Managing Premedications and the Risk for Reactions to Infusional Monoclonal Antibody Therapy
Abstract
Monoclonal antibodies—including rituximab, alemtuzumab, trastuzumab, bevacizumab, cetuximab, and panitumumab—have improved the treatment of various malignancies. Although generally better tolerated with less toxicity than conventional anticancer agents, monoclonal antibodies may cause infusion-related reactions like other infusional agents. The incidence of infusion reactions varies by agent, but severe events occur only occasionally, mostly with the first or second infusion. Although the exact etiology of infusion reactions remains unclear, they may arise via either IgE- or non-IgE–dependent mechanisms. There is a compelling clinical need to improve the risk assessment for severe infusion reactions. The recent identification of pre-existing IgE crossreacting with cetuximab, its association with severe reactions, and regional variation in the prevalence may provide a marker for high-risk assessment. Premedication with antihistamines, acetaminophen, and/or corticosteroids is a common practice to prevent infusion reactions with all monoclonal antibodies. However, a recent observational study suggests that premedication may no longer be necessary after the second infusion of cetuximab if patients did not develop any symptoms with the first two infusions. Considering the heterogeneity of infusion reactions, clinicians need to recognize the underlying nature of these events in order to identify patients at risk as well as provide optimal prophylactic measures and management of symptoms.
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In clinical practice, one way to reduce the extent and rate of hypersensitivity and infusion-related reactions is to continue dosing at a slower intravenous infusion rate.
“In clinical practice, one way to reduce the extent and rate of hypersensitivity and IRRs is to continue dosing at a slower intravenous infusion rate [77, 78].”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [78]
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- Authors
- Chung, C. H.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Chung, Christine H.
- ORCID
- Chung, Christine H.
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-06-01
- Volume
- 13
- Issue
- 6
- Pages
- 725-732
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- OpenAlex
- W2097020324
- Cited by
- 278
- References
- 36
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 17 · 2023: 16 · 2022: 18 · 2021: 12 · 2020: 21 · 2019: 13 · 2018: 16 · 2017: 17 · 2016: 14 · 2015: 20 · 2014: 16 · 2013: 15 · 2012: 19
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Monoclonal and Polyclonal Antibodies Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- infusion reactions, monoclonal antibodies, premedication, cetuximab, risk assessment, antihistamines, corticosteroids, paracetamol, rituximab, alemtuzumab, trastuzumab, bevacizumab, panitumumab, prophylaxis
- MeSH terms
- Antibodies, Monoclonal, Antineoplastic Agents, Drug Hypersensitivity, Humans, Infusions, Intravenous, Neoplasms, Premedication, Treatment Outcome, Risk Assessment
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