1
|
Sefah K, Kilowski KA, Gifford SA, Grove A, Shaffer J, Bryan B, Ahmad S, Holloway RW. Standardized Titration Protocol Reduces the Incidence of Paclitaxel Infusion-Related Hypersensitivity Reactions. JCO Oncol Pract 2023; 19:1199-1205. [PMID: 37906723 DOI: 10.1200/op.23.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Infusion-related hypersensitivity reactions with paclitaxel are common despite the use of dexamethasone and diphenhydramine premedications. Paclitaxel titration protocols that may reduce reactions are empirically derived from clinical observations, and there are no phase III trials that confirm superiority of any management recommendations. The purpose of this study was to compare the frequency and severity of hypersensitivity reactions associated with a recently initiated standardized paclitaxel titration protocol verses standard-of-care (SOC) infusion protocols. MATERIALS AND METHODS This was a retrospective review of hypersensitivity reactions in patients receiving paclitaxel infusions at five ambulatory infusion centers using a standardized titration protocol (February 2021 to April 2021) versus SOC paclitaxel (November 2018 to December 2019). Patients were age 18 years or older and presented for their first or second infusions. The primary study measure was the rate of hypersensitivity reactions. Secondary evaluations included the timing of the reaction after the start of the infusion, use of premedications, and severity of reactions. RESULTS A total of 451 patients were included in this study. Eighty-four (18.6%) patients were identified in the titration protocol group and 367 (81.4%) patients in the SOC group. Hypersensitivity reactions occurred in 4.8% of the titration group and 18.3% of the SOC group (odds ratio [OR], 0.224; 95% CI, 0.09 to 0.74; P = .002). Grade 3 or greater infusion reactions were 0% in the titration group versus 18% in the SOC group (OR, 0.28; P < .008). Reactions occurred later with the titration protocol, compared with the SOC paclitaxel infusion. Finally, no differences were observed in the use of appropriate premedications. CONCLUSION A standardized paclitaxel titration protocol was associated with a significant reduction in the rate of infusion-related hypersensitivity reactions in patients receiving their first and second infusions. A prospective randomized trial is needed to validate these observations.
Collapse
Affiliation(s)
- Kofi Sefah
- AdventHealth Pharmacy, Oncology Division, Orlando, FL
| | | | | | - Angela Grove
- AdventHealth Pharmacy, Oncology Division, Orlando, FL
| | - Jon Shaffer
- AdventHealth Pharmacy, Oncology Division, Orlando, FL
| | - Baylee Bryan
- AdventHealth Pharmacy, Oncology Division, Orlando, FL
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL
| |
Collapse
|
2
|
Yeşilkaya S, Aksu K, Vural Solak GT, Demir Ş, Topel M, Erçelebi DÇ, Koca Kalkan İ, Ateş H, Köycü Buhari G, Nazik Bahçecioğlu S. Rapid drug desensitization to taxanes: a descriptive study from Turkey. J Oncol Pharm Pract 2023:10781552231213318. [PMID: 37936390 DOI: 10.1177/10781552231213318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
AIM To present the characteristics of drug hypersensitivity reactions (DHRs) among taxane recipients with non-small cell lung carcinoma (NSCLC), and to describe the results of rapid drug desensitization (RDD). METHODS A retrospective cross-sectional study included 45 patients who were treated with taxane for NSCLC and were found to be hypersensitive to taxane. All patients were administered the standard 3-bag, 12-step RDD protocol following the development of DHR. RDD success was evaluated separately for each cycle, and successful RDD was defined as the completion of the cycle with application of 12 steps of the desensitization protocol and the absence of early and/or late reactions afterwards. RESULTS Among 45 patients hypersensitive to taxane 43 (95.6%) successfully received taxane cycles with desensitization. Failed RDD occurred in only 2 (4.4%) patients. The total number of desensitization cycles was 183, of which 181 (98.9%) were successful. The mean age of patients with successful desensitization was 59.42 ± 10.48 years and 37 (86.0%) of them were male. CONCLUSION RDD is a reliable procedure that enables effective administration and completion of first-line taxane treatments in taxane-sensitive patients.
