Immunotherapy treatments in cancer have seen a rapid growth in use due to their increased adoption into standard clinical care across a range of cancers. The delivery of immunotherapy treatment is influenced by the ability of pharmacy to prepare the treatment in advance of the patient’s appointment time. Preparation of drug in advance is problematic due to high drug cost and short expiry (24 hours). Aiming to improve manufacturing workflow and reduce drug wastage, a tailored service model was implemented to manufacture pembrolizumab and nivolumab in advance of patients’ appointment times.
The immunotherapy service model includes the following interventions: 1) Where possible immunotherapy patients are scheduled to receive treatment on Thursdays and Fridays; 2) Treatment protocols are reviewed the day prior; 3) Based on factors such as dose and appointment time orders are authorised for advanced manufacturing prior to the patient’s appointment time; 4) Cancelled treatments made in advance are reallocated to other patients for same-day treatment.
From January to July 2017, 699 pembrolizumab and 688 nivolumab pathways were reviewed for advanced manufacturing. An average of 57% of pembrolizumb and 65% of nivolumab treatments per day were authorised for advanced manufacturing. In total 43 pembrolizumab treatments were cancelled, 26 were premade of which 22 were reallocated to another patient. 53 nivolumab treatments were cancelled, 39 were premade of which 31 were reallocated to another patient. Overall there has been a significant increase in advanced manufacturing. In June 2016, an average of 17% of immunotherapies were manufactured prior to appointment time compared to 62% in June 2017.
Implementation of advanced manufacturing of pembrolizimuab and nivolumab resulted in more treatments being available in the treating unit prior to patients’ appointment time, with improvement in manufacturing workflow, and without significant drug wastage.