Twenty RCTs (n=9,411) were included in the review.
Haematological cancers (10 RCTs, n=3,131).
There were 6 RCTs of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) versus CHOP alone. Three RCTs reported similar infection rates in both groups. One RCT found a lower rate of grade III-IV infection in the RCHOP arm (12% versus 20%) and another found a higher rate of infection-related deaths in the RCHOP arm (1.5% versus 1%). The sole RCT conducted among human immunodeficiency virus (HIV)-positive patients found a significantly higher infection-related death rate in the RCHOP arm (14% versus 2%, p=0.035).
There were 4 RCTs of other comparisons. No significant differences were found between the groups when rituximab with non-CHOP chemotherapy was compared with non-CHOP chemotherapy alone (3 RCTs). In one small RCT (n=21), patients receiving alemtuzumab (only) had a 70% increase in total infections compared with controls receiving observation.
Solid cancers (10 RCTs, n=6,280).
There were 5 RCTs of trastuzumab for primary breast cancer. Five RCTs reported on the use of trastuzumab for primary breast cancer. In comparisons of trastuzumab plus chemotherapy versus chemotherapy alone (4 RCTs), RCTs reported higher rates in most MoAb arms of grade I-II infection (2.8%, 3.9%, 1 RCT, 2 comparisons), grade III-IV infection (0.9% ,1 RCT) and overall infections (6%, 15.2%, 18%, 3 RCTs). However, infection-related deaths were 2% higher in the control arm in one comparison (1 RCT). An RCT (n=3,387) of trastuzumab versus observation reported higher rates of grade III-IV infection (0.9%) and overall infections (1.1%) in the MoAb arm.
There were 5 RCTs of MoAbs for other solid cancers. Comparisons of bevacizumab plus chemotherapy versus chemotherapy alone reported higher overall rates of infection in the MoAb arms of 3 RCTs, two of which had both low- and high-dose arms (1%, 6%/10% and 5%/20%, respectively). However, grade III-IV infections were only 0 to 1% higher in the MoAb arm (1 RCT). Two RCTs comparing cetuximab with chemotherapy or radiotherapy versus chemotherapy or radiotherapy alone reported a 1.9% increase in overall infection rates and a 5% increase in grade III infections (respectively) in the MoAb arms.