Collapse
Affiliation(s)
- Selma Yeşilkaya
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Kurtuluş Aksu
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Gürgün Tuğçe Vural Solak
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Şenay Demir
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Musa Topel
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Dilek Çuhadar Erçelebi
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - İlkay Koca Kalkan
- Division of Immunology and Allergy, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Hale Ateş
- Division of Immunology and Allergy, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Gözde Köycü Buhari
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Sakine Nazik Bahçecioğlu
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
3
|
Bulut İ, Yegin Katran Z. Hypersensitivity Reaction and Rapid Drug Desensitization with Chemotherapeutics: A Tertiary Reference Center Experiences. Int Arch Allergy Immunol 2023; 184:849-855. [PMID: 37442106 DOI: 10.1159/000530959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/28/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Chemotherapy drugs have been in our lives for a long time, and all agents have the potential to develop hypersensitivity. Rapid drug desensitization is an option when hypersensitivity develops. The aim of this study was to examine the characteristics, diagnostic processes, and treatment results of patients with chemotherapeutic agent hypersensitivity who applied to our tertiary reference center. METHODS Patients who applied to our tertiary allergy outpatient clinic between January 2016 and September 2022 due to chemotherapy-induced drug hypersensitivity were examined. Demographic data of the patients, cancer diagnoses, chemotherapy regimens, skin tests, premedication scheme, desensitization cycle were evaluated. We applied a 16-step desensitization in patients with index reaction anaphylaxis or positive skin tests. If the index reaction was not anaphylaxis or skin tests were negative, we applied a 12-step desensitization. If the prick test with chemotherapeutic drugs was negative especially with taxanes, premedication was administered. We used the montelukast, cetirizine, and methylprednisolone for premedication. RESULTS Fifty-one patients were evaluated; 35 (68.6%) were female. The most common malignancy was colorectal cancer in 17 (33.3%) patients. The most common agent responsible for hypersensitivity was oxaliplatin in 17 (33.3%) patients, followed by paclitaxel in 13 (25.4%). When the symptoms of immediate reaction to chemotherapeutic drugs were analyzed as described in the EAACI position paper, only skin and mucosal involvement was seen in 24 (46.8%) patients; only respiratory system involvement or back pain was seen in 3 (6.2%) patients; multisystem involvement meeting the criteria for anaphylaxis was seen in 24 (47%) patients. Skin test was positive in 17 (56.6%) of 30 patients who developed a reaction with platin. Prolonged anaphylaxis was developed in 1 patient, and desensitization was not performed again. Fifty of 51 patients were able to receive the target chemotherapy dose by desensitization. In total, a 172-step desensitization was applied to 51 patients. CONCLUSION If completing the cycle is considered a treatment success, this was achieved in 98% (50/51) patients with rapid drug desensitization. This gives us the opportunity to use first-line chemotherapy agents.
Collapse
Affiliation(s)
- İsmet Bulut
- Department of Allergy and Immunology, Süreyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Yegin Katran
- Department of Allergy and Immunology, Süreyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
4
|
Kozubek P, Wołoszczak J, Gomułka K. Immune Reactions in Major Types of Oncological Treatment. Int J Mol Sci 2023; 24:11257. [PMID: 37511017 PMCID: PMC10378943 DOI: 10.3390/ijms241411257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant effectiveness, they are not free from side effects, such as allergic and dermatological reactions. These reactions can vary in severity and outcome, including potential death. Examples, among others, are type I-IV hypersensitivity reactions of various origins and skin reactions including rashes, itching and redness, but also severe cutaneous syndromes. Due to the therapy used, these may include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis. In some cases, it is necessary to interrupt therapy, which may result in a poorer outcome and shorten the patient's survival. This paper reviews various types of research documents published since 2016. It aims to systematize the latest knowledge and highlight the need for further research into ways to avoid adverse reactions.
