Safety of accelerated infusion of nivolumab and pembrolizumab

Abstract

Nivolumab and pembrolizumab are checkpoint inhibitors targeting programmed cell death-1, used for several types of cancer. The increased use of these drugs and the growing number of cancer patients place a significant burden on the hospital ward capacity. Safely reducing the infusion time of immune checkpoint inhibitors could improve capacity. The aim of this implementation project was to explore the safety of accelerated infusion time for nivolumab and pembrolizumab. Patients who received monotherapy nivolumab or pembrolizumab were included in the implementation project. The administration time according to label of nivolumab and pembrolizumab was reduced over 2-3 treatment cycles from 60 and 30-10 min. Vital signs were measured every 15 min from start until 30 min after completion of each administration. If a hypersensitivity reaction (HSR) occurred, infusion was interrupted, and its severity was graded. Between January 2023 and December 2024, 101 patients were enrolled (316 infusions). This included 72 patients with nivolumab and 29 with pembrolizumab treatment. Only grade 1 and 2 HSR were observed. In total 11 HSRs were observed during the administration of nivolumab. Nine HSRs occurred during the 30-minute and two during the 10-minute infusion. No HSR was recorded with pembrolizumab. The accelerated infusion of nivolumab and pembrolizumab in 10 min is safe and results in considerable time efficiency. This strategy is potentially feasible for more immune checkpoint inhibitors and should therefore be considered to facilitate the treatment of the increasing number of cancer patients.

Keywords: Accelerated infusion; Immune checkpoint inhibitors; Nivolumab; Pembrolizumab; Safety; Time efficiency.