Infusion-Related Reactions: Clinical Trials and Guideline-Driven Prophylaxis and Management Strategies for Patients Undergoing NSCLC Treatment

Management of Infusion-Related Reactions: Summary for Physicians

General Approach to IRRs

• Institutional hypersensitivity guidelines should be developed for common offenders:
• Platinum agents

• Taxanes

• Monoclonal antibodies

• Immunotherapy agents
• In absence of institutional protocols, package inserts provide guidance on:
• Required premedications

• Management of reactions by grade/severity

• Recommendations for subsequent dosing

Standard Premedication Strategy

• Dual histamine blockade approach:
• H1 antagonist (diphenhydramine or cetirizine)

• H2 antagonist (famotidine)

• Corticosteroids

Considerations for Future Doses After IRR

• Step titration method may be introduced
• Additional premedications may be considered
• Cetirizine can replace diphenhydramine in patients susceptible to anticholinergic adverse effects
• Montelukast may be used for pretreatment at home

Focus on Amivantamab

• High IRR incidence: 67% in CHRYSALIS study
• SKIPPirr trial investigated enhanced premedication protocols:
• Dexamethasone 8 mg twice daily for 2 days prior to infusion

• Dexamethasone 8 mg 1 hour before infusion

• Standard premedications (diphenhydramine, acetaminophen)

• This protocol reduced IRR incidence to 22.5%

Key decisions following IRRs include determining whether to restart the current infusion after reaction resolution (with physician and patient agreement) and modifying premedication approaches for subsequent infusions.