(029) Characterizing Hypersensitivity Reactions and Management within an NCI-Designated Comprehensive Cancer Center

Poster Abstract: Background/Rationale:
Anticancer agents such as antineoplastic, immunotherapy, and targeted agents are critical for the treatment of cancer. However, their potential to cause hypersensitivity reactions (HSR) may have serious consequences including severe or fatal anaphylactic reactions. Furthermore, HSRs may result in additional treatment, delays in discharge from ambulatory infusion centers, ED visits, inpatient admissions in severe cases, and increased costs to organizations. Contributing factors to increased HSR rates include changes in nursing staff or practice, timing and route of pre-medications, and non-standard administration practices. Additionally, unclear language in medication order sets allows for individual interpretation, contributing to variations in administering both pre-medications and causative agents. Fred Hutchinson Cancer Center (FHCC) faces additional variances across the system in workflow, staffing, and medication formularies between partnered organizations, namely UW Medicine, making standardization challenging. Assessment of current rates of HSRs, published best practices, and development of recommendations to improve FHCC’s approach will improve patient outcomes and access, while reducing chair time, need for additional medications, and costs to the organization. This study aims to compare the incidence of HSRs at FHCC to historical rates, and contrast prevention and management strategies at our institution to accepted best practices.

Methods
Patients at FHCC who received an antineoplastic agent from 08/1/2022 to 08/01/2023 with resulting HSR were included in the analysis. An infusion was flagged for review if a rescue medication was administered after the start of the infusion. HSR were stratified by immunotherapy and chemotherapy agents. Prevention and management strategies for the 6 agents with the highest HSR incidence rates will be compared to current best practices. Additionally, each HSR will be reviewed for situation and patient-specific factors to characterize factors contributing to increased HSR rates within the FHCC system. Evaluation of the literature will allow for assessment of the first endpoint, to compare the overall incidence of HSR in the top 6 causative immunotherapy and antineoplastic agents at FHCC to historical rates. Secondary endpoints include defining prevention and management strategies at FHCC, compared to accepted best practices, and identifying factors leading to increased HSR rates at FHCC.

Results and Discussion
Results are pending. This project has the potential to assess current practices at FHCC for preventing and managing HSR and identify common factors that lead to increased rates of HSR. This work will also contribute to implementation of a HSR tracker and accessible dashboard to monitor for and address increases in reaction rates over time.

References (must also be included in final poster): Durvalumab (Imfinzi®) Injection, for intravenous use. [Prescribing Information]. Cambridge, England: AstraZeneca Pharm. LP., 2022
Rituximab (Rituxan®) Injection, for intravenous use. [Prescribing Information]. San Francisco, CA: Genentech, Inc., 2010
Cetuximab (Erbitux®) injection, for intravenous use. [Prescribing Information]. Indianapolis, IN:Eli Lilly and Co., 2021
Doxorubicin hydrochloride (Doxil®) liposome injection, for intravenous use. [Prescribing Information]. Deerfield, IL: Baxter Healthcare Corporation, 2019.
Paclitaxel (Taxol®) injection, for intravenous use. [Prescribing Information]. Lake Forest, IL: Hospira Inc., 2021
Docetaxel (Taxotere®) injection, for intravenous use. [Prescribing Information]. Lake Forest, IL: Hospira Inc., 2023
Roselló S, Blasco I, García Fabregat L, et al. Management of infusion reactions to systemic anticancer therapy: ESMO Clinical Practice Guidelines. Ann Oncol 2017; 28: iv100–iiv18.
Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Published: November 27. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute.
Tsao LR, Young FD, Otani IM, et al. Hypersensitivity reactions to platinum agents and taxanes. Clin Rev Allergy Immunol 2022; 62: 432–448.
Seghers S, Teuwen LA, Beyens M, et al. Immediate hypersensitivity reactions to antineoplastic agents - A practical guide for the oncologist. Cancer Treat Rev. 2023;116:102559.
Jao ME, Indorf AL, Segal EM, et al. Impact of institutional interventions on the rate of paclitaxel hypersensitivity reactions [published online ahead of print, 2023 Apr 6]. J Oncol Pharm Pract. 2023;10781552231168594.