When Herceptin gets under the skin--literally

Roche's ($RHHBY) Herceptin (trastuzumab) has been hugely successful in breast cancer, with annual sales of $1.8 billion in 2008, but it has to be given as an intravenous injection. A recent success with a formulation that can be injected just under the skin in only 5 minutes or so could make treatments much more convenient and less time-consuming for both patients and healthcare professionals, potentially even allowing patients to take the drug at home.

In the HannaH Phase III study, an international team (funded by Roche) gave patients with HER2-positive early breast cancer subcutaneous or intravenous trastuzumab along with standard chemotherapy and surgery. The safety and effectiveness of the two forms of the drug were similar, and the researchers concluded that the subcutaneous formulation "offers a valid treatment alternative." The results were published in The Lancet Oncology.

Intravenous administration of trastuzumab usually involves an initial 90 minutes of IV administration, and then 30 minutes connected to a drip every three weeks, for long periods. In a commentary in The Lancet Oncology, Spanish researchers Jose Perez-Garcia and Javier Cortes suggest that "the results of this study could lead to the approval of this new route of trastuzumab administration, not only in the neoadjuvant, but also in the adjuvant or the metastatic setting."

According to Perez-Garcia and Cortes, a randomized study called PrefHer is recruiting and will look at patient preference and healthcare professional satisfaction with subcutaneous administration of trastuzumab in patients with HER2-positive breast cancer. They added: "The ability to deliver the drug in about 5 minutes without the need to secure intravenous access makes subcutaneous treatment more convenient. In addition to time savings, once the drug can be administered at home, patients will be able to continue their lives with less hospital dependence, which is an important psychological aspect. This treatment will also save resources in terms of nurses and cleaning in already crowded hospitals."

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