title: Highly frequent and enhanced injection site reaction induced by peripheral venous injection of fosaprepitant in anthracycline-treated patients.
abstract: BACKGROUND
  Fosaprepitant-associated injection site reaction (ISR) has been reported in patients treated with cisplatin, an irritant drug. We conducted this retrospective study to clarify the incidence and symptoms of fosaprepitant-associated ISR in patients treated with anthracycline.
  
  
  METHODS
  Fifty six patients receiving 159 injections administering doxorubicin/cyclophosphamide (AC), fluorouracil/epirubicin/cyclophosphamide (FEC), or rituximab/cyclophosphamide/doxorubicin/vincristine/prednisolone (R-)CHOP regimen through a peripheral vein at ambulatory treatment centers reviewed for this study from patients' medical records. Incidence of ISR was compared between 24 patients with fosaprepitant injection (fosaprepitant group) and 32 patients without fosaprepitant (control group). Frequency and symptoms of ISR per injection were also compared between 61 injections with fosaprepitant and 98 injections without fosaprepitant.
  
  
  RESULTS
  Both the ISR incidence rate per patient and per injection were significantly higher in the fosaprepitant group than in the control group (67% vs. 16%; P=0.0002, 34% vs. 8.2%; P<0.0001, respectively). By multivariate analysis, fosaprepitant injection was found to be a significant independent variable correlated with ISR risk. Symptoms observed in 61 injections of fosaprepitant were pain (n=14, 23%), erythema (n=10, 16%), swelling (n=6, 10%), and delayed drip infusion (n=6, 10%). After the observation period, no ISR occurred when the administration route was changed to central venous injection or oral aprepitant was administered despite the continuation of chemotherapy.
  
  
  CONCLUSIONS
  ISR occurred more frequently and severely when fosaprepitant was injected through the peripheral vein in patients treated with anthracyclines compared to those without fosaprepitant.
authors.affiliation: 1. Department of Pharmacy, Nagoya City West Medical Center.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: 2. Department of Pharmacy, Nagoya City University Hospital.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kondo
authors.affiliation: 3. Department of Hematology and Oncology, Nagoya City West Medical Center.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Inagaki
authors.affiliation: 4. Division of Oncology, Nagoya City University Hospital.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: 5. Nursing department, Nagoya City West Medical Center.
authors.forename: Chika
authors.initials: C
authors.lastname: Okada
authors.affiliation: 6. Nursing department, Nagoya City University Hospital.
authors.forename: Kumi
authors.initials: K
authors.lastname: Naruse
authors.affiliation: 6. Nursing department, Nagoya City University Hospital.
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sahashi
authors.affiliation: 2. Department of Pharmacy, Nagoya City University Hospital.
authors.forename: Junko
authors.initials: J
authors.lastname: Kuroda
authors.affiliation: 3. Department of Hematology and Oncology, Nagoya City West Medical Center.
authors.forename: Hiroka
authors.initials: H
authors.lastname: Ogura
authors.affiliation: 4. Division of Oncology, Nagoya City University Hospital.
authors.forename: Shiori
authors.initials: S
authors.lastname: Uegaki
authors.affiliation: 4. Division of Oncology, Nagoya City University Hospital.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: 4. Division of Oncology, Nagoya City University Hospital.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mori
authors.affiliation: 7. Department of Dermatology, Nagoya City West Medical Center.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Sawada
authors.affiliation: 8. Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: 9. Department of Breast and Endocrine Surgery, Nagoya City West Medical Center.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugiura
authors.affiliation: 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Endo
authors.affiliation: 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Yoshimoto
authors.affiliation: 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyama
authors.affiliation: 11. Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iida
authors.affiliation: 1. Department of Pharmacy, Nagoya City West Medical Center.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamada
authors.affiliation: 2. Department of Pharmacy, Nagoya City University Hospital.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kimura
authors.affiliation: 3. Department of Hematology and Oncology, Nagoya City West Medical Center.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wakita
keywords: Antiemesis; anthracycline; fosaprepitant; injection site reaction; venous toxicity