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Open Access 03-01-2024 | Premedication

Steroid Premedication and Monoclonal Antibody Therapy: Should We Reconsider?

Authors: Emma-Anne Karlsen, MBBS/BSc, Euan Walpole, MBBS (Hons), Fiona Simpson, BSc (Hons), PhD

Published in: Current Treatment Options in Oncology | Issue 3/2024

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Opinion statement

Monoclonal antibody (mAb) therapy is now considered a main component of cancer therapy in Australia. Although traditionally thought of as pure signalling inhibitors, a large proponent of these medications function through antibody-dependent cell-mediated cytotoxicity (ADCC). Currently, most protocols and institutional guidelines for ADCC-mediated mAbs promote the use of corticosteroids as premedication: this is implemented to reduce infusion-related reactions (IRRs) and antiemesis prophylaxis and combat concurrently administered chemotherapy-related syndromes. Concerningly, the inhibitory effects of ADCC by corticosteroids are well documented; henceforth, it is possible the current standard of care is misaligned to the literature surrounding ADCC. Subsequently, clinicians’ decisions to act in contrast to this literature may be reducing the efficacy of mAbs. The literature suggests that the redundant use of corticosteroids should be cautioned against when used in conjunction with ADCC-mediated mAbs—this is due to the consequent reduction in anti-tumour activity. Owing to the fact IRRs typically occur upon initial infusion, the authors advocate for individual clinicians and institutional protocols to considering augmenting their practice to corticosteroid premedication at the first dose only, unless clinically indicated. Additionally, product information (PI) and consumer medicine information (CMI) documents distributed by Australian and international regulatory agencies should consider disclosing the risk of concurrent steroids with these medications. Moreover, the authors suggest considering alternative medications for the management of side effects.
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Metadata
Title
Steroid Premedication and Monoclonal Antibody Therapy: Should We Reconsider?
Authors
Emma-Anne Karlsen, MBBS/BSc
Euan Walpole, MBBS (Hons)
Fiona Simpson, BSc (Hons), PhD
Publication date
03-01-2024
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 3/2024
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-023-01170-4

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