Lenz Heinz-Josef
University of Southern California, Los Angeles, USA.
Oncologist. 2007 May;12(5):601-9. doi: 10.1634/theoncologist.12-5-601.
Like nearly all systemic cancer therapies, monoclonal antibodies are associated with hypersensitivity reactions. This article reviews the characteristics and management of hypersensitivity reactions to monoclonal antibodies and commonly used chemotherapy agents.
MEDLINE was searched for recent studies and reviews pertaining to hypersensitivity reactions with monoclonal antibodies (cetuximab, rituximab, trastuzumab, panitumumab, bevacizumab), platinum compounds (carboplatin, oxaliplatin), and taxanes (paclitaxel, docetaxel). Emphasis was placed on articles that provided practical information on hypersensitivity reaction management. Data found in the literature were supplemented with information from the package insert for each agent.
Severe hypersensitivity reactions are rare, with an incidence of < or =5%, provided patients receive proper premedication, close monitoring, and prompt intervention when symptoms occur. Hypersensitivity reactions to platinum compounds are generally consistent with type 1 hypersensitivity, occurring after multiple cycles of therapy. Reactions to taxanes and monoclonal antibodies produce similar symptoms, but are generally immediate, occurring during the first few minutes of the first or second infusion. However, 10%-30% of reactions to monoclonal antibodies are delayed, and may occur in later infusions, indicating the importance of close observation of the patient following administration. Mild-to-moderate reactions can be managed by temporary infusion interruption, reduction of the infusion rate, and symptom management. Rechallenge should be considered after complete resolution of all symptoms. Severe reactions may require treatment discontinuation.
Hypersensitivity or infusion reactions to platinum compounds are acquired; reactions to taxanes and monoclonal antibodies are immediate and typically occur during the first few minutes of the first infusion. The different time of onset should be considered when developing strategies for preventing and managing hypersensitivity reactions. The decision to rechallenge or discontinue treatment after a reaction occurs depends on the severity of the reaction and other clinical factors.
与几乎所有全身性癌症治疗方法一样，单克隆抗体与过敏反应相关。本文综述了单克隆抗体及常用化疗药物过敏反应的特点与处理方法。
检索MEDLINE数据库，查找有关单克隆抗体（西妥昔单抗、利妥昔单抗、曲妥珠单抗、帕尼单抗、贝伐单抗）、铂类化合物（卡铂、奥沙利铂）和紫杉烷类（紫杉醇、多西他赛）过敏反应的近期研究和综述。重点关注提供过敏反应处理实用信息的文章。文献中的数据辅以每种药物说明书中的信息。
严重过敏反应罕见，发生率≤5%，前提是患者接受适当的预处理、密切监测，并在症状出现时及时干预。铂类化合物过敏反应一般符合1型过敏反应，在多个治疗周期后发生。紫杉烷类和单克隆抗体的反应产生相似症状，但通常是即刻发生，在首次或第二次输注的最初几分钟内出现。然而，10% - 30%的单克隆抗体反应是延迟性的，可能在后续输注时发生，这表明给药后密切观察患者的重要性。轻至中度反应可通过暂时中断输注、降低输注速度和对症处理来解决。在所有症状完全缓解后应考虑再次给药。严重反应可能需要停药。
铂类化合物的过敏或输注反应是后天获得的；紫杉烷类和单克隆抗体的反应是即刻发生的，通常在首次输注的最初几分钟内出现。制定预防和处理过敏反应的策略时应考虑不同的起病时间。反应发生后再次给药或停药的决定取决于反应的严重程度和其他临床因素。
