Survey about the conditions of preparation and administration of cetuximab in francophone hospitals

Hypersensitivity reactions, about 3%, are described with cetuximab but an unusual high rate is observed in our hospital. A survey about the conditions of preparation and administration of cetuximab was realized to compare local practices with other institutions’ practices in order to identify factors that explain the high rate of hypersensitivity reactions observed in our hospital.

The questionnaire of 23 items concerned three thematics : preparation, administration and institutions’ practices. It was published on line on the website Survey Monkey®. The study was broadcast locally and then nationally. The survey period was from April 2016 to June 2017. The answers were analysed with a database on the software Excel®.

Finally, 51 establishments answered the survey. Only 35,3 % (18/51) of centers use needles to prevent high pressure inside sealed vials of cetuximab and remove air from the bag after injection of cetuximab into the infusion bag. The stability period for cetuximab preparations is fixed to 48 hours in 70,3 % of cases (34/48) or reduced to 24 hours (29,2%, 14/48). Three hospitals (5,9 %, 3/51) are used to apply a test dose before complete cetuximab infusion. A double premedication is prescribed in 91,4 % of cases (32/35) and triple premedication in 5,7% of cases (2/35). Infusion rates for the first administration and following treatments are respected or decreased. Four pharmacists are informed about practice of allergic tests in their hospitals (12,9 %, 4/31).

Few of preparation units remove air from the infusion bags. Air liquid interface is a factor of antibodies alteration in case of mechanical agitation, for example if infusion bags are transported by pneumatic conveying systems, but use of these systems is unusual. The stability period, the double premedication and infusion rates recommended by the pharmaceutical firm seem to be respected. Few participants respect the recommendation not to use spikes to prevent high pressure inside vials. The survey shows that 12-Steps tolerance induction to maintain the cetuximab treatment for allergic patients is unknown.