Alternative Trastuzumab Dosing Schedules Are Associated With Reductions in Health Care Greenhouse Gas Emissions.

Abstract

PURPOSE:

Cancer care-related greenhouse gas (GHG) emissions harm human health. Many cancer drugs are administered at greater-than-necessary doses, frequencies, and durations. Alternative dosing strategies may enable reductions in cancer care GHG emissions without compromising patient outcomes.

MATERIALS AND METHODS:

We used streamlined life-cycle analysis in a case-control simulation to estimate the relative reductions in GHG emissions that would be expected to result from using each of three alternative dosing strategies of trastuzumab (6-month adjuvant treatment duration, once every 4-week dosing, and both) in human epidermal growth factor receptor 2 (HER2)+ breast cancer. Using primary data and conversion factors from the environmental science literature, we estimated per-patient relative reduction in GHG emissions and, using SEER data, health impacts (in terms of disability-adjusted life-years [DALYs] and excess mortality per kg CO2) on bystanders for each alternative dosing strategy.

RESULTS:

Compared with the trastuzumab dosing strategy commonly used at baseline (12-month duration of adjuvant therapy and once every 3-week dosing in all settings), adoption of both 6-month adjuvant trastuzumab and once every 4-week trastuzumab dosing would reduce GHG emissions by 4.5%, 18.7%, and 14.6% in the neoadjuvant, adjuvant, and metastatic settings, respectively. We estimate that US-based adoption of alternative trastuzumab dosing would reduce annual DALYs and excess lives lost due to environmental impact of US-based trastuzumab therapy for HER2+ breast cancer by 1.5 and 0.9, respectively.

CONCLUSION:

Alternative dosing strategies may materially reduce the population health impacts of cancer care by reducing environmental impact. Regulatory decision making and health technology assessments should consider a treatment's environmental and population health impacts. Clinical trials of alternative dosing strategies are justified on the basis of environmental and population health impacts.

• Authors: Sofia I Jacobson, Alec J Kacew, Randall W Knoebel, Po-Hung Hsieh, Mark J Ratain, Garth W Strohbehn
• Journal: JCO oncology practice (JCO Oncol Pract) Vol. 19 Issue 9 Pg. 799-807 (09 2023) ISSN: 2688-1535 [Electronic] United States
• PMID: 37450776 (Publication Type: Journal Article)

Chemical References

• Greenhouse Gases
• Trastuzumab

Topics

• Humans
• Female
• Greenhouse Gases
• Greenhouse Effect
• Trastuzumab (pharmacology, therapeutic use)
• Delivery of Health Care
• Breast Neoplasms (drug therapy)