CheckMate 67T and the Potential of Subcutaneous Nivolumab Administration

A roundtable discussion, moderated by Rana McKay, MD, discussed the latest updates in frontline treatment for renal cell carcinoma, including how data from the American Society of Clinical Oncology Genitourinary Cancers Symposium 2024 alters the treatment paradigm. Dr. McKay was joined by Nizar Tannir, MD; Hans Hammers, MD; and Katy Beckermann, MD.

In the sixth segment of the roundtable series, the panel transitioned to relevant considerations from the CheckMate 67T study and shared their thoughts on the potential of subcutaneous nivolumab administration.

Watch the next segment in this series.

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Dr. McKay: Another study presented in the Orals Abstracts was the CheckMate 67T study, examining a different formulation of nivolumab: subcutaneous rather than intravenous. It was administered on a 4-week schedule compared to IV nivolumab given every 2 weeks. This study was predominantly conducted outside the US in the refractory setting. What are your thoughts on subcutaneous nivolumab? How do you anticipate its outcome?

Dr. Tannir: I believe there is pressure due to the shortage of nurses and space constraints within the healthcare systems of the US and Europe. If there is a therapy that can be administered subcutaneously rather than intravenously, thus eliminating the need for patients to occupy a chair for an extended period, it would be well-received. We discussed this with our European colleagues last night, and they share similar challenges regarding space and nursing shortages. They were excited about the potential of subcutaneous nivolumab.

Given that 70 percent of cancer patients are treated in community settings, it is essential to consider how community oncologists will respond to this news and whether they will adopt subcutaneous administration. If patients are receiving nivolumab alone, they may spend only half an hour in the clinic, whereas if they’re receiving nivo/ipi, they will need to remain in the chair for the ipi infusion. However, combining immunotherapy with a tyrosine kinase inhibitor (TKI) allows patients to leave the clinic within 5 minutes after the injection. Nonetheless, understanding how this will impact practices at academic centers and in the community requires assessing the cost implications. If subcutaneous nivolumab significantly increases costs compared to the intravenous route, it may pose challenges for healthcare systems and patients.

Dr. Hammers: I completely agree. While transitioning to subcutaneous administration may seem altruistic, financial interests also play a role. It could extend patent life and revenue streams. Many therapeutic antibodies are already administered at home, offering patients convenience. However, shifting from infusion to injection raises issues such as co-payment and financial burdens on patients, revenue loss for private practices and cancer centers, among others. It is a complex issue, but I appreciate innovations that enhance convenience and save time, particularly for patients in rural areas who would otherwise face lengthy travels for infusion appointments. However, any changes must consider the strain on our healthcare system’s finances.

Dr. McKay: I share your concerns. Monitoring remains crucial; unlike simpler treatments, immunotherapy requires close monitoring of various parameters. While subcutaneous administration may seem convenient, it is not a self-administered injection. Healthcare professionals need to administer it slowly over a 5-minute period due to its viscosity. While having options and access is beneficial, conducting a cost analysis and evaluating the time saved from the moment a patient arrives at the center to completion of their appointment are vital considerations.