Table 1.
Concerns About Choice of Infusion Rate of Anticancer Agents
| Multiple Concerns | Typical Medications | Rationales and Recommendations |
|---|---|---|
| Efficacy | Methotrexate | Rapid infusion could improve efficacy of methotrexate in primary central nervous system lymphomas.5 |
| Fluorouracil | Continuous infusion could achieve better efficacy compared with bolus administration in advanced colorectal cancer patients.6 | |
| Arsenic trioxide | Slow infusion could obtain high efficiency on leukocytosis.8 | |
| Safety | Platinum compounds, doxorubicin, carmustine | Slow infusion is safer than fast infusion.9–20 |
| Gemcitabine | Fast infusion is safer than slow infusion.22,23 | |
| Paclitaxel, fluorouracil | Optimal flow rates for paclitaxel and fluorouracil are based on the balance between multiple risks of toxicity.24–28 | |
| Economic efficiency | Biosimilar monoclonal antibodies (bevacizumab, rituximab, daratumumab, ramucirumab) | The optimal infusion rate may bring economic benefits (e.g., higher patient satisfaction, improved institutional efficiency and more nursing time available for other activities).29–38 |
| Endostar | Continuous infusion may be a more economical choice compared with traditional intravenous drip administration.39 | |
| Clinical indications | Paclitaxel, rituximab, methotrexate | These medications may exhibit disease-specific requirements for infusion rates.40–42 Pharmacists and nurses should be familiar with patient diagnosis during appropriateness review and intravenous drug administration. |
| Severity and type of hypersensitivity reactions | Platinum compounds | It is wise to triage patients to appropriate desensitization protocols (e.g., shorten, stand, or prolonged) according to clinical categorizations based on severity and type of HSRs.44 |
| Formulation features | Nanoparticle albumin-bound paclitaxel, doxorubicin liposome | New formulation can overcome the defect of infusion regimen due to special requirements on infusion rate.45–47 |
| Genetic polymorphism | Gemcitabine, methotrexate | It is interesting to develop an individualized dosing strategy based on both infusion rate and genotype [gemcitabine: SCL28A3 (rs7867504; T>C), CDA c.79A>C; methotrexate: CC genotypes at SLCO1B1 rs4149056]22,48,51 |
Abbreviations: CDA, cytidine deaminase; SCL28A3, solute carrier family 28 member 3; HSRs, hypersensitivity reactions; SLCO1B1, solute carrier organic anion transporter family member 1B1.