High incidence of cetuximab-related infusion reactions in head and neck patients

• Published in: ESMO open 2018, Vol.3 (5), p.e000346, Article e000346
• Main Authors: Palomar Coloma, Virginia, Bravo, Pamela, Lezghed, Naima, Mayache-Badis, Lamia, Herrera Gómez, Ruth Gabriela, Iacob, Mariana, Nicouleau, Laurence, Desmaris, Romain, Tao, Yungan, Leibu, Cristian, Matias, Margarida, Lemare, Francois, Even, Caroline, Annereau, Maxime, Ferté, Charles
• Format: Article
• Language: English
• Subjects: allergy gistory; cetuximab infusion reactions; hnscc; Life Sciences; Original Research; risk factors; tobacco history
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1136/esmoopen-2018-000346

BackgroundCetuximab is crucial in the management of squamous cell carcinoma of the head and neck of patients. Grade 3–4 cetuximab-induced infusion reactions (CI-IRs) occur in 2% of patients with colorectal cancer. Despite the 2.7% CI-IR rate in the EXTREME trial, higher rates were reported in small series of patients with head and neck squamous cell carcinoma (HNSCC) (6%–18%). There is an urgent need to better appraise the natural history and the predictive factors for CI-IRs in patients with HNSCC exposed to cetuximab.MethodsThe medical records from patients with HNSCC (n=428) treated by cetuximab at Gustave Roussy from January 2013 to December 2015 were reviewed. The impact of potential risk factors was analysed.ResultsOut of 428 patients, 24 patients (5.4%) presented CI-IR, including grade 3–4 (95.7%); about 21% (5/24) requiring intensive care unit referral and quasi all occurred within the first cycle (21/24). In a multivariate analysis, the occurrence of grade 3–4 CI-IR was associated with tobacco and alcohol history (p=8.5e–3) and with prior allergy history (p=2.9e–3). CI-IRs tended to be associated with poor overall survival in patients with recurrent and metastatic HNSCC and with a higher number of further lines of chemotherapy.ConclusionIn real life, CI-IRs appear far more common in patients with HNSCC (5.4%) than reported in prospective trials. This is the largest series of patients ever focusing on the risk of CI-IR in patients with HNSCC. Prior allergy history and tobacco history are associated with CI-IR and could be used to better allocate treatment. Further prospective data are required to confirm these findings.