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Safety and efficacy of an outpatient 12-step desensitization protocol for antineoplastic agents
  1. Idil Eroglu1,2,
  2. Olga T Filippova1,
  3. Maria Kirrane3,
  4. Mary Orpen3,
  5. Vianca Almonte3,
  6. Rachel Thomas3,
  7. Melissa Lee-Teh4,
  8. Richard Tizon4,
  9. Nancy Sklarin1 and
  10. Roisin O’Cearbhaill2,5
  1. 1Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Weill Cornell Medical College, New York, New York, USA
  3. 3Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  5. 5Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Roisin O’Cearbhaill, Weill Cornell Medical College, New York, NY 10065, USA; ocearbhr{at}mskcc.org

Abstract

Objective Antineoplastic agents can cause hypersensitivity reactions that may preclude further treatment, possibly compromising patient outcome if the tumor remains sensitive to such agent. Although desensitization protocols can be used to re-introduce agents after the development of a hypersensitivity reaction, these protocols vary across institutions. Our study evaluated the safety and efficacy of our desensitization protocol.

Methods All patients who underwent desensitization to platinum, taxane, liposomal doxorubicin, or trastuzumab between November 2016 and May 2021 after a prior hypersensitivity reaction to the specific agent were included in a retrospective review. The 12-step, outpatient desensitization protocol included pretreatment with a leukotriene receptor antagonist, antihistamines, and corticosteroids, as well as extended infusion times. Successful desensitization was defined as the completion of ≥3 cycles without discontinuation of the agent due to a hypersensitivity reaction.

Results A total of 186 eligible patients were included. Median age was 59.5 years (range 26–87). 155 (83%) patients were treated with platinum. 55 (30%) patients were treated for colorectal cancer and 52 (28%) for ovarian cancer. 104 (56%) patients completed ≥3 cycles of therapy during desensitization. The median infusion time was 380 min (range 325–360 min). The median number of desensitization cycles was 3, with 694 cycles completed among all patients. A total of 79 (42%) patients had a breakthrough hypersensitivity reaction during desensitization, 4 of whom required epinephrine, and 84 (45%) patients discontinued the agent undergoing desensitization due to progression of disease.

Conclusions Our outpatient 12-step, institutional desensitization protocol for antineoplastic therapy proved safe and efficacious, with 56% of patients successfully completing ≥3 cycles and not requiring an inpatient admission.

  • ovarian cancer
  • medical oncology

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Conceptualization: ROC, ML, RT, NS; Data curation: ROC, IE; Formal analysis: ROC, IE, OF; Methodology: ROC, IE, OF, NS; Roles/Writing - original draft: ROC, IE, OF; Writing - review & editing: all authors. Guarantor: ROC.

  • Funding Funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

  • Competing interests REO reports personal fees from Tesaro/GSK, Regeneron, Seattle Genetics, Fresenius Kabi, the Gynecologic Oncology Foundation, Bayer, Immunogen, MJH Sciences and Curio, as well as others from AstraZeneca Pharmaceuticals (meal) and Hitech Health (travel). REO is also a non-compensated steering committee member for the PRIMA, Moonstone (Tesaro/GSK), DUO-O (AstraZeneca) studies, and Carina Biotech. Her institute receives funding for clinical research from Bayer/Celgene/Juno, Tesaro/GSK, Ludwig Cancer Institute, Abbvie/StemCentrx, Regeneron, TCR2 Therapeutics, Atara Biotherapeutics, MarkerTherapeutics, Syndax Pharmaceuticals, Genmab/Seagen Therapeutics, Sellas Therapeutics, Genentech, Kite Pharma, and the Gynecologic Oncology Foundation.

  • Provenance and peer review Not commissioned; externally peer reviewed.