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Bevacizumab 5 mg/kg Can Be Infused Safely Over 10 Minutes

Diane L. Reidy, Ki Y. Chung, John P. Timoney, Vivian J. Park, Ellen Hollywood, Nancy T. Sklarin, Raymond J. Muller, Leonard B. Saltz

From the Divisions of Solid Tumor Oncology and Pharmacy Services, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Leonard B. Saltz, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-917, New York, NY 10021; e-mail: saltzl{at}mskcc.org

Purpose Bevacizumab is a humanized monoclonal antibody that targets vascular endothelial growth factor. As a result of concerns for potential infusion-related hypersensitivity reactions (HSRs), initial phase I trials used a 90-, 60-, 30-minute initial infusion sequence. We sought to determine if the initial prolonged infusion was still necessary and if an infusion time of fewer than 30 minutes could be safely used.

Methods We used computerized pharmacy records to identify all patients who received bevacizumab at our institution in the first 2 years of commercial availability (February 1, 2004, to June 30, 2006). Our institutional adverse drug reaction reporting program was used to identify any infusion reactions possibly related to bevacizumab, and patient medical records were reviewed for confirmation.

Results A total of 1,077 patients were treated with 10,606 doses of bevacizumab, and 765 of these patients received a 5-mg/kg dose (total of 8,494 doses). No HSRs occurred with the 90-, 60-, 30-minute infusion sequence in the first 202 patients. The standard infusion rate was then modified to 30 minutes for all bevacizumab doses. No HSRs were encountered. The infusion was again modified to a rate of 0.5 mg/kg/min. Of the 370 patients who received a total of 2,311 doses of bevacizumab at 5 mg/kg over 10 minutes, six (1.6%) experienced events of minor clinical consequence that were possibly consistent with nonserious HSRs.

Conclusion Ninety- and 60-minute initial infusion times are unnecessary. Use of a standard infusion rate of 0.5 mg/kg/min is safe, logical, and the current policy at our institution.

Supported by funds from the Memorial Sloan-Kettering Cancer Center.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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