Increasing time constraints facing the Cancer Day Unit at Gold Coast University Hospital necessitated the adoption of an accelerated bevacizumab infusion protocol. A safety audit was carried out as a requirement of quality assurance to compare the incidence of infusion-related hypersensitivity reactions, hypertension and proteinuria between the accelerated infusion protocol (30 minutes C1, followed by 10 minute subsequent infusions) versus the standard protocol (90 minutes C1, 60 minutes C2, followed by 30 minute subsequent infusions).
Data was collected retrospectively for Cohort 1, who received the standard infusion protocol between 1/7/13 and 31/5/14, and prospectively for Cohort 2 who received the accelerated infusion protocol between 1/7/14 and 31/5/15. Eligible subjects included bevacizumab naïve patients being treated for metastatic colorectal cancer at a dose of 5mg/kg or 7.5mg/kg. Adverse events were graded according to the NCI-CTCAE grading criteria.
A total of 27 eligible patients were included in cohort 1, and received 141 bevacizumab infusions, with 1 documented infusion-related hypersensitivity reaction (grade 1) in a patient receiving their first cycle over 90 minutes. Cohort 2 included 28 eligible patients who received 168 infusions, with no documented hypersensitivity reactions.
Blood pressure was documented on 137 occasions for cohort 1, and 164 occasions for cohort 2. Episodes of hypertension were classified as grade 1 (40% versus 49%), grade 2 (27% versus 27%) or grade 3 (4% versus 4%) for cohorts 1 and 2 respectively. Urine dipstick results were documented on 96 occasions for cohort 1 and 102 occasions for cohort 2, with episodes of proteinuria classified as grade 1 (11% versus 10%), grade 2 (2% versus 1%) or grade 3 (2% versus 1%) for cohorts 1 and 2 respectively.
There was no increase in infusion-related hypersensitivity reactions, hypertension or proteinuria with the accelerated infusion protocol compared with the standard infusion protocol.