Onco Wiki / Regimen

Infusion reaction rescue protocol (mAb / chemotherapy IRR Grade ≥2)

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Notes

CTCAE v5.0 IRR grading + NCCN/ESMO/MASCC anaphylaxis management framework. Highest-risk agents for IRR: rituximab cycle 1 (~75% any-grade, ~10% G3+), obinutuzumab cycle 1 day 1 (~65%), daratumumab cycle 1 (~50% IV; ~13% SC), amivantamab cycle 1 day 1 (~65% IV; ~13% SC), cetuximab cycle 1 (~3% G3+; SE US ~20% with alpha-gal IgE), paclitaxel (~10% any-grade; cremophor vehicle hypersensitivity), carboplatin/oxaliplatin (cumulative; cycles 6+ — true IgE-mediated, desensitization protocol indicated), L-asparaginase (anaphylaxis ~5-10% with native E. coli formulation; less with PEG-asparaginase / Erwinia), bleomycin (rare; idiosyncratic). Premedication standard: acetaminophen 650-1000 mg PO + diphenhydramine 25-50 mg PO/IV + ranitidine 50 mg IV (or famotidine 20 mg IV) ≥30 min before infusion; add IV steroid for high-risk agents (rituximab cycle 1, obinutuzumab cycle 1, daratumumab cycle 1, amivantamab cycle 1, taxanes). Slow first-cycle infusion rate is universally protective. Desensitization (incremental dose escalation over 3-4h with 12-step protocol) allows continuation of life-saving therapy in true IgE-mediated reactions — requires allergy/immunology + ICU-capable setting.

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