Collapse
Affiliation(s)
- Patrycja Kozubek
- Student Scientific Group of Adult Allergology, 50-369 Wrocław, Poland
| | - Julia Wołoszczak
- Student Scientific Group of Adult Allergology, 50-369 Wrocław, Poland
| | - Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wrocław, Poland
| |
Collapse
|
5
|
Seghers S, Teuwen LA, Beyens M, De Blick D, Sabato V, Ebo DG, Prenen H. Immediate hypersensitivity reactions to antineoplastic agents - A practical guide for the oncologist. Cancer Treat Rev 2023; 116:102559. [PMID: 37084565 DOI: 10.1016/j.ctrv.2023.102559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
Immediate hypersensitivity reactions (IHRs) to antineoplastic agents occur frequently, and every oncologist will encounter these reactions in their clinical practice at some point. The clinical signature of IHRs can range from mild to life-threatening, and their occurrence can substantially impede the treatment course of patients with cancer. Yet, clear guidelines regarding the diagnosis and management are scarce, especially from an oncologic point of view. Therefore, herein, we review the definition, pathophysiology, epidemiology, diagnosis and management of IHRs to chemotherapeutic agents and monoclonal antibodies. First, we focus on defining the specific entities that comprise IHRs and discuss their underlying mechanisms. Then, we summarize the epidemiology for the antineoplastic agents that represent the most common causes of IHRs, i.e., platinum compounds, taxanes and monoclonal antibodies (mAbs). Next, we describe the possible clinical pictures and the comprehensive diagnostic work-up that should be executed to identify the culprit and safe alternatives for the future. Finally, we finish with reviewing the treatment options in both the acute phase and after recovery, with the aim to improve the oncologic care of patients with cancer.
Collapse
Affiliation(s)
- Sofie Seghers
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium; Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Laure-Anne Teuwen
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Beyens
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Dennis De Blick
- Department of emergency medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Didier G Ebo
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Hans Prenen
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium; Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium; Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.
| |
Collapse
|
6
|
Robinson M, Geirnaert M, Anderson B, McKibbin L. Canada’s First Joint Oncology-Allergy Clinic: Successful Desensitization to Trastuzumab Following Severe Anaphylactic Reaction in Which Epinephrine Was Inappropriately Withheld. Curr Oncol 2023; 30:2862-2868. [PMID: 36975431 PMCID: PMC10046925 DOI: 10.3390/curroncol30030218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Background: Recognition of anaphylaxis and differentiation from other infusion reactions in an oncology setting is imperative; epinephrine is the recommended treatment for anaphylaxis and should be administered immediately to patients in whom anaphylaxis is suspected. Trastuzumab has a potentially tremendous oncological benefit, and when hypersensitivity reactions occur, rechallenge with desensitization protocols has become more common. Oncology presents a unique situation in which repeat drug exposure after a serious adverse reaction is often warranted due to the mortality risk of untreated cancer—allergists can assist with both symptom assessment and risk mitigation. Case presentation: This case showcases successful desensitization in a 43-year-old female with locally advanced HER2-positive breast cancer following a severe anaphylactic reaction to trastuzumab, in which epinephrine was not administered. We report the establishment of the Medical Oncology and Allergy Clinic: Canada’s first multidisciplinary clinic aimed at expediting the assessment and management of oncology patients with adverse drug reactions (including chemotherapy, contrast media, antimicrobials) and those with primary and acquired immunodeficiency. Conclusions: We propose this multidisciplinary clinic model as a treatment framework moving forward, with the goal of continuing first-line therapies in cancer patients who develop drug-hypersensitivity (i.e., through desensitization). This case highlights the unmet need for a multidisciplinary approach to the management of oncology patients who experience hypersensitivity reactions.
Collapse
Affiliation(s)
- Madeline Robinson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
- Correspondence:
| | - Marc Geirnaert
- Provincial Oncology Drug Program, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Brady Anderson
- Section of Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Lundy McKibbin
- University of Manitoba, Department of Internal Medicine, Section of Allergy & Clinical Immunology, Winnipeg, MB R3E 0W2, Canada
| |
Collapse
|
7
|
Yang BC, Castells MC. The Who, What, Where, When, Why, and How of Drug Desensitization. Immunol Allergy Clin North Am 2022; 42:403-420. [DOI: 10.1016/j.iac.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Kang SY, Seo J, Kang HR. Desensitization for the prevention of drug hypersensitivity reactions. Korean J Intern Med 2022; 37:261-270. [PMID: 35123386 PMCID: PMC8925949 DOI: 10.3904/kjim.2021.438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.
