Document Type
Article
Abstract
Background: Irinotecan, a topoisomerase I inhibitor, is commonly used to treat gastrointestinal cancers. The infusion time of irinotecan is usually over 90 minutes; however, studies support the safety and feasibility of 30-minute infusions. A shortened infusion duration may improve patient quality of life, optimize infusion chair utilization, and reduce wait times. Faster infusion rates may increase the risk of acute cholinergic side effects, reported in up to 50% of patients (all grades). Current institutional practice in the gastrointestinal medical oncology (GIMO) clinic involves administering irinotecan over 90 minutes and using atropine as needed for reversing cholinergic symptoms. For patients who develop symptoms, subsequent cycles include scheduled atropine premedication, typically without extending the irinotecan infusion time.
Methods: This was a single-center, retrospective, quality improvement study of adult GIMO patients who initiated irinotecan (conventional)-based treatment administered over 90 minutes (pre-intervention) versus 30 minutes (post-intervention). Patients were excluded for a diagnosis of neuroendocrine neoplasm, cancer of unknown primary, or investigational study participation. The primary endpoint of this study was to reduce irinotecan ambulatory infusion time by 60 minutes for at least 50% of GIMO patients. Secondary endpoints included average irinotecan infusion time, incidence of atropine administration during cycle 1, and incidence of adverse effects.
Results: A total of 339 patients were included in this analysis (184 pre-intervention; 155 post-intervention). The irinotecan infusion duration was reduced by 60 minutes in 81% of GIMO patients by December 18, 2025. Acute irinotecan-related adverse events (IRAEs) occurred in 26.6% of pre-intervention patients and 36.1% of post-intervention patients (RR, 1.36; 95% CI, 0.99–1.86; P = .06), most commonly abdominal cramping (14.7% vs 30.3%). Other cholinergic symptoms occurred at similar frequencies. Infusion disruptions occurred in 9.2% and 14.8% of pre-intervention and post-intervention patients, respectively, and all post-intervention patients completed treatment without infusion extensions exceeding 90 minutes. During cycle 1, atropine was administered to 78 pre-intervention and 85 post-intervention patients, with atropine given as a premedication in 35.9% and 25.9%, respectively. Across both cohorts, atropine premedication was associated with lower IRAE rates (11%-18% vs 29%-39%).
Conclusion: A shortened 30-minute irinotecan infusion is feasible and maintains comparable tolerability to the standard 90-minute regimen in gastrointestinal malignancy patients. Atropine premedication was associated with reduced acute adverse events across both infusion durations. These findings support the adoption of a 30-minute infusion protocol to optimize institutional efficiency and patient experience.
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Recommended Citation
Ochs RN, Donovan DJ, Betrabet NA, Covert WM. Evaluation of Shortened Irinotecan Infusion Times and Adverse Effects Incidence for Gastrointestinal Medical Oncology Patients. Advances in Cancer Education and Quality Improvement. 2026; 2(2).
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