Challenges in IV Administration of Immune Checkpoint Inhibitors & Interest in SubQ

Patients receiving intravenous immune checkpoint inhibitors face significant time-related challenges that impact their daily lives and treatment experience. Many patients must navigate multiple clinic visits lasting several hours, checking in at outpatient practices, lab areas, and infusion units, which creates substantial disruption to work schedules and requires caregivers to accompany them. Venous access becomes increasingly problematic over time, causing pain throughout treatment, and while ports offer a solution, they still require painful needle insertions through the septum every two weeks despite numbing medications. Some patients experience deteriorating vein quality after one to two years of therapy, losing their initial easy venous access, and certain patients with conditions like movement disorders face additional difficulties sitting still during IV administration.

Healthcare facilities managing patients on IV checkpoint inhibitors encounter operational constraints that limit their capacity to serve growing patient populations. Infusion chair bottlenecks force creative scheduling solutions to accommodate both follow-up and new patients, while IV administration requires complex coordination with labs, imaging, and multi-agent regimens. Safety requirements for managing acute reactions, line management, and pharmacy stability constraints contribute to operational inefficiencies. Wait times for pharmacy preparation and clinic chairs create significant delays at busy institutions managing high patient volumes.

Subcutaneous checkpoint inhibitors offer promising solutions for improving patient experiences and practice efficiency. Healthcare providers express enthusiasm about subcutaneous options like nivolumab, particularly for patients requiring maintenance therapy, as studies demonstrate comparable efficacy while eliminating painful venous access procedures. These formulations may come in ready-to-use vials that nurses can prepare at chairside, potentially eliminating pharmacy compounding steps and streamlining operations. Some institutions are establishing injection bays where patients can receive subcutaneous therapy immediately after seeing their oncologist and having labs checked, without requiring infusion center access.