Dose Finding Study of Subcutaneous Pertuzumab
 

Hi all, I have the opportunity to participate in this trial. A phase 1 open label, two-part, multicentre Perjeta subcutaneous dose-funding study but wanted to ask the groups opinion on whether it is a good idea to do so. I was diagnosed Her2, epositive in 2013 and completed treatment in 2014. Since then all has been clear. Do you think there is any harm in completing this trial or would it be better to "leave well alone". Really appreciate your thoughts.

Billie. NZ

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

Billie

I should have done research before I try to answer you but my gut feeling is to leave well alone. My pharmacy education has always emphasized that IV dosage gives you the highest blood levels of a drug followed by IM or oral. I cant for the life of me see the purpose of subcutaneous Perjeta. Is it to save the insurance companies the cost of IVapparatus? As cynical as that sounds I cant think of any other reason. Maybe someone else on the board has some knowledge about subcutaneous Perjeta that I lack. I will research it for you. Im giving you a shoot from the hip response based on what I hane been taught.

Paul

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

Billie

I did some very quick research. They are starting to do the same thing with Herceptin ie giving it subcurtaneously combined with Hyaluronidase (probably to improve the relatively
poor subcutanous absorbtion). The reasoning behind these trials is that IV administration
is time consuming for the patient and health care system. As time is money as the old saying goes and health insurance companies are a major component of the health care system my cynical response might not be that far off. What they are trying to do is determine a subcutaneous dose that will give the same blood levels as the IV dose. The reasoning behind this is not to increase response but to save time and money. Im very conservative. My reasoning is "if it aint broke dont fix it. Personally Id avoid this. However talk with your Oncologist about it.

Paul

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

I had Perjeta for 2 1/2 years as a trial drug for stage 4 patients only.
Last year I progressed and was given subcut. Herceptin. It was much quicker but sometimes uncomfortable. Especially if given when too cold! Had injection for 13 months and now back to IV's. I have often wondered if the injection was the best way to have it!

Perjeta still a trial drug here ( Scotland) & always by IV.

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

Thank you so much for looking into this I never gave it a though that they might be looking at ways to save money. I though it might prove to be useful information for others so think I will leave well enough alone. Again thank you so much for taking the time to respond to my query, it is nice to be able to reach out to people who understand. Billie

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

Hi Billie, I'm in Sydney and I started getting subcut Herceptin back in early 2016 (or maybe 2015). I had been having Herceptin via IV for the previous 8 years, and was excited for the subcut option. It's a standard dose for everyone, and I think that Paul is right in that it's a time and money saver for the health system. Herceptin, IV or subcut, is funded by the Government here, however, interestingly each time I had the subcut I had to pay $35 - not much, but I just didn't understand why. Anyway, I noticed the day after the injection I would feel 'flu-ey', which I had never felt before on IV, and wondered if the dose was too much for me........ Then after 9 years of no problems with Hereptin, my ejection fraction dropped significantly, and I had to stop Herceptin, and I'm still off it. I have a belief (based just on my experience) that the subcut Herceptin was too much for my heart. Mind you, they don't know for certain that the problem was caused by Herceptin - there are cases of late onset heart toxicity from Adriamycin which I had back in 2001 when first diagnosed.

My heart function is returning having been under a cardiologist and on Beta Blockers and Ace Inhibitors, and in fact my oncologist is happy to recommence Herceptin. I've decided to wait until I come back from a European holiday in July to start again, but the plan is definitely to go back to IV Herceptin, and to start with weekly doses, and continue to monitor heart function. I know this is not Perjeta, but I feel it might be better to have personalised dosing. Best wishes,
Marie

Re: Dose Finding Study of Subcutaneous Pertuzumab
 

Marie,
Your experience is interesting. My oncologist hasn't been keen on my moving to subcut Herceptin - maybe now I can guess why. She has spoken about the "one size fits all" dosage and hasn't been happy with the available data. Hope you can get back on Herceptin without the heart problems. It is a relatively easy regime, though when I think about being due for cycle 82, my eyes roll.
Best wishes..... Pam