Alternative Pembrolizumab Use Offers Environmental Benefits

A recent study has shed light on the potential environmental benefits of alternative pembrolizumab administration strategies, showing that these methods could lead to significant reductions in carbon dioxide emissions. The findings were published in the June issue of *The Lancet Oncology*.

The research was led by Dr. Alex K. Bryant from the Veterans Affairs Center for Clinical Management Research in Ann Arbor, Michigan. Dr. Bryant and his team conducted a retrospective analysis involving a cohort of patients who received one or more doses of pembrolizumab between May 1, 2020, and September 30, 2022. The team generated simulated data on pembrolizumab use under three nearly equivalent alternative administration strategies. These strategies included weight-based dosing, pharmacy-level vial sharing and dose rounding, and extended-interval dosing.

During the study period, 7,813 veterans were identified as having received at least one dose of pembrolizumab-containing therapy. In total, 59,140 pembrolizumab administrations were recorded. Out of these, 78.2 percent were dosed at 200 mg every three weeks, while 21.8 percent were dosed at 400 mg every six weeks. Additionally, 25.3 percent of the administrations were coadministered with infusional chemotherapies.

The researchers observed that implementing weight-based dosing, extended interval dosing, and pharmacy-level stewardship for all pembrolizumab infusions could have led to 24.7 percent fewer administration events. This reduction in the frequency of drug administration could result in an estimated 200 metric tons less carbon dioxide emissions annually. The primary reason for this decrease is the reduced travel distance for patients receiving treatment.

The study emphasizes that adopting these alternative dosing strategies could have broader benefits beyond environmental sustainability. The authors note that reducing the frequency and volume of drug administration could advance public health and cut economic costs, without necessarily compromising the treatment outcomes for patients.

One of the study's authors disclosed a connection to Merck, the pharmaceutical company that manufactures pembrolizumab. This disclosure is important for transparency in understanding potential conflicts of interest.

In summary, this study highlights the significant environmental advantages that could be achieved through alternative pembrolizumab administration strategies. By reducing the frequency of doses, the overall carbon footprint associated with the drug's use could be substantially lowered. This approach not only supports environmental sustainability but also offers potential public health and economic benefits, demonstrating that innovative healthcare strategies can align with broader global objectives.