Advertisement

Outcome of 490 Desensitizations to Chemotherapy Drugs with a Rapid One-Solution Protocol

Published:January 18, 2018DOI:https://doi.org/10.1016/j.jaip.2017.11.033

      Background

      Hypersensitivity reactions to chemotherapy drugs are quite frequent. Desensitization for chemotherapy drugs has become an option to maintain first-line therapy in patients who have suffered such reactions.

      Objective

      The objective of this study was to describe our experience in desensitization with antineoplastic agents using a rapid 1-solution protocol.

      Methods

      We performed a 3-year prospective observational study recording all patients who were desensitized with this protocol. All patients signed an informed consent. Skin test was performed at concentrations previously described as nonirritant. Desensitization was performed using only 1 solution of the drug prepared following the manufacturer instructions. Most drugs were diluted in a volume of 500 mL. We started infusion at 5 mL/h and increased doses at 15-minute intervals to 10, 25, 50, 75, and 100 mL/h. If no reaction occurred, and if the pharmacokinetics of the drug allowed it, we stepped up to 150, 200, and 250 mL/h.

      Results

      Ninety patients were desensitized to 93 drugs: oxaliplatin (30), carboplatin (16), paclitaxel (19), docetaxel (6), cetuximab (5), rituximab (6), and others (11). A total number of 490 procedures were performed. Sixteen patients (17.77%) presented 26 reactions (5.3%). Most reactions appeared in patients who were desensitized to platins and in patients with severe reactions. All but 3 cycles were completely administrated. No deaths or hospital admissions were recorded.

      Conclusions

      This 1-solution protocol for desensitization has demonstrated to be safe and useful in our study population, especially for mild-to-moderate reactions and nonplatinum drugs. If our results were reproducible in other centers and larger populations, they could contribute to simplifying protocols and making desensitization available for more patients.

      Key words

      Abbreviations used:

      CTCAE v.3 (Common Terminology Criteria for Adverse Events, Version 3.0), IDT (Intradermal test), SPT (Skin prick test), ST (Skin test)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal

      Subscribe:

      Subscribe to The Journal of Allergy and Clinical Immunology: In Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Castells M.
        • Sancho-Serra M.C.
        • Simarro M.
        Hypersensitivity to antineoplastic agents: mechanism and rapid desensitization.
        Cancer Immunol Immunother. 2012; 61: 1575-1584
        • Castells M.
        • Tennant N.
        • Sloane D.
        • Hsu F.I.
        • Barrett N.
        • Hong D.
        • et al.
        Hypersensitivity to chemotherapy: outcomes and safety of rapid desensitization in 413 cases.
        J Allergy Clin Immunol. 2008; 122: 574-580
        • Madrigal-Burgaleta R.
        • Berges-Gimeno M.P.
        • Angel-Pereira D.
        • Ferreiro-Monteagudo R.
        • Guillén-Ponce C.
        • Pueyo C.
        • et al.
        Hypersensitivity to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment.
        Allergy. 2013; 68: 853-861
        • Vidal C.
        • Méndez-Brea P.
        • López-Freire S.
        • Bernárdez B.
        • Lamas M.J.
        • Amisén M.
        • et al.
        A modified protocol for rapid desensitization to chemotherapy agents.
        J Allergy Clin Immunol Pract. 2016; 4: 1003-1005
        • Picard M.
        • Pur L.
        • Caiado J.
        • Giavina-Bianchi P.
        • Regnier-Galvâo V.
        • Berlin S.
        • et al.
        Risk stratification and skin testing to guide re-exposure in taxane induced hypersensitivity reactions.
        J Allergy Clin Immunol. 2015; 137: 1155-1163
        • Pérez-Rodríguez E.
        • Hernández-Pérez M.A.
        • Martínez-Tadeo J.A.
        Successful desensitization to natalizumab using a 1-solution protocol.
        Ann Allergy Asthma Immunol. 2017; 118: 113-114
        • Brown S.
        Clinical features and severity grading of anaphylaxis.
        J Allergy Clin Immunol. 2004; 114: 371-376
        • Picard M.
        • Regnier-Galvao V.
        Current knowledge and management of hypersensitivity reactions to monoclonal antibodies.
        J Allergy Clin Immunol Pract. 2017; 5: 600-609
        • de las Peñas R.
        • Blasco A.
        • de Castro J.
        • Escobar Y.
        • García-Campelo R.
        • Gúrpide A.
        SEOM clinical guideline update for the prevention of chemotherapy-induced nausea and vomiting.
        Clin Transl Onc. 2016; 18: 1237-1242
        • Hong D.
        • Bankova L.
        • Cahill K.
        • Kyin T.
        • Castells M.
        Allergy to monoclonal antibodies: cutting-edge desensitization methods for cutting-edge therapies.
        Expert Rev Clin Immunol. 2012; 8: 43-54
        • Brennan P.J.
        • Rodríguez Bouza T.
        • Ida Fsu F.
        • Sloane D.E.
        • Castells M.C.
        Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment.
        J Allergy Clin Immunol. 2009; 124: 1259-1266
        • Feldweg A.M.
        • Lee C.W.
        • Matulonis U.A.
        • Castells M.
        Rapid desensitization for hypersensitivity reactions to paclitaxel and docetaxel: a new standard protocol used in 77 successful treatments.
        Gynecol Oncol. 2005; 96: 824-829
        • Lax T.
        • Long A.
        • Banerji A.
        Skin testing in the evaluation and management of carboplatin-related hypersensitivity reactions.
        J Allergy Immunol Pract. 2015; 3: 856-862
        • Alvarez-Cuesta E.
        • Madrigal-Burgaleta R.
        • Angel-Pereira D.
        • Ureña-Tavera A.
        • Zamora-Verduga M.
        • Lopez-González P.
        • et al.
        Delving into cornerstones of hypersensitivity to antineoplastic and biological agents: value of diagnostic tools prior to desensitization.
        Allergy. 2015; 70: 784-794
        • Breslow R.G.
        • Caiado J.
        • Castells M.C.
        Acetylsalicylic acid and montelukast block mast cell mediator-related symptoms during rapid desensitization.
        Ann Allergy Asthma Immunol. 2009; 102: 155-160
        • Trotti A.
        • Colevas C.
        • Setser A.
        • Rush V.
        • Jaques D.
        • Budach V.
        • et al.
        CTCAE v3.0: development of a comprehensive grading system for the adverse events of cancer treatment.
        Semin Radiat Oncol. 2003; 13: 176-181