Journal article
Risk factors for and pre-medications to prevent cetuximab-induced infusion reactions in patients with squamous cell carcinoma of the head and neck
Oral oncology, Vol.50(9), pp.895-900
09/01/2014
DOI: 10.1016/j.oraloncology.2014.06.017
PMCID: PMC4130782
PMID: 25037161
Abstract
Objectives: Cetuximab, a chimeric monoclonal antibody, is the only targeted therapy approved for squamous cell carcinoma of the head and neck (SCCHN). Infusion reactions (IRs) occur in 6-18% of patients pre-medicated with diphenhydramine. Evidence for clinical risk factors for IRs is limited and the benefit of additional pre-medication to prevent IRs is unclear.
Materials and methods: A retrospective, single institution study of 243 SCCHN patients treated with cetuximab to evaluate potential risk factors for IRs and to assess the efficacy of additional pre-medications (nebulized albuterol and intravenous (IV) corticosteroids and/or H-2-blockers) to decrease the risk of IR.
Results: IR (grades 1-4) and high grade (grades 3-4 only) IR occurred in 47 (19.3%) and 16 (6.6%) patients, respectively. Multivariate analysis identified Caucasian race (OR7.11, p = 0.003), medication allergy (OR3.74, p = 0.002), and blood eosinophils >3% (OR2.75, p = 0.01) independently increased the risk of IR; Caucasian race (OR5.57, p = 0.007) and medication allergy (OR4.10, p = 0.0007) increased the risk of high grade IR. IR (grades 1-4) and high grade IR occurred in 31.8% and 22.7% pre-medicated with diphenhydramine alone. Univariate analysis identified albuterol, famotidine, and corticosteroids decreased the risk of high grade IR. Furthermore, there was a significant difference between the possible combinations of the pre-medications and the risk of high grade IR by Fisher Exact test (p = 0.003) whereby the combination of albuterol, famotidine and corticosteroids was effective in preventing high grade IR. Thirty (64%) of the 47 patients who developed an IR were re-challenged and did not experience a recurrence of an IR.
Conclusion: These data may be used to identify patients at higher risk for cetuximab-induced IR who may be advised to not receive cetuximab or who may benefit from additional pre-medications to decrease the risk of a high grade IR. (C) 2014 Elsevier Ltd. All rights reserved.
Details
- Title: Subtitle
- Risk factors for and pre-medications to prevent cetuximab-induced infusion reactions in patients with squamous cell carcinoma of the head and neck
- Creators
- Waseem Touma - Dept Internal Med, Div Hosp Med, St Louis, MO USASami S. Koro - Dept Internal Med, Div Med Oncol, St Louis, MO USAJessica Ley - Dept Internal Med, Div Med Oncol, St Louis, MO USATanya M. Wildes - Dept Internal Med, Div Med Oncol, St Louis, MO USALoren Michel - Dept Internal Med, Div Med Oncol, St Louis, MO USAYu Tao - Washington Univ, Sch Med, Div Biostat, St Louis, MO 63110 USADouglas Adkins - Dept Internal Med, Div Med Oncol, St Louis, MO USA
- Resource Type
- Journal article
- Publication Details
- Oral oncology, Vol.50(9), pp.895-900
- Publisher
- Elsevier
- DOI
- 10.1016/j.oraloncology.2014.06.017
- PMID
- 25037161
- PMCID
- PMC4130782
- ISSN
- 1368-8375
- eISSN
- 1879-0593
- Number of pages
- 6
- Grant note
- UL1TR000448 / NCATS at the NIH 1K12CA167540 / NCI at the NIH K12CA167540 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) UL1TR000448 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 09/01/2014
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984697739202771
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