Operationalizing Weight-Based Dosing of Pembrolizumab: Opportunities and Challenges

The high cost of cancer care is partly driven by the high price of key oncologic drugs, such as pembrolizumab, which are often administered as flat doses rather than the weight-based doses for which they were originally ap­proved by the US Food and Drug Administration. Pharmacoeconomic experts have advocated for a return to weight-based dosing as a drug waste-minimiza­tion strategy and to reduce the cost of cancer care. However, this recommend­ed shift may present significant workflow challenges. At the American Oncology Network (AON), a large multisite community oncology practice participating in the Enhancing Oncology Model (EOM) with Thyme Care, we implemented various strategies to influence weight-based dosing of pembrolizumab. Approximate­ly 8% of EOM episodes involve pembrolizumab administration, of which 70% in­volve patients whose weight would allow for reduced vial usage with weight-based dosing. Following several technological and process improvements, about 45% all pembrolizumab administrations at AON are now dosed by weight. Key takeaways from this effort include optimizing uses for technology, streamlining workflow, educating physicians, and using live-tracking modeling to measure performance and calibrate ongoing effort against results.