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Recognizing and managing infusion-related reactions is crucial for clinicians administering these therapies, and educating patients is essential.

Infusion-related reactions (IRRs) are adverse responses to the infusion of pharmacologic or biologic substances prevalent in anticancer therapies administered intravenously or subcutaneously. These reactions are typically mild to moderate, but they can escalate to life-threatening conditions if not promptly managed. Recognizing and managing IRRs is crucial for clinicians administering these therapies, especially nurses, and educating patients about potential reactions is essential.

IRR Incidence

Recently, a team of investigators examined IRRs to better understand the anticancer therapies that can cause IRRs minutes to hours after the infusion and help clinicians recognize early signs of an IRR and promptly manage the event. They published their findings online in ESMO Open.

The incidence of IRRs varies based on therapy, cancer type, and administration practices. Chemotherapy and monoclonal antibodies (mAbs) exhibit different incidence rates, with mAbs often causing more heterogeneous reactions. According to the authors, studies show wide-ranging incidence rates, necessitating a standardized approach for definition and reporting. The National Cancer Institute defines IRRs as adverse reactions to infusion, encompassing immune-mediated and non-immune-mediated reactions. Symptoms vary but often include mucocutaneous, respiratory, and circulatory manifestations.

Identifying risk factors for IRRs, such as drug class, route of administration, and patient characteristics, aids in proactive management. Premedication strategies, including corticosteroids and antihistamines, mitigate IRR risk by targeting inflammatory pathways. In severe cases, additional interventions like epinephrine may be necessary.

Clinicians must recognize and respond to IRRs promptly, the authors wrote. Monitoring vital signs during infusion, assessing for early signs of reactions, and stopping infusion at the first indication of an IRR are essential steps. Management protocols involve supportive care, adjusting patient position, providing oxygen, and assessing for anaphylaxis criteria. Post-reaction assessment includes monitoring vital signs, observing for recurrence, and educating patients about potential recurrence signs.

IRRs associated with taxanes, platinum compounds, and monoclonal antibodies (mAbs) represent potential challenges in cancer therapy. Taxane-induced IRRs may result from various mechanisms, including IgE-mediated mast cell activation and direct action on basophils, commonly occurring during initial infusions. Prophylaxis with premedication is standard practice.

Platinum compound IRRs typically involve IgE-mediated reactions but may vary in timing and presentation. Due to insufficient evidence, routine prophylaxis is not recommended, and alternative strategies are preferred.

The mechanisms underlying mAb-induced IRRs are not fully elucidated, but cytokine release and IgE-mediated allergic reactions are implicated.

Managing IRRs

Premedication and incremental infusion rates are used to prevent and manage these reactions, primarily occurring during initial infusions.

Standardized management protocols for IRRs in clinical practice are crucial to ensure patient safety and treatment quality. Essential steps include training healthcare providers, implementing standardized reporting procedures, and adopting hospital-wide protocols.

After an IRR episode, careful evaluation of the precipitating factors and patient characteristics is necessary to determine treatment continuation. Restarting therapy with adjusted infusion rates and additional premedication is generally successful after symptoms resolve.

The study authors concluded that standardized definitions, proactive risk assessment, premedication strategies, and prompt recognition and management are vital in mitigating the impact of IRRs associated with anticancer therapies. They added that collaborative efforts among healthcare providers and patient education are essential for ensuring safe administration and optimizing treatment outcomes.