Abstract
Goals of work
Monoclonal antibody (MoAb) treatments can result in severe infusion reactions. Managing infusion reactions in the outpatient setting introduces clinical and resource challenges for patients and providers, but there is little information regarding prevention, management, or outcomes of severe infusion reactions. This study represents one of the first attempts to describe the clinical consequences of severe infusion reactions associated with MoAb treatment.
Materials and methods
Clinic staff identified adults treated with rituximab, cetuximab, or bevacizumab who experienced a grade 3 or higher (severe) infusion reaction. Chart reviews from 19 oncology practice sites across the USA captured patient demographics, infusion reaction management procedures, and clinical outcomes.
Main results
With an average age of 62 years, the sample comprised of 76 patients who experienced a severe infusion reaction while receiving rituximab (n = 47), cetuximab (n = 24), and bevacizumab (n = 5). The most common pretreatment medications were acetaminophen and antihistamine in the rituximab group and corticosteroids (42%) in the cetuximab group. All cetuximab and the majority of rituximab severe infusion reactions occurred during the first cycle of therapy. Postinfusion reaction management typically included corticosteroids, oxygen, and intravenous fluids. Overall, 22% were hospitalized for a mean of 4 days (range = 2.0 to 6.0 days). Permanent discontinuation of MoAb therapy occurred after the majority of cetuximab (79 to 100%) related severe infusion reactions.
Conclusions
Severe infusion reactions are intensive events that present a serious challenge to patients and oncology practices. Efforts to prevent or reduce such reactions could be of great benefit.
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Notes
The participating sites with number of charts reviewed in parentheses are listed as follows: Associates in Oncology and Hematology (2), Chattanooga, TN; Augusta Oncology Associates (3), Augusta, GA; Cancer Center of Colorado Springs—Colorado Springs, CO (5); Cedar Valley Medical Specialists (2), Waterloo, IA; Commonwealth Cancer Center—Danville, KY (5); Eastern Connecticut Hematology and Oncology (4), Norwich CT; Highlands Oncology Group (13), Fayetteville, AR; Johnson Memorial Hospital cancer Care Center (9), Franklin, IN; Joliet Oncology Hematology Associates (5), Joliet, IL; Medical Oncology and Hematology PC (1), Waterbury, CT; Ministry Medical Group, Rhinelander, WI (4); Nevada Cancer Center (0), Las Vegas, NV; Oncology and Hematology Specialists, PA (4)—Mountain Lakes, NJ; David A. Pfister, M.D. (3), Oakland, CA; Stockton Hematology Oncology (1), Stockton, CA; The West Clinic (5), Memphis, TN; West Kentucky Hematology and Oncology Group (4), Paducah, KY; Western Maryland Health System (6), Cumberland, MD; Wilshire Oncology (0), Pomona, CA
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Acknowledgment
Funding for this research was provided by a research grant from Amgen (Thousand Oaks, CA). Amgen is the manufacturer of panitumumab, a MoAb indicated for treatment of CRC. LS conceived of the study and participated in the design and coordination of the study and interpreted the summary of data findings. ES contributed to the design of the study, supervised data collection and quality control procedures, and supervised the summary of data findings. BF contributed to the study design and coordination of the study. AH supervised the summary of data findings and drafted the manuscript. All authors read and approved the final manuscript.
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Schwartzberg, L.S., Stepanski, E.J., Fortner, B.V. et al. Retrospective chart review of severe infusion reactions with rituximab, cetuximab, and bevacizumab in community oncology practices: assessment of clinical consequences. Support Care Cancer 16, 393–398 (2008). https://doi.org/10.1007/s00520-007-0329-5
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DOI: https://doi.org/10.1007/s00520-007-0329-5