Oncology Drug Reference Sheet: Tocilizumab

April 14, 2020 by Chelsea Backler MSN, APRN, AGCNS-BC, AOCNS®

Tocilizumab (Actemra®was approved in August 2017 for the treatment of chimeric antigen receptor (CAR) T cell–induced cytokine release syndrome. In March 2020, the U.S. Food and Drug Administration approved a randomized, double-blind, placebo-controlled, phase III clinical trial to assess the safety and efficacy of tocilizumab plus standard of care in patients hospitalized with severe COVID-19 pneumonia.

Category/Class

Humanized interleukin-6 receptor-inhibiting monoclonal antibody.

Indication

Dosing for CRS

Administering more than 800 mg per infusion is not recommended for CRS.

Administration

Give via IV infusion over 60 minutes. If symptoms show no clinical improvement after the first dose, repeat for up to three doses. Allow for at least an eight-hour interval between infusions. Tocilizumab may be administered alone or in combination with corticosteroids.  

Adverse Reactions

The most common reactions (≥ 5%) are upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, and injection site reactions. Serious reactions are hypersensitivity reactions, serious infections, and gastrointestinal perforation.

Warnings and Precautions

Serious, sometimes fatal, infections because of bacterial, mycobacterial, invasive fungal, viral, protozoal, or other opportunistic pathogens have been reported in patients receiving tocilizumab.

Nursing Considerations

Tocilizumab should not be administered to patients with an active infection, including localized infections. Laboratory values, including liver enzymes, absolute neutrophil count, and platelet count, should be monitored for the need for dose adjustments; see the package insert for full dose modifications. Avoid use of live vaccines while on tocilizumab. Patients should be evaluated for risk and tested for latent tuberculosis (TB) prior to starting and monitored for TB symptoms throughout tocilizumab therapy. Assess patients for a history of diverticulitis or gastrointestinal ulcers.

Drug-Drug and Drug-Food Interactions

Tocilizumab interacts with CYP450; coadministering tocilizumab with CYP3A4 substrate drugs may decrease the substrate drugs' effectiveness. The effect may persist for several weeks after stopping tocilizumab therapy.

Patient Education

Gero-Oncology Considerations

In clinical trials, patients aged 65 or older had a higher incidence of infections.

Safe Handling

Based on animal data, tocilizumab may cause fetal harm.


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