Hypersensitivity reactions (HSR) to antineoplastic agents may lead to discontinuation of first-line treatments. Rapid drug desensitization (RDD) allows for a safe reintroduction in allergic patients.
To evaluate the safety and efficacy of the Brigham and Women’s Hospital’s 12-step RDD in a Portuguese cancer patient population, and to identify markers associated with breakthrough reactions (BTR) to platins.
We have conducted a retrospective review of desensitizations undertaken at the Immunoallergology Day-Care Unit of the Santa Maria Hospital in Lisbon from July 2008 to July 2019. Adult cancer patients with immediate HSR were included. Skin testing was performed to platins, trastuzumab and cetuximab. The 12-step protocol was used for most patients and a shorter protocol was used in 9 taxane-reactive patients with the aim of resuming regular infusions.
A total of 1471 RDD were performed in 272 patients to 136 platins, 124 taxanes, 13 monoclonal antibodies, and 10 other drugs. Skin testing was positive in 127 of platin-reactive patients (95.3%) and negative in cetuximab- and trastuzumabreactive patients. There were 141 BTR during RDD (9.6% of infusions), 79.4% induced by platins, the majority mild reactions (68.8%). Eight paclitaxel-reactive patients completed a shorter protocol and resumed regular infusions successfully. Multiple platin infusions (cut-off: ≥10) and Total IgE≥100U/mL were identified as independent risk factors for BTR in platin-reactive patients.
This large singlecenter study confirms the safety and efficacy of the 12-step RDD protocol in a different cancer population, providing evidence of its universal applications. Total IgE is a potential useful biomarker to identify high-risk platin-reactive patients.
Copyright © 2020. Published by Elsevier Inc.