Collapse
Affiliation(s)
- Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Jeongmin Seo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul,
Korea
| |
Collapse
|
9
|
Papasotiriou I, Hatzidaki E. Personalized dendritic cell vaccination in cancer therapy: An evidence-based research study. J Cancer Res Ther 2022; 19:S52-S58. [PMID: 37147983 DOI: 10.4103/jcrt.jcrt_522_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Although chemotherapy is considered to be the golden standard, it does not come without a price. Toxicities and resistance are frequently limiting its effectiveness. Immunotherapy has emerged as a safer therapeutic alternative but still has a long way until it has proven to be of equal efficacy. A type of immunotherapy is dendritic cell (DC) vaccination. Aims and Objectives We have developed a novel platform for the generation of autologous DCs that have been activated against peptides that are personalized for each patient individually. The aim of the study was to clinically evaluate this platform. Materials and Methods Our platform and our algorithm for the determination of the immunogenic peptides has been tested. DC generation was verified both morphologically and by CD80/86 expression. Peptide antigenicity was determined using a number of T-cell epitope prediction algorithms. Response to therapy was evaluated using response evaluation criteria in solid tumors (RECIST) criteria by the doctors involved. Immune status was also evaluated before and after DC vaccination and correlated with circulated tumor cell count. Results It was found that DC vaccine increased immune activation while correlated with decreased circulating tumor cell counts. Clinical evaluation by the determination of immune markers may be a superior tool than using RECIST criteria. Conclusion Dendritic cell therapies could prove to be a valuable tool in cancer treatment.
Collapse
|
10
|
Deng M, Chai H, Yang M, Wei X, Zhang W, Wang X, Li J, Wang Z, Chen H. Stevens-Johnson Syndrome Caused by Enzalutamide: A Case Report and Literature Review. Front Oncol 2021; 11:736975. [PMID: 34868926 PMCID: PMC8635634 DOI: 10.3389/fonc.2021.736975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Enzalutamide is the most frequently prescribed compound for treating metastatic castration-resistant prostate cancer (mCRPC). Common adverse drug events of enzalutamide are febrile neutropenia, hot flashes, hypertension, and fatigue. METHODS We present a case of a patient with mCRPC who received enzalutamide and developed Stevens-Johnson syndrome (SJS). The culprit drug was confirmed using the Naranjo Adverse Drug Reaction Probability Scale. Clinical characteristics and management principles were analyzed in combination with literature reports. RESULTS SJS occurred within two weeks of enzalutamide therapy. Supportive care such as steroid treatment led to a complete resolution of skin lesions and improved clinical symptoms after three weeks. CONCLUSION Most cutaneous adverse events occur early during enzalutamide therapy, and close observation should be given within two weeks of starting treatment.
Collapse
Affiliation(s)
- Min Deng
- College of life sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
- Department of Pharmacy, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huirong Chai
- Department of Geriatrics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Meng Yang
- Department of Geriatrics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xueman Wei
- Department of Geriatrics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenjun Zhang
- Department of Geriatrics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xuebin Wang
- Department of Pharmacy, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Juanjuan Li
- Department of Pharmacy, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhuo Wang
- College of life sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
- Department of Pharmacy, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haitao Chen
- Department of Geriatrics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
11
|
Asfotase Alfa hypersensitivity: an outpatient 8-steps desensitization protocol. Immunol Res 2021; 69:609-611. [PMID: 34528188 DOI: 10.1007/s12026-021-09232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
|
12
|
Abstract
Hypersensitivity reactions (HSRs) to chemotherapy agents can present a serious challenge to treating patients with preferred or first-line therapies. Allergic reactions through an immunologic mechanism have been established for platinum and taxane agents, which are used to treat a wide variety of cancers including gynecologic cancers. Platin HSRs typically occur after multiple cycles of chemotherapy, reflecting the development of drug IgE sensitization, while taxane HSRs often occur on first or second exposure. Despite observed differences between platin and taxane HSRs, drug desensitization has been an effective method to reintroduce both chemotherapeutic agents safely. Skin testing is the primary diagnostic tool used to risk-stratify patients after initial HSRs, with more widespread use for platinum agents than taxanes. Different practices exist around the use of skin testing, drug challenge, and choice of desensitization protocol. Here, we review the epidemiology, mechanism, and clinical presentation of HSRs to platinum and taxane agents, as well as key controversies in their evaluation and management.
