Management of Fever After Pembrolizumab Infusion
Immediate Assessment and Grading
- The American Society of Clinical Oncology recommends that for fever occurring within hours of pembrolizumab infusion, immediately stop or slow the infusion rate, provide symptomatic treatment with antipyretics and antihistamines, and restart at 50% of the previous rate once symptoms resolve if the reaction is Grade 1-2 1
- Grade 1-2 reactions present with pyrexia and chills as the primary symptoms, typically without hemodynamic instability, with an incidence of infusion reactions with pembrolizumab of approximately 3% 1
Acute Management Protocol
- For Grade 1-2 reactions, stop or slow the infusion rate immediately and provide symptomatic treatment, including administering antipyretics, such as acetaminophen 650-1000 mg, and antihistamines, such as diphenhydramine 25-50 mg IV or oral equivalent 1, 2
- Monitor vital signs for 15 minutes until symptoms resolve, and restart the infusion at 50% of the previous rate after complete symptom resolution, gradually increasing the rate back to the original infusion speed if well tolerated 1, 2
Prevention for Subsequent Infusions
- Premedication with antipyretic and antihistamine may be considered for patients who have experienced prior infusion reactions, including administering acetaminophen 1000 mg 30-60 minutes before infusion and giving antihistamine prior to infusion 1, 2
Post-Infusion Monitoring
- Observe patients for 1-2 hours after infusion completion, particularly after a reaction has occurred, and educate patients about delayed reactions that can occur up to 24 hours post-infusion 2, 3, 4