Nivolumab is a fully human IgG4 monoclonal antibody (moAb) against programmed cell death protein 1, approved for the treatment of over ten types of cancer. The use of this and other moAbs has augmented considerably in recent years and this in turn has caused an increase of hypersensitivity reactions (HSR).
We present the case of a patient with metastatic renal cell cancer (RCC) who developed a grade 3 cytokine release reaction (CRR) to nivolumab. The maintenance of the symptoms despite of the administration of symptomatic treatment and slowing down the infusion rate of nivolumab during the 1st and 2nd reaction required an allergy evaluation of our patient.
Skin testing to Nivolumab with negative results and baseline tryptase within the normal range were observed during the allergy workout. A desensitization protocol with specific premedication was applied to reintroduce the moAb, with no further issues. Moreover, a follow up of the patient in the oncology setting was done showing disease stabilization.
The CRR should be treated by desensitization, in contrast to infusion reactions. The diagnosis of CRR phenotype is based on the clinical presentation and recently, and elevation of IL-6 levels has been shown to be a useful biomarker along with negative skin testing. We can conclude that after a HSR and an appropriate allergy diagnosis of CRR, nivolumab can be safely reintroduced by desensitization without reducing the target dose or the appropriate dilution concentration.
Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners. 2021 Dec 08 [Epub ahead of print]
Laura Sánchez Togneri, Ignacio Duran, Fernando Rodríguez Fernández, Leticia de Las Vecillas
Department of Oncology, 16516Marqués de Valdecilla University Hospital-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain., Department of Allergy, 16516Marqués de Valdecilla University Hospital-Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.