Collapse
|
13
|
Pandya A, Gregory ER, Cherian S, Parashar S, Gierer S. Implementation of EMR-based standardized antibiotic desensitization protocols and its impact on providers. Allergy Asthma Proc 2021; 42:160-166. [PMID: 33685562 DOI: 10.2500/aap.2021.42.200115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: As desensitization protocols become more readily available and published, more institutions are implementing them and searching for ways to streamline the process. There have been no published studies to date on the effect that electronic medical record systems (EMR) have on the safety and efficiency of β-lactam antibiotic desensitization. Objective: The purpose of this study was to evaluate the changes in workflow, efficiency, and medical errors after implementation of β-lactam antibiotic desensitization. Methods: A collaborative effort between the Allergy/Immunology Division and the Pharmacy Department led to the creation and implementation of antibiotic desensitization order sets. Pre- and postimplementation of β-lactam antibiotic surveys were sent to pharmacists and allergy/immunology fellows and attendings at a single-center tertiary care center. Results: There were only 26 valid respondents (12.3%) to both the pre- and postimplementation surveys. The percentage of respondents who thought that the time needed to prepare desensitization materials was < 4 hours increased from 23% to 77% (p < 0.001). The percentage of respondents who thought that the time needed to input electronic desensitization orders was < 1 hour increased from 19% to 54% (p = 0.002). The percentage of respondents who identified zero errors increased from 42% to 92% (p = 0.001). The perception of the overall desensitization process efficiency significantly increased (p < 0.001). Conclusion: Creation of standardized electronic β-lactam antibiotic desensitization order sets significantly decreased the time taken to order and prepare materials and increased overall efficiency.
Collapse
Affiliation(s)
- Aarti Pandya
- From the Section of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Missouri
| | - Eric R. Gregory
- Department of Pharmacy Services, The University of Kansas Health System, Kansas City, Kansas; and
| | - Sheeba Cherian
- Division of Allergy, Clinical Immunology and Rheumatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Sonya Parashar
- Division of Allergy, Clinical Immunology and Rheumatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Selina Gierer
- Division of Allergy, Clinical Immunology and Rheumatology, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
14
|
Seegobin K, Majeed U, Lou Y, Zhao Y, Manochakian R. Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20966895. [PMID: 33149916 PMCID: PMC7586266 DOI: 10.1177/2050313x20966895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
With the advent of targeted therapy for non-small-cell lung cancer, there are many new available treatment options for patients whose cancer harbors an actionable mutation or alteration. These new medications come with numerous side effects, for some of which, the management is not well defined. Alectinib is a second-generation tyrosine kinase inhibitor approved for stage-IV lung adenocarcinoma with anaplastic lymphoma kinase gene rearrangement. Severe (⩾Grade 3) skin rash is a rare side effect of alectinib. Reintroducing alectinib in patients with severe skin rash is not well defined in the medical literature. While other case reports have outlined their approach and desensitization protocol, the maximum dose that patients were titrated up to in a desensitization protocol was 300 mg twice daily. Here, we report a case of Grade 3 skin rash secondary to alectinib, and our experience in managing the rash and reintroducing alectinib with a unique desensitization protocol to a max of 600 mg twice daily (full dose). This case could provide further guidance to oncologists managing patients with this adverse event and may aid in reducing concerns to both patients and physicians about recurrence of skin rash at the maximum dose.
Collapse
Affiliation(s)
- Karan Seegobin
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Umair Majeed
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Yanyan Lou
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Yujie Zhao
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Rami Manochakian
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| |
Collapse
|
15
|
de Lira-Quezada CE, Villarreal-Gonzalez RV, Gonzalez-Diaz SN, Carrasco-Diaz LL. Successful oxaliplatin desensitization protocol in a patient with colorectal metastatic cancer. J Oncol Pharm Pract 2020; 27:490-493. [PMID: 32635810 DOI: 10.1177/1078155220939143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Platinum compounds are frequently used for the treatment of colorectal cancer as initial chemotherapy. Oxaliplatin is a third-generation platinum used for the treatment of stage III colorectal cancer and is associated with hypersensitivity reactions. The incidence of hypersensitivity reaction is approximately 12%, with 1-2% of patients developing moderate to severe reactions. CASE REPORT A 54-year-old male patient with stage III B colon cancer was diagnosed and chemotherapy with oxaliplatin was indicated by the oncology service. Within 20 min of the first cycle of oxaliplatin, he developed dyspnea, laryngeal spam, foreign body sensation in the throat, nausea, and diarrhea; therefore, the infusion of oxaliplatin was suspended, and intramuscular epinephrine was administered and intravenous hydrocortisone along with chlorpheniramine with adequate resolution of symptoms.Management and outcome: Intradermal skin test performed at the concentration of 5 mg/ml (dilution 1:100) was positive. Due to the symptoms presented we decided to perform desensitization to oxaliplatin (total dose: 250 mg) with three bags-12 steps protocol with an initial concentration dose of 1/100 of the total dose in a course of 5.56 h with no hypersensitivity reactions. DISCUSSION Approximately 50% of patients who are exposed to oxaliplatin may have hypersensitivity despite premedication. Desensitization protocol induces tolerance to a drug temporarily and is dependent on continuous exposure.
