Chemotherapy in the 21st century is only now beginning to evolve from its early, traumatic treatments. We are still using the potent toxins that kill every dividing cell and make patients physically sick and bereft of the normal protections that help to prevent infections and subsequent malignancies. However, in the past few years, we have seen the emergence of elegant, less traumatic, and more targeted cancer therapies such as tyrosine kinase inhibitors and monoclonal antibodies. These agents have had a profound effect on extending overall survival while also having fewer adverse treatment effects that have historically been seen with chemotherapy.
Allergies May Develop
In addition to the terrible burden of cancer, patients can become allergic to their chemotherapy. This happens with some frequency with both older and newer treatments. Older treatments — carboplatin, for example — can cause allergic reactions so often that oncologists will need to perform skin testing routinely to check for the onset of allergies. The newer monoclonal antibodies can also cause serious and life-threatening reactions. These factors can complicate treatment for patients and clinicians alike.
For board-certified allergists, much time is spent helping patients tolerate the treatments and therapies that they need but which cause them to have allergic reactions. When managing allergies, the desensitization process involves giving the actual allergen substance. This includes giving antibiotics to desensitize patients who are allergic to antibiotics. In some cases, it may mean giving stinging insect venoms to desensitize patients who are allergic to stings from bees, wasps, hornets, and fire ants. In other cases, clinicians may need to administer inhalant allergens (eg, cat, dog, dust mite, and pollen) in order to desensitize patients to these common allergens.
Implementing Allergy-Specific Approaches
There has been much research over the past 5 years into the development of approaches for desensitizing patients who are allergic to the chemotherapy regimens they need. In my personal experience, I have set up a treatment in a program at DeKalb Medical’s Cancer Center in Atlanta. Over the past 10 months, we have successfully completed dozens of chemotherapy desensitizations. These included desensitizations for a variety of agents, including carboplatin, oxaliplatin, cisplatin, rituximab, paclitaxol, and docetaxel. To our knowledge, this is the first time that rapid chemotherapy desensitization has been performed on a large scale in a non-academic outpatient setting.
The desensitizations take about 6 to 8 hours and must be done each time that specific chemotherapy agents are given. Pre-medications are given prior to administration of the drug. The goal is to provide treatments that are generally very gentle. Oftentimes, it means administering different over-the-counter medications, such as oral antihistamines, ibuprofen, and aspirin.
With effective strategies in place to provide chemotherapy rapid desensitization, cancer patients who are facing death now have more options to receive the best possible treatment and manage these side effects to much-needed therapy. The program at DeKalb Medical Center is available to patients and oncologists in the Atlanta area, and we have had referrals from many oncologists who have come from far-away locations to receive this treatment. As the focus on cancer care continues to move toward treating the whole patient — not just the patient’s cancer — it’s important that clinicians seek out these opportunities to optimize outcomes for individuals with this disease.
Readings & Resources (click to view)
Castells MC, Tennant NM, Sloane DE, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitizations in 413 cases. J Allergy Clin Immunol. 2008;122:574-580.
Hesterberg PE, Banerji A, Oren E, et al. Risk stratification for desensitization of patients with carboplatin hepersensitivity: clinical presentation and management. J Allergy Clin Immunol. 2009;123:1262-1267.
Jones R, Ryan M, Friedlander M. Carboplatin hypersensitivity reactions: re-treatment with cisplatin desensitization. Gynecol Oncol. 2003;89:112-115.
Broome CB, Schiff RI, Friedman HS. Successful desensitization to carboplatin in patients with systemic hypersensitivity reactions. Med Pediatr Oncol. 1996;26:105-110.
Confino-Cohen R, Fishman A, Altaras M, Goldberg A. Successful carboplatin desensitization in patients with proven carboplatin allergy. Cancer. 2005;104:640-643.