility’s overall efficiency by administering Rituximab SC versus Rituximab IV. The transition from IV to SC Rituximab is further supported by the application of a cost analysis. To date, SC Rituximab is non-inferior and has a comparable safety profile when compared to IV Rituximab. A SC injection of Rituximab could have many benefits for Alberta cancer patients while still ensuring efficacy and optimal treatment of their disease.
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