Collapse
Affiliation(s)
- Cindy E de Lira-Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Rosalaura V Villarreal-Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Sandra N Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Ligia L Carrasco-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| |
Collapse
|
16
|
Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
Collapse
Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
| |
Collapse
|
17
|
Botson JK. Pegloticase hypersensitivity desensitisation: an outpatient, 3-bag, 12-step protocol. BMJ Case Rep 2020; 13:e234721. [PMID: 32565437 PMCID: PMC7307524 DOI: 10.1136/bcr-2020-234721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/04/2022] Open
Abstract
Pegloticase is a highly effective treatment for refractory gouty arthropathy. Unfortunately, the medication is also highly immunogenic, leading to infusion reactions, loss of drug efficacy and anaphylaxis. Desensitisation, a procedure to tolerise a patient to a medication previously causing a hypersensitivity reaction, has been used successfully in oncology for chemotherapy treatment. The same principle can be applied to other specialties. Presented is a 48-year-old man who experienced multiple, severe infusion reactions to pegloticase administered for gouty arthropathy. A rapid desensitisation was performed using an outpatient, 3-bag, 12-step protocol, which allowed multiple additional pegloticase infusions to be performed without incident. This is the first reported case of a patient successfully desensitised after an infusion reaction to pegloticase. Though additional patients are needed to confirm these results, this represents a significant opportunity to recapture and continue pegloticase therapy in patients treated for refractory gouty arthropathy.
Collapse
Affiliation(s)
- John K Botson
- Orthopedic Physicians Alaska, Anchorage, Alaska, USA
| |
Collapse
|
18
|
Lee JH, Moon M, Kim YC, Chung SJ, Oh J, Kang DY, Lee SY, Lee KH, Yun J, Kang HR. A One-Bag Rapid Desensitization Protocol for Paclitaxel Hypersensitivity: A Noninferior Alternative to a Multi-Bag Rapid Desensitization Protocol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:696-703. [PMID: 31678295 DOI: 10.1016/j.jaip.2019.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Desensitization is used to safely continue treatment with a culprit drug in patients with drug hypersensitivity. Currently, a multi-bag protocol is widely used for rapid desensitization, but performing the desensitization procedure is labor intensive as pharmacists and nurses need to prepare and administer diluted solutions. However, it has not been investigated whether dilution is essential for successful desensitization. OBJECTIVE To investigate the efficacy and safety of a nondilution, 1-bag protocol in comparison with a conventional multi-bag protocol for desensitization of patients with paclitaxel hypersensitivity. METHODS Patients who underwent paclitaxel desensitization between 2011 and 2018 were analyzed in this retrospective cohort study. The completion rate, time to completion, and occurrence and severity of breakthrough reaction (BTR) between a 1-bag protocol and a multi-bag protocol were compared. RESULTS A total of 211 desensitization procedures were performed, of which 207 procedures (98.1%) were completed successfully. The administration time was significantly shorter in the 1-bag protocol group compared with the conventional multi-bag protocol group (266.0 ± 149.3 minutes vs 484.2 ± 178.6 minutes, P < .05) without differences in the completion rate (97.6% vs 98.9%, P = .645), the incidence of BTR (16.1% vs 27.6%, P = .778), and the proportion of severe BTR (2.6% vs 5.7%, P = .134). CONCLUSIONS A nondilution, 1-bag protocol is noninferior to a multi-bag rapid desensitization protocol and can be a safe and effective option for paclitaxel desensitization.
Collapse
Affiliation(s)
- Jae-Ha Lee
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Mira Moon
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Young-Chan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jie Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jihyun Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Yoon Kang
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| | - James Yun
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Division of Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Hye-Ryun Kang
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|