Beyond Infusion: Real-World Insights Into Infusion-Related Reactions in Monoclonal Antibody Therapy

The exact mechanism responsible for infusion-related reactions (IRRs) after monoclonal antibody (mAb) therapy is unclear. It is also unknown before treatment which patient will develop IRRs. The reported incidence of IRRs varies per and between mAbs, and real-world incidence data are scarce. The purpose of this study was to evaluate the real-world incidence of IRRs in our large tertiary teaching hospital.

We conducted a retrospective analysis of all patients treated with at least one of the following mAbs: atezolizumab, bevacizumab, durvalumab, ipilimumab, nivolumab, panitumumab, pembrolizumab, trastuzumab, pertuzumab, and rituximab. Patient data were included between January 01, 2021, and June 30, 2022. IRRs were graded according to Common Terminology Criteria for Adverse Events.

We included 692 patients, of whom 6.7% (n = 47) had experienced one or more IRRs (n = 63). The highest incidence of IRRs (n = 50) were found in patients treated with rituximab (incidence IRR 26%), followed by patients treated with ipilimumab plus nivolumab (IRR incidence 13%), which was mostly attributed to nivolumab (9%). This is higher compared with literature (2.2%-4.0%). In patients treated with trastuzumab plus pertuzumab, 3.8% had an IRR (n = 3 patients; n = 4 IRRs). For the other drugs, no IRRs were reported.

In this large real-world cohort, we found higher-than-expected numbers of IRRs of patients treated with ipilimumab plus nivolumab. Our research shows that when IRRs are adequately recognized and managed, all patients can safely continue with mAb treatment.