Incidence, Risk Factors, and Management of Infusion-Related Reactions in Breast Cancer Patients Receiving Trastuzumab

Abstract

Identify risk factors associated with trastuzumab-associated infusion-related reactions.Describe the impact of premedications on the incidence and/or severity of trastuzumab-associated infusion-related reactions. ABSTRACTBackground. Trastuzumab has become a mainstay of therapy for human epidermal growth factor receptor-2 overexpressed breast cancer in nearly all stages of the disease. Like many monoclonal antibodies, trastuzumab is associated with infusionrelated reactions (IRRs) that are not well described, and incidence varies widely between reports (0.7%-40% of patients). Materials and Methods. A retrospective chart review of breast cancer patients who received trastuzumab was conducted. The primary objective was to describe the incidence, risk factors, and management of IRRs during the first 12 weeks of trastuzumab therapy in a general population of breast cancer patients. Results. A total of 197 patients who received trastuzumab (1,788 doses) were evaluated. Thirty-three IRRs were identified

Diagnoses and Management of Drug Hypersensitivity and Anaphylaxis in Cancer and Chronic Inflammatory Diseases: Reactions to Taxanes and Monoclonal Antibodies

“…Certain patients can manifest with nausea, chills, fever, and malaise [7,25,26]. For trastuzumab, typical first-time infusion reactions include chills and/or fever and occur in approximately 40 % of patients [27]. These are thought to be due to the release of proinflammatory cytokines (such as IL-6 and TNF-α) and do not tend to be severe, except for the findings of the anti-CD28 mAb TGN1412 phase 1 trial in which six volunteers who received the drug developed multiorgan failure as a result of a severe cytokine storm [28].…”

Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs

“…Typical first-time infusion reactions for trastuzumab include chills and/or fever and occur in approximately 40 % of patients [36]. These are thought to be due to the release of proinflammatory cytokines (such as IL-6 and TNF-α) and do not tend to be severe, except for the findings of the of the anti-CD28 monoclonal antibody TGN1412 phase 1 trial in which six volunteers who received the drug developed multiorgan failure as a result of a severe cytokine storm [37].…”

Trastuzumab infusion reactions in breast cancer. Should we routinely observe after the first dose?

“…Onset of mild-to-moderate symptoms such as chills, fever, hypotension and dyspnoea are classified as an IRR; these symptoms are poorly defined and so lead to a variation in IRR rates in the literature. A retrospective review of 197 patients demonstrated IRR in 16% and anaphylaxis in 1% 9. A large retrospective analysis of 25 000 patients shows anaphylaxis in 0.3% of patients 10.…”