Korean doctors consider adoption of subcutaneous cancer therapies amid global trends

Korea is at a crossroads in cancer treatment as global immuno-oncology drugs shift toward faster, more convenient subcutaneous (SC) formulations.

The question is whether Korea’s healthcare system will adopt these innovations or maintain its reliance on intravenous (IV) treatments.

The U.S. FDA's recent approval of two major SC cancer therapies—Bristol Myers Squibb's Opdivo Qvantig (nivolumab and hyaluronidase-nvhy) and Roche's Tecentriq SC (atezolizumab and hyaluronidase-tqjs)—has set a new precedent.

These SC therapies reduce administration times dramatically—from 30 to 60 minutes for IV treatments to just 3 to 10 minutes for SC alternatives.

For U.S. patients, this speed opens the door to at-home injections, especially as telemedicine regulations loosen and nursing visits become a viable option for cancer care. Tecentriq SC is already being evaluated in a phase 2 study for safe at-home use, offering U.S. patients a more comfortable and less time-consuming treatment option.

However, Korea's situation differs significantly. While the benefits of SC therapies are clear, the country’s existing infrastructure complicates their widespread adoption.

“In international markets, one of the key advantages of SC injections is the possibility of nurse-administered home visits, which significantly enhances convenience,” said Ahn Hee-kyung, a hematology-oncology professor at Samsung Medical Center. “In Korea, the benefits of at-home care are not fully realized due to regulatory and structural constraints.”

Additionally, the self-administration of cancer treatments is prohibited in Korea, even during clinical trials, further limiting the appeal of SC therapies that could otherwise be administered at home.

"The need for SC therapies is less urgent here than in the U.S.," said Professor Hong Min-hee of Yonsei Cancer Center, who specializes in lung cancer. "In Korea, where access to hospitals is relatively easy, the shift toward SC therapies is less pressing."

Local innovation may help drive change. MSD, known as Merck & Co. in the U.S. and Canada, holds exclusive global rights to ALT-B4, a recombinant human hyaluronidase enzyme developed by Alteogen, a major Korean biotech firm. 

MSD has completed phase 3 clinical trials for the SC version of Keytruda (pembrolizumab), which uses Alteogen’s SC technology. The results show the SC formulation is as effective as the IV version, administered every six weeks.

An Alteogen official noted that logistical challenges with IV treatments—such as travel, accommodation, and the time required for pre- and post-treatment care—make SC therapies a promising alternative. "Reducing these burdens is crucial and could significantly impact both patients and healthcare providers," he said.

Despite the potential benefits, Korea’s existing infrastructure continues to favor IV therapies. "SC injections require nurses to apply pressure for 5 to 10 minutes, which can be physically taxing," explained Professor Ahn. "In contrast, IV infusions allow nurses to attach the line and attend to other tasks, making IV methods more practical in hospital settings." 

Nevertheless, Professor Ahn remains hopeful. “If insurers cover SC treatments like Keytruda, these therapies could significantly improve patients' quality of life,” she added. 

Based on the phase 3 clinical results, MSD plans to submit a biologics license application (BLA) to the FDA, although the timeline for U.S. and domestic approval remains undisclosed.

Globally, the SC market continues to expand. Janssen has filed an FDA application for the SC formulation of its immunotherapy, Rybrevant (amivantamab), following successful phase 3 trials.

In Korea, GI Innovation has also entered the SC field, launching a phase 1 trial for its immune-oncology drug, GI-102, in December at 14 global medical centers.