Beyond the Trials: Practical Implementation and Future Directions in SCAC Management

Implementation and Access Considerations

Institutional implementation factors include formulary approval processes for retifanlimab, which, as a new agent, requires systematic integration into hospital drug protocols. Since retifanlimab has not been approved for other indications, institutions face the challenge of incorporating an entirely new therapeutic agent. Payer authorization represents the primary barrier, with insurance companies often lacking updated pathways for newly approved combination therapies.

Access barriers particularly affect patients in rural or remote areas who may live hours from treatment centers, complicating weekly chemotherapy administration schedules. The published regimen of weekly carboplatin/paclitaxel with every-4-week immunotherapy creates logistical challenges that require individualized solutions. However, experts strongly recommend against modifying proven dosing schedules without safety data, preferring to address access through patient support services rather than protocol deviations.

Treatment expectation management requires honest discussions about disease chronicity while emphasizing the meaningful improvements in progression-free survival and response rates demonstrated in PODIUM-303. The integration of immunotherapy represents significant progress, offering better disease control and potentially prolonged survival with manageable toxicity profiles. Patient education should focus on the marathon nature of treatment while highlighting the improved outcomes compared with historical standards.