Thirty-minutes infusion rate is safe enough for bevacizumab; no need for initial prolong infusion

Abstract

Bevacizumab (Bev) is a vascular endothelial growth factor-A monoclonal antibody that targets tumor angiogenesis. The transfusion rate of Bev is 90 min in the first dose, 60 min in the second and than from the third dose it is 30 min if no hypersensitivity reaction occurs in the first two doses. The purpose of this study determines whether these initial prolonged infusions are really necessary or not. Between 2007 and 2009, we were using the standard schedule for Bev infusions. In July 2009, we reviewed our medical reports, nursing orders and adverse drug reaction forms to identify the Bev used patients and possible hypersensitivity reactions (HSRs). Depending on that information between August 2009 and July 2014, we started to make Bev infusions in 30 min from the first dose of the therapy. In this study, we documented the findings of these 30-min infusion used patients. From August 2009 to July 2014, we treated 145 patients with 1,145 Bev infusions each one in 30 min. Out of 145 patients, 12 of them received only single dosage of Bev infusion treatment. Bev doses were 5 mg/kg for 87 patients, 7.5 mg/kg for 64 patients, 10 mg/kg for four patients and 15 mg/kg for only one patient. No HSRs were reported during these transfusions. Initial prolonged infusion times are unnecessary for Bev. Thirty-minute infusion rates can be used safely for all courses.

Optimizing the Dosing Regimen of Cetuximab and Ramucirumab Using the Model‐Informed Drug Development Paradigm

“…A summary of retrospective studies of various therapeutic antibodies (bevacizumab, rituximab, daratumumab, and infliximab), as well as prospective studies (ramucirumab and nivolumab) that implemented shortened infusion times and included IRR incidence as an end point was presented (Table S2). [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] Reportedly, a shorter infusion time did not appear to increase the incidence of IRRs in these studies. Thus, the evidence developed using MIDD approaches indicated that the commonly held perception that infusion rate is related to IRR incidence may not hold true for the antibodies studied.…”

“…Lilly then conducted a literature review for supportive evidence, as suggested by the FDA. A summary of retrospective studies of various therapeutic antibodies (bevacizumab, rituximab, daratumumab, and infliximab), as well as prospective studies (ramucirumab and nivolumab) that implemented shortened infusion times and included IRR incidence as an end point was presented ( Table ) 52–66 . Reportedly, a shorter infusion time did not appear to increase the incidence of IRRs in these studies.…”

The Rate of Infusion Represents an Important Aspect of Administering Anticancer Agents

“…31 The feasibility of rapid bevacizumab infusion in 30 minutes at the first time has been confirmed, thereby resulting in a significant reduction in chemotherapy chair time and nursing workload. 32,33…”

“…The optimal infusion rate may bring economic benefits (e.g., higher patient satisfaction, improved institutional efficiency and more nursing time available for other activities). [29][30][31][32][33][34][35][36][37][38] Endostar Continuous infusion may be a more economical choice compared with traditional intravenous drip administration. 39…”

A Prospective Trial Evaluating the Safety of a Shortened Infusion of Ramucirumab in Patients with Gastrointestinal Cancer

“…Sehn et al also examined that a 90-minute rituximab administration for more than 1,200 cases and reported that no grade 3 or 4 infusion reactions were observed [8]. As for bevacizumab, trastuzumab, and panitumumab, similar studies have been performed and indicated that it is possible to shorten infusion time [9][10][11][12]. Therefore, we hypothesized that it is possible to shorten the infusion duration of ramucirumab for patients without IRR during the first administration.…”