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Infusion-related reactions to therapeutic monoclonal antibodies used for cancer therapy

Ann S LaCasce, MD
Mariana C Castells, MD, PhD
Harold Burstein, MD, PhD
Jeffrey A Meyerhardt, MD, MPH
Section Editors
Reed E Drews, MD
N Franklin Adkinson, Jr, MD
Deputy Editors
Diane MF Savarese, MD
Anna M Feldweg, MD


Humanized monoclonal antibodies (MoAbs) represent a significant addition to therapeutic armamentarium for a variety of malignancies. Many of the agents that are used for cancer therapy share a risk for infusion reactions, most of which occur with the first dose. Although the majority of reactions are mild and not life threatening, serious reactions can occur and may be fatal if not managed appropriately.

After an introductory section summarizing the characteristics of infusion reactions and the general principles underlying prevention and treatment of these reactions, this review will discuss the reactions that occur with individual MoAbs used for cancer treatment and the prevention and management of these reactions. A discussion of infusion reactions to conventional cytotoxic agents is presented separately, as is a more in depth discussion of cutaneous adverse effects associated with both cytotoxic agents and the therapeutic MoAbs. (See "Infusion reactions to systemic chemotherapy" and "Cutaneous side effects of conventional chemotherapy agents" and "Cutaneous complications of molecularly targeted therapy and other biologic agents used for cancer therapy".)


Timing — Infusion reactions to MoAbs typically develop within 30 minutes to two hours after the initiation of drug infusion, although symptoms may be delayed for up to 24 hours. The majority of reactions occur after the first or second exposure to the agent, but between 10 and 30 percent occur during subsequent treatments [1]. In general, the likelihood of an infusion reaction declines with each subsequent course of therapy.

The incidence of an infusion reaction during the first drug administration varies among individual agents and is highest for rituximab (both intravenous and subcutaneous) and alemtuzumab (≥50 percent each), trastuzumab (up to 40 percent), and cetuximab (up to 20 percent, depending on the geographic area of residence).

Signs and symptoms of infusion reactions — Intravenous infusion reactions may affect any organ system in the body. Most are mild in severity, although severe and even fatal reactions occur. The most common signs and symptoms of infusion reactions are:


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Literature review current through: Jul 2017. | This topic last updated: Aug 03, 2017.
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