CP-046 Hypersensitivity reactions to chemotherapy: so… what do we do now?

Abstract

BackgroundDespite using steroid premedication before administering potentially highly allergenic chemotherapy (taxanes, platinum drugs, biological macromolecules, etc.), some patients get sensitised during the first cycles and tend to develop hypersensitivity reactions. This leads to early treatment interruption, which could be critical for the patient’s outcome. Once identified, the allergen may be re-administered under a desensitisation protocol, inducing a tolerance state in which the patient doesn’t react again. During each session, the whole dose is administered starting at a very low infusion rate, which is periodically increased until the regular rate is achieved. Patients with a positive skin test, severe reaction despite negative test, and those who react again during controlled administration are candidates for desensitisation.PurposeTo describe the management and outcomes of patients who reacted to chemotherapy, and how oncologists changed their prescriptions to available options.Material and methodsWe carried out a retrospective study (period 2011–2014), obtaining data from patients’ clinical histories and chemotherapy records. SPSS20 was used for data coding and statistical processing.ResultsSixteen patients (81.2% female, average 62.9 ± 7.3 years, diagnosed with ovarian cancer) experienced mild (9), moderate (3) or severe (4) hypersensitivity reactions to chemotherapy (68.8% platinum drugs). Five patients had a positive skin test; only three were enrolled on desensitisation programmes, the remaining two switched treatment line. Two patients had a severe reaction but a negative test, one of them was enrolled and the other switched treatment. The remaining nine (negative test, mild-moderate reaction) didn’t experience a second reaction during controlled infusions, so they kept the same treatment; just one reacted and was proposed for the programme. Four desensitisations were carried without incident, the remaining one had to be stopped due to a reaction when the infusion reached the top rate during the first session.ConclusionDesensitisation, provided by Drug Allergy and Hospital Pharmacy departments, allows standard treatment lines to be continued, modifying oncologists’ decisions and improving patient outcomes.References and/or AcknowledgementsNo conflict of interest.