Aims: The SAHCDC Register, adopted from EviQ and other evidence-based resources, is the contemporary standard for SA cancer treatments. Single patient use (SPU) applications document intentional variations from registered protocols. This study reviewed temporal trends of SPUs since system inception.
Methods: We conducted a retrospective audit of all the SPU protocols submitted to the SAHCDC between July 2016 and June 2026. A descriptive analysis of the extracted data from these applications was performed to evaluate temporal changes. Proportion with repeat applications (more than one application over the study period for the same drug/indication pair) was also calculated.
Results: A total of 1,857 SPUs were submitted across 20 hospitals in SA by 285 clinicians between 2016 and July 2026. Annual volume grew 3.7-fold from 76 in 2017 to 283 in 2025. The most common cancer types were breast (190, 10.2%), CNS (161, 8.7%), lymphoma (148, 8%), colorectal (139, 7.5%), lung (134, 7.2%), and leukaemia/MDS (131, 7.1%). 10% of the applications preceded PBS listing for the drug and/or indication. Immunotherapy-containing applications increased from 1.3% (2017) to 42.3% (2026). Of 503 unique drug-cancer type pairs, 346 (68.8%) received more than one application over the study period. The median was 6 applications per repeat pair (mean 9.2, range 2–77). High dose methotrexate/rituximab for CNS lymphoma was the most dominant repeat application.
Conclusion: Single patient cancer drug applications in SA have grown substantially over the past decade, with a shift toward immunotherapy/targeted agents. Evidence based treatment standards are important. However, this study shows that clinicians commonly adopt new standards ahead of regulatory determinations. This study highlight the importance of having a nimble and robust system to optimise and personalise care.