Rapid desensitization in patients with immediate hypersensitivity to antineoplastic drugs Clinical outcomes and risk factors

Abstract

Background: Hypersensitivity reactions (HSRs) to chemotherapy and monoclonal antibodies may necessitