Transparency Submission

Cannon, Joan
jcannon@tersera.com
3124505956
05/21/2024
Company: TerSera
Guideline: Older Adult Oncology
Panel: Older Adult Oncology Panel

Algorithm Page Number: OAO-F (4 OF 4), PDF Page 32
Specific Change Requested: For the table entitled Risk Factors For the Development of Delirium in Older Patients With Cancer, we propose that in the Cancer-Related Factors column, the fifth row be altered as follows: “Toxicities from chemotherapy support (eg, first-generation antihistamines, steroids, antiemetics, anxiolytics, opioids.”
FDA Clearance: QUZYTTIR (cetirizine hydrochloride for injection) is FDA approved for the treatment of acute urticaria [1].
Rationale for Requested Change: The table of Medications Commonly Used For Supportive Care That Are of Concern in Older Patients on page OAH-H (3 OF 7) specifies “first-generation” antihistamines as medications of concern due to negative effects such as delirium, and instead recommends use of second-generation antihistamines [2]. Similarly, the 2023 Beers criteria strongly recommends against use of “first-generation” antihistamines in adults =65 years of age due to strong anticholinergic properties associated with increased risk of falls, delirium, and dementia [3]; these concerns are echoed by the European Society for Medical Oncology (ESMO) guideline on delirium in adult cancer (footnote 9 on page OAO-F [4 OF 4]), which names diphenhydramine – a first-generation antihistamine – as a risk factor for delirium due to its established anticholinergic activity [4]. We propose the above-mentioned addition of “first-generation” for consistency with the table on OAH-H (3 OF 7) and with the recommendation in the Beers criteria.
Citation of Literature
1. QUZYTTIR (cetirizine hydrochloride injection). Prescribing Information. Deerfield, IL: TerSera Therapeutics LLC; 2020.
2. Dotan E, Walter LC, Beechinor R, et al. Older Adult Oncology, Version 1.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023.
3. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71:2052-2081.
4. Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl 4):iv143-iv165.