Skip to main content
Search
Search
Advanced Search
Skip main navigation
Open access
Research Article
2 June 2026

The value of time savings in breast cancer therapy for patients and healthcare providers: the subcutaneous injection of pertuzumab and trastuzumab fixed-dose combination at a tertiary care center in the UAE

Author: Khaled H.A. Al Qawasmeh https://orcid.org/0000-0002-8965-6529 [email protected]Author Info & Affiliations
Volume 15, Number 6
https://doi.org/10.57264/cer-2026-0007
PDFFormats

Abstract

Aim: To measure time saving associated with the subcutaneous (SC) fixed-dose combination of pertuzumab and trastuzumab (PH FDC SC) compared with intravenous (IV) pertuzumab and trastuzumab in patients with HER2-positive breast cancer. Materials & methods: This was a single-center local observational study consisting of a retrospective chart review of patients who received PH FDC SC or IV pertuzumab and trastuzumab in the UAE. Eligible patients were adults aged ≥18 years diagnosed with early or metastatic breast cancer. Data collected included demographics, treatment indication and nursing documentation of medication administration. The primary end point was a composite of patient length of stay during administration of SC versus IV pertuzumab and trastuzumab, and pharmacist preparation time. For secondary end points, annual clinical hours saved were extrapolated based on a 100% switching rate for a cohort of 75 patients undergoing 18 cycles annually (1350 visits). Results: Fifty patients with three visits per patient were included in the final analysis; PH FDC SC was administered in 50% of the visits resulted in a total of 150 occurrences of treatment administration. The mean age was 47.0 ± 10.9 years. Patients' length of stay was significantly shorter in the SC arm by a mean difference of 190.9 ± 13.6 min saved per patient (95% CI: 163.9, 217.9). Median pharmacist preparation time was significantly shorter (8 min [Q1: 4; Q3: 15]; p = 0.006) with the SC formulation compared with the IV formulation (13 min [Q1: 6; Q3: 28]). When extrapolated, switching to the SC formulation would save 2468.25 clinical hours saved annually across nursing and pharmacy services. Conclusion: PH FDC SC was associated with significant time savings for both patients and healthcare providers. The transition to SC administration unlocked 2468.25 clinical hours annually, translating into notable indirect cost reductions through optimized resource utilization and improved operational efficiency compared with IV administration.

Plain language summary

What is this summary about?

The combination of pertuzumab and trastuzumab was made available as a medication for breast cancer to be given under the skin. This product was equally effective and safe as that given directly into bloodstream. The under-skin form was more convenient for physicians and patients in terms of shorter time needed to receive the medication. The aim of this local study was to measure the time saved by breast cancer patients when the combined medication was given under the skin compared with that given directly into a vein. Another aim was to measure time spent by pharmacists for preparing each formulation.

What were the results?

Fifty patients with three visits per patient were included. Patients' length of stay was significantly shorter in the under-skin group by 190.9 min saved per patient. Similarly, pharmacy preparation time was significantly shorter (8 vs 13 min) with the under-arm formulation compared with the formulation given into the vein.

What do the results of the studies mean?

The under-arm form of the combination of pertuzumab and trastuzumab was associated with significant time savings for both patients and healthcare providers compared with the form given directly through the vein.

Formats available

You can view the full content in the following formats:

View PDFView Full Text

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Gao JJ, Osgood CL, Gong Y et al. FDA Approval summary: pertuzumab, trastuzumab, and hyaluronidase-zzxf injection for subcutaneous use in patients with HER2-positive breast cancer. Clin. Cancer Res. 27(8), 2126–2129 (2021).
PubMed
Google Scholar
• Summarizes the regulatory perspective and the pivotal data that led to the approval of the fixed-dose combination, reinforcing the clinical validity of the transition to subcutaneous (SC).
2.
Council of Arab Health Ministers, Union of Arab Pharmacists. Phesgo (pertuzumab and trastuzumab). Local Prescribing Information (LEAF PHESGO VIAL GCC). Basel, Switzerland, F. Hoffmann-La Roche Ltd (2024).
Google Scholar
3.
DuMond B, Patel V, Gross A, Fung A, Weber S. Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive breast cancer: a multidisciplinary approach. J. Oncol. Pharm. Pract. 27(5), 1214–1221 (2021).
PubMed
Google Scholar
4.
O'Shaughnessy J, Sousa S, Cruz J et al. Long-term safety and efficacy of the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer in PHranceSCa, a randomized, open-label Phase II study. Clin. Breast Cancer 25(6), 554–559.e1 (2025).
PubMed
Google Scholar
• Provides critical long-term follow-up data on safety and health-related quality of life, confirming the sustained benefits of the subcutaneous formulation over time.
5.
Tan AR, Im SA, Mattar A et al; FeDeriCa study group. Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection plus chemotherapy in HER2-positive early breast cancer (FeDeriCa): a randomised, open-label, multicentre, non-inferiority, Phase III study. Lancet Oncol. 22(1), 85–97 (2021). Erratum in: Lancet Oncol. 22(2), e42 (2021).
PubMed
Google Scholar
•• This Phase III study establishes the noninferiority of the fixed-dose SC combination compared to intravenous (IV) administration, providing the clinical basis for its use in HER2-positive breast cancer.
6.
US Food and Drug Administration. Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) injection, for subcutaneous use: Prescribing Information. Silver Spring, MD: FDA (2020). (Last accessed: 27 March 2026). https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/761170s000lbl.pdf
Google Scholar
7.
US Food and Drug Administration. Perjeta (pertuzumab) Injection, for intravenous use: Prescribing Information. Silver Spring, MD: FDA (2012). https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125409lbl.pdf
Google Scholar
8.
McCloskey C, Ortega MT, Nair S, Garcia MJ, Manevy F. A systematic review of time and resource use costs of subcutaneous versus intravenous administration of oncology biologics in a hospital setting. Pharmacoecon. Open 7(1), 3–36 (2023).
PubMed
Google Scholar
•• A comprehensive systematic review that validates the global trend of time and resource savings when switching from intravenous to SC administration in oncology.
9.
Figallo M, Delgado MF, Gonzalez M, Arenas A. Cost minimization analysis of treatments for metastatic HER2-positive breast cancer in Peru: fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injections. PLOS ONE 19(11), e0295730 (2024).
PubMed
Google Scholar
10.
O'Shaughnessy J, Sousa S, Cruz J et al; PHranceSCa study group. Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): a randomised, open-label Phase II study. Eur. J. Cancer 152, 223–232 (2021).
PubMed
Google Scholar
•• This was a crossover study to demonstrate a strong patient preference (85%) for the SC route, highlighting the humanistic benefits that complement the clinical efficacy.
11.
Jackisch C, Manevy F, Frank S, Roberts N, Shafrin J. White paper on the value of time savings for patients and healthcare providers of breast cancer therapy: the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection as an example. Adv. Ther. 39(2), 833–844 (2022).
PubMed
Google Scholar
• Articulates the broader value proposition of time savings, translating clinical efficiency into institutional and patient-centric benefits.
12.
Awwad S, Angkawinitwong U. Overview of antibody drug delivery. Pharmaceutics 10(3), 83 (2018).
PubMed
Google Scholar
13.
Bittner B, Richter W, Schmidt J. Subcutaneous administration of biotherapeutics: an overview of current challenges and opportunities. BioDrugs 32(5), 425–440 (2018).
PubMed
Google Scholar
14.
Anderson KC, Landgren O, Arend RC, Chou J, Jacobs IA. Humanistic and economic impact of subcutaneous versus intravenous administration of oncology biologics. Future Oncol. 15(28), 3267–3281 (2019).
PubMed
Google Scholar
15.
De Cock E, Pivot X, Hauser N et al. A time and motion study of subcutaneous versus intravenous trastuzumab in patients with HER2-positive early breast cancer. Cancer Med. 5(3), 389–397 (2016).
PubMed
Google Scholar
16.
Manevy F, Filkauskas G, Levy P, Fredriksson J, Sussell J. Potential non-drug cost differences associated with the use of the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in the treatment of HER2-positive early breast cancer patients in Western Europe and the United States. J. Clin. Oncol. 39(Suppl. 15), 544–544 (2021).
Google Scholar
17.
Seweryn M, Banaś T, Augustyńska J, Leszczyńska A, Potocki PM. Non-drug related costs of treatment with pertuzumab and trastuzumab in HER2-positive breast cancer patients in Poland. Oncol. Clin. Pract. 20(3), 181–189 (2024).
Google Scholar
|