A new non-dilution rapid desensitization protocol successfully applied to all-grade platinum hypersensitivity
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Desensitization is a safe alternative for patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapeutic agents and widely used in real practice by employing stepwise administration of multiple serial dilutions of the culprit drugs. However, its labor-intensive nature has required a simpler protocol that is easier to prepare and perform.
We performed an observational study of patients with platinum HSR who underwent a new non-dilution one-bag desensitization protocol. Premedication consisted of Montelukast as well as H1 and H2 blockers. The outcomes and safety profiles of a new protocol were assessed.
A total of 36 patients were recruited (oxaliplatin 23, carboplatin 9, and cisplatin 4) and the most common grade of HSR presented was grade 2 (61.1%), followed by grade 3 (25%), and grade 1 (13.9%). Of 175 desensitization procedures, all cases were successfully completed in re-administration of culprit chemotherapeutic platinum agents; 146 (83.4%) had no breakthrough reactions (BTRs) while 29 (16.6%) did. Most BTRs were mild reactions (grade 1, 51.7%) or moderate reactions (grade 2, 44.8%) of Brown’s Scale. Although there was one case of asymptomatic mild hypotension (grade 3, 3.5%), categorized as severe reaction, dyspnea, desaturation, and anaphylaxis did not occur. The proportion of severe HSRs was significantly lower than that of initial HSRs (3.5% vs. 25%, P = 0.0167).
The new non-dilution desensitization protocol was safe and effective for re-administration of culprit platinum agents in patients with a history of HSRs. Therefore, this new protocol can be used as an alternative to existing protocols using multiple serial dilutions.
KeywordsDrug hypersensitivity Antineoplastic agents Desensitization Immunologic Platinum Drug-related side effects and adverse reactions
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This research was supported by a Grant from Ministry of Food and Drug Safety to the regional pharmacovigilance center in 2017.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 8.Network NCC (2017) NCCN clinical practice guidelines in oncology-ovarian cancer including fallopian tube cancer and primary peritoneal cancer (Version 2.2017)Google Scholar
- 14.Madrigal-Burgaleta R, Berges-Gimeno M, Angel-Pereira D, Ferreiro-Monteagudo R, Guillen-Ponce C, Pueyo C, Gomez de Salazar E, Alvarez-Cuesta E (2013) Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment. Allergy 68(7):853–861CrossRefGoogle Scholar
- 20.Takase N, Matsumoto K, Onoe T, Kitao A, Tanioka M, Kikukawa Y, Yamaguchi S, Fujiwara K, Negoro S (2015) 4-Step 4-h carboplatin desensitization protocol for patients with gynecological malignancies showing platinum hypersensitivity: a retrospective study. Int J Clin Oncol 20(3):566–573CrossRefGoogle Scholar
- 26.Sohn K-H, Kang D-Y, Kim J-Y, Lee S-Y, Lee K-H, Han S-W, Kang H-R (2018) Incidence and risk of oxaliplatin-induced hypersensitivity in patients with asymptomatic prior exposure: a prospective observational study. J Allergy Clin Immunol Pract. https://doi.org/10.1016/j.jaip.2017.12.026 CrossRefPubMedGoogle Scholar
- 29.Alvarez-Cuesta E, Madrigal-Burgaleta R, Angel-Pereira D, Ureña-Tavera A, Zamora-Verduga M, Lopez-Gonzalez P, Berges-Gimeno M (2015) Delving into cornerstones of hypersensitivity to antineoplastic and biological agents: value of diagnostic tools prior to desensitization. Allergy 70(7):784–794CrossRefGoogle Scholar