5PSQ-101 Strategies to reduce the risk of infusion reactions to fosaprepitant in highly emetogenic chemotherapy

<h3>Background and Importance</h3> Fosaprepitant is a prodrug of aprepitant, a neurokinin-1(NK1) receptor antagonist widely used in antiemetic protocols, often in combination with other agents, to prevent nausea and vomiting in highly emetogenic regimens. Polysorbate 80, an excipient in the formulation, has been associated with infusion site reactions (ISRs). Therefore, optimising the administration protocol for fosaprepitant is essential to minimise adverse events and enhance patient safety. <h3>Aim and Objectives</h3> This study aims to evaluate the incidence of ISRs associated with fosaprepitant use in highly emetogenic regimens and assess the effectiveness of preventive measures implemented in clinical practice. <h3>Material and Methods</h3> A retrospective analysis was conducted at a university hospital where fosaprepitant was integrated into the antiemetic protocol starting in December 2023. Fosaprepitant was prepared in 100 mL of 0.9% sodium chloride, mixed with 12 mg of dexamethasone and 8 mg of ondansetron, and administered over 20 minutes, adhering to physicochemical guidelines established by Moya-Gil et al (J Anal Bioanal Tech 2016). Following a noted increase in ISRs in January 2024, pharmacists and nurses reviewed the preparation and administration processes. Data were collected from December 2023 to September 2024, through the Farmis-Oncofarm system. Corrective measures implemented in February 2024 included dilution in 250 mL of saline, extending the infusion time to at least 30 minutes, continuous monitoring of infusion rates, and comprehensive training for healthcare staff and patients. Statistical analysis was performed using SPSS 20. <h3>Results</h3> Among the 1537 fosaprepitant infusions, the overall incidence of infusion site reactions (ISRs) was 1.30% (20/1537), affecting 4.16% of patients (15/361). Of the total reported complications related to the infusion site, 76.92% were attributed to fosaprepitant (20/26) including phlebitis and extravasation. After the intervention, ISRs decreased significantly from 13 cases pre-intervention (301 infusions) to seven post-intervention (1236 infusions), resulting in a statistically significant reduction (RR 0.13; 95% CI 0.05–0.33; p&lt;0.05). The study’s limitations include its retrospective design, potential variability in clinical practice, and possible underreporting of adverse reactions, which may affect the validity of the findings. <h3>Conclusion and Relevance</h3> The implementation of preventive measures significantly reduced fosaprepitant-related ISRs. These findings highlight the importance of a multidisciplinary approach and continuous monitoring to optimise antiemetic protocols and enhance patient safety during cancer treatment. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest