Retrospektivna analiza infuzijskih reakcij po parenteralni aplikaciji kemoterapevtikov na Onkološkem inštitutu Ljubljana v letih 2019 do 2023

Kadiš, Lea (author), Kerec Kos, Mojca (mentor), Eberl, Andreja (comentor)

Rakava obolenja so v zadnjih letih drugi najpogostejši vzrok smrti v Sloveniji, saj oboleva vedno večje število ljudi. Večje število bolnikov pomeni tudi vedno večjo potrebo po uporabi parenteralne kemoterapije, ki lahko ob aplikaciji povzroči infuzijsko reakcijo (IR). Namen retrospektivne raziskave je analizirati incidenco in lastnosti IR, ki so bile zabeležene pri bolnikih, ki so se na Onkološkem inštitutu Ljubljana med leti 2019 in 2023 zdravili s kemoterapijo. Zanimalo nas je, v katerem ciklu terapije se IR pojavijo, kako pogosto bolniki nadaljujejo z aplikacijo učinkovine še isti dan po umiritvi simptomov oziroma v prihodnjih ciklih ter kako pogosta in uspešna je desenzibilizacija. Na Onkološkem inštitutu Ljubljana so v obdobju raziskave aplicirali 13 različnih citostatičnih učinkovin in do IR je prišlo v 403 primerih. Najvišjo incidenco IR smo zabeležili pri bolnikih, ki so prejeli pegilirano liposomalno obliko doksorubicina (7,42 %), sledila sta oksaliplatin (6,91 %) ter paklitaksel (3,10 %), nekoliko nižjo pojavnost IR pa smo opazili pri bolnikih, ki so prejemali karboplatin (1,95 %). Pri ostalih učinkovinah so bile incidence IR nižje (manj kot 1 %). Antraciklinski antibiotiki ter taksani so IR povzročali pretežno ob prvem ali drugem ciklu terapije, medtem ko je bil ob aplikaciji platinovih spojin pojav preobčutljivosti kasnejši, z mediano v 7 ciklu terapije. Po pojavu IR so po umiritvi simptomov še isti dan nadaljevali z aplikacijo učinkovine pri pegiliranem liposomalnem doksorubicinu (95 %), docetakselu (93 %) ter paklitakselu (73 %). Pri ostalih učinkovinah je bil odstotek nadaljevanja terapije bistveno nižji in sicer je bil najnižji pri karboplatinu in oksaliplatinu, kjer je v istem dnevu s terapijo nadaljevalo zgolj 6 oziroma 7 % bolnikov. Tudi ob prihodnjih ciklih terapije je trend podoben, saj je s terapijo nadaljevalo največ bolnikov, ki so prejemali docetaksel (86 %), pegilirani liposomalni doksorubicin (84 %) in paklitaksel (81 %). Tudi tukaj so najnižji odstotek nadaljevanja s terapijo imele platinove spojine (okoli 25 %). Ob izpostavitvi učinkovini, ki je enkrat že privedla do IR, je do ponovne IR v večini primerov prišlo pri nizkem številu bolnikov (okoli 20 %). Kadar je bila ob ponovni izpostavitvi učinkovini uporabljena desenzibilizacija, je le-ta še dodatno zmanjšala ponoven pojav IR za vsaj 50 %. V raziskavi zbrani podatki prispevajo k boljšemu razumevanju IR, kar je ob čedalje višji incidenci rakavih obolenj ter posledično večji uporabi citostatičnih učinkovin bistvenega pomena.

• Language: Slovenian
• Keywords: Infuzijska reakcija, parenteralna kemoterapija, incidenca, desenzibilizacija, Onkološki inštitut Ljubljana.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2024
• Publication date in RUL: 05.09.2024

Secondary language

• Language: English
• Title: Retrospective analysis of infusion-related reactions following parenteral administration of chemotherapeutics at the Institute of Oncology Ljubljana from 2019 to 2023

Abstract

Cancer has become the second most common cause of death in Slovenia in recent years, with an increasing number of people being affected. The growing number of patients also means a rising need for the use of parenteral chemotherapy, which can cause the occurence of infusion reactions (IR) during administration. The purpose of this retrospective study is to analyze the incidence and characteristics of IRs recorded in patients treated with chemotherapy at the Oncology Institute Ljubljana between 2019 and 2023. We determined during which cycle of therapy IRs occurred, how often patients continued with the administration of the drug on the same day after symptom resolution, and the frequency and success of desensitization. Our study revealed that among 13 different cytotoxic agents administered at the Institute of Oncology, IRs occurred in 403 cases. The highest incidence of IR was recorded for pegylated liposomal doxorubicin (7,42%), followed by oxaliplatin (6,91%) and paclitaxel (3,10%), with a slightly lower incidence for carboplatin (1,95%). Other agents had significantly lower IR incidence (below 1%). Anthracycline antibiotics and taxanes mostly caused IRs during the first or second therapy cycle, whereas IRs to platinum compounds appeared later, with a median around the 7th therapy cycle. After an IR, patients continued the drug administration on the same day after symptoms subsided for pegylated liposomal doxorubicin (95%), docetaxel (93%), and paclitaxel (73%). For other agents, the percentage was significantly lower, with the lowest being for carboplatin and oxaliplatin, where only 6% and 7% of patients, respectively, continued therapy on the same day. The trend was similar in subsequent therapy cycles, with the highest continuation rates for docetaxel (86%), pegylated liposomal doxorubicin (84%), and paclitaxel (81%). The lowest continuation rates were again observed with platinum compounds (around 25%). Upon re-exposure to the drug that initially caused an IR, the recurrence of IR was low, occurring in approximately 20% of patients. When desensitization was used, the recurrence of IR was further reduced by at least 50%. The data collected in this study will contribute to a better understanding of IRs, which is crucial given the increasing incidence of cancer and the consequent greater use of cytotoxic agents.

• Keywords: Infusion reactions, parenteral chemotherapy, incidence, desensitization, Institute of Oncology Ljubljana.