Weight-based, extended interval dosing and pharmacy-level stewardship strategies would result in fewer administration events
By Elana Gotkine HealthDay Reporter
THURSDAY, June 13, 2024 (HealthDay News) — Alternative pembrolizumab administration strategies may have environmental advantages, such as less carbon dioxide emission, according to a study published in the June issue of The Lancet Oncology.
Alex K. Bryant, M.D., from the Veterans Affairs Center for Clinical Management Research in Ann Arbor, Michigan, and colleagues conducted a retrospective analysis using a cohort of patients who received one or more pembrolizumab doses between May 1, 2020, and Sept. 30, 2022. Simulated pembrolizumab use data were generated under three near-equivalent counterfactual pembrolizumab administration strategies defined by combinations of weight-based dosing, pharmacy-level vial sharing and dose rounding, and extended-interval dosing. The greenhouse gas emissions related to pembrolizumab use were estimated for each counterfactual dosing strategy.
During the study period, 7,813 veterans were identified who received at least one dose of pembrolizumab-containing therapy, and 59,140 pembrolizumab administrations occurred: 78.2 and 21.8 percent were dosed at 200 mg every three weeks and 400 mg every six weeks, respectively; 25.3 percent were coadministered with infusional chemotherapies. The researchers found that compared with baseline dosing, adoption of weight-based, extended interval dosing and pharmacy-level stewardship strategies for all pembrolizumab infusions would have resulted in 24.7 percent fewer administration events and an estimated 200 metric tons less carbon dioxide emitted per year, mainly due to reductions in the distance traveled by patients to receive treatment.
“Adoption of alternative dosing strategies that reduce the frequency (and volume) of drug administration could advance public health, improve environmental sustainability, and reduce economic costs without necessarily compromising disease-specific outcomes for the patients,” the authors write.
One author disclosed ties to Merck, the manufacturer of pembrolizumab.
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