Fosaprepitant-induced phlebitis: a focus on patients receiving doxorubicin/cyclophosphamide therapy

Abstract

Purpose The purpose of this study was to investigate the incidence of fosaprepitant-associated infusion site adverse events (ISAEs) among a cohort of breast cancer patients receiving doxorubicin/cyclophosphamide (AC) chemotherapy. Methods A retrospective review of electronic medical record (EMR) data was performed for all patients who were initiated on AC from January 2011 to April 2012. Data collected included baseline demographics, antiemetic regimen, documentation of ISAEs and type of intravenous (IV) access. Descriptive statistics (mean and standard deviation or percentages) were summarized overall, by type of IV access and initial antiemetic given. Results Among the 148 patients included in this analysis, 98 initially received fosaprepitant and 44 received aprepitant. The incidence of ISAEs associated with fosaprepitant administration was 34.7% (n=34), while the incidence of aprepitant-associated ISAEs was 2.3% (n=1). All ISAEs were associated with peripheral IV access. The most commonly reported ISAEs were: infusion site pain (n=26), erythema (n=22), swelling (n=12), superficial thrombosis (n=8), infusion site hives (n=5) and phlebitis/thrombophlebitis (n=5). Twenty-six patients experienced more than one type of ISAE. Conclusions The incidence and severity of ISAEs associated with fosaprepitant administration among a group of patients receiving AC chemotherapy is significant and appreciably higher than what has been previously reported.

Doxorubicin-Induced Systemic Inflammation Is Driven by Upregulation of Toll-Like Receptor TLR4 and Endotoxin Leakage

“…For example, doxorubicin (DOX), one of the most effective CTA to date, induces severe inflammatory responses in various organs including the liver, kidney, intestine, and blood vessels (1)(2)(3)(4)(5), in addition to its known major adverse effect of cardiac toxicity (6). The levels of proinflammatory cytokines, such as IL1 and TNFa, were significantly increased following doxorubicin administration; meanwhile, blocking their functions alleviated the tissue damage caused by doxorubicin (7)(8)(9)(10).…”

An analysis of fosaprepitant-induced venous toxicity in patients receiving highly emetogenic chemotherapy

“…In order to compare the incidence of venous reactions in patients receiving AC from our recent report 12 versus those receiving platinum-based regimens, a detailed description of patient demographics in these two groups is illustrated in Table 1. The treatment groups had similar baseline demographics, except for a few differences including gender and primary cancer site.…”

“…Infusion site adverse events were defined as any recorded pain or other adverse events observed at the infusion site and in blood vessels at or near the infusion site, as was done in the previous study with AC 12. Patient records were reviewed for type and severity of adverse events, including all inpatient and outpatient information from the first fosaprepitant infusion to the last documented patient encounter.…”

“…Additionally, we compared the venous toxicity incidences of those who had received AC in the previous study 12 to patients receiving platinum-based chemotherapy in the current study. Statistical analysis using χ 2 and univariate logistic regression was used to evaluate the association between treatment regimen, fosaprepitant, and risk of ISAE.…”

“…Pursuant to this observation, Mayo antiemetic guidelines were changed so that patients receiving AC chemotherapy were given oral aprepitant, instead of IV fosaprepitant. A subsequent retrospective analysis of Mayo experience was performed, identifying an incidence of venous toxicity related to IV fosaprepitant in 34.7 % of patients receiving AC versus only 2.3 % in such patients receiving oral aprepitant 12. Of note, venous toxicity was noted to be more common in the IV fosaprepitant arm of a randomized trial by Grunberg et al, but the incidence of such was reportedly low (2.7 versus 34.7 % in our study) 10.…”