Hypersensitivity Reactions to Anticancer Monoclonal Antibodies

Abstract

Therapeutic monoclonal antibodies (TmAbs) are new treatment options for cancer. While their use is more common, hypersensitivity reactions (HSRs) to these drugs have been increased, preventing the use of first-line therapies. The aim of this review is to update and discuss the HSRs to TmAbs in their clinical features and management. Type 1 hypersensitivity is the most common type of the HSRs to TmAbs, followed by cytokine release reactions (CRRs) and type 4 hypersensitivity. Mixed reactions of various types might also occur. TmAbs can have different immunogenicity depending on their non-human epitope contents, target proteins, and solubilizing additives. It may be also affected by the patient’s baseline condition and the number of administrations. When HSRs occur, it is recommended to classify the mechanism into type 1/type 4 hypersensitivity and CRRs. A skin test and desensitization are generally the most useful management for type 1 hypersensitivity but there is no standardized protocol for TmAbs yet. Readministration is contraindicated in type 4 hypersensitivity reactions and supportive care is effective in CCRs. Understanding the characteristics and measures for each HSRs may be helpful to ensure the safe use of anticancer monoclonal antibodies. (PeRM 2023;15:1-10)