A new critique published in the Journal of Clinical Oncology is challenging the perceived value of transitioning pembrolizumab to a subcutaneous formulation, suggesting the move may serve pharmaceutical patent strategies more than it benefits patients or health systems.
The trade-off of convenience
In the article “Beyond Convenience: Does Subcutaneous Pembrolizumab Add Value for Patients and Health Systems?”, authors Laure-Anne Teuwen, Rachel P. Riechelmann and Bishal Gyawali question the actual utility of the subcutaneous (subQ) delivery method. While proponents argue that a subcutaneous injection is more convenient than traditional intravenous administration, the authors request whether this convenience is real and, if so, what the accompanying cost is.
Bishal Gyawali, an Associate Professor at Queen’s University, suggests that the push for subQ formulations may be a case of “patent hopping.” This practice can lead to increased expenses for health systems and may actively hinder efforts to optimize the dosing of immunotherapies.
Research Context: This analysis builds upon a previous paper authored by Bishal Gyawali titled “Cost of Convenience in Cancer Care,” which examined the broader financial and systemic implications of prioritizing convenience in oncology treatments.
Impact on health systems and research
The authors argue that when “convenience” becomes the primary driver for new drug formulations, the resulting costs are borne by the health system. Beyond the financial burden, there is a concern that these shifts distract from critical clinical goals, specifically the optimization of immunotherapy doses to ensure maximum efficacy and safety for the patient.

By questioning the value proposition of subcutaneous pembrolizumab, the researchers are calling for a more rigorous evaluation of whether such changes provide a meaningful clinical advantage or simply extend the commercial lifecycle of a drug.
Clarifying the debate
Does the subcutaneous version of pembrolizumab offer a clinical advantage?
The authors of the study question if the formulation adds any real value to patients and health systems, specifically questioning if the perceived convenience justifies the potential costs.
What is “patent hopping” in this context?
In the opinion of the authors, This represents a strategy where a new formulation of an existing drug is introduced to maintain patent protection and high costs, potentially at the expense of health system budgets and dose optimization research.
How should health systems balance the desire for patient convenience with the need for sustainable drug pricing and clinical optimization?




