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

EP: 1.Overcoming Challenges in NSCLC Management From a Pharmacist’s Perspective

EP: 2.First-Line Focus: Molecular Testing and Guideline-Directed Therapy in EGFR-Positive NSCLC

EP: 3.Recent Clinical Trial Highlights for NSCLC Treatment

EP: 4.Integrating Clinical Trial Findings Into Everyday Pharmacy Practice

EP: 5.Barriers to Bridging Clinical Trial Data to Routine Pharmacy Practice

EP: 6.Enhancing Patient Care Through Multidisciplinary Team Collaboration in Management of NSCLC

EP: 7.Breaking New Ground: Emerging Therapies for Treatment of EGFR-Positive NSCLC

EP: 8.Balancing Treatment and Quality of Life: Adverse Events of First-Line Agents in NSCLC

EP: 9.Strategies to Minimize Toxicities, and the Pharmacist’s Role in Educating and Supporting Patients With NSCLC

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EP: 10.Infusion-Related Reactions: Clinical Trials and Guideline-Driven Prophylaxis and Management Strategies for Patients Undergoing NSCLC Treatment

EP: 11.Infusion Hesitancy and the Impact of Route of Administration of NSCLC Treatment Options in Patients’ Quality of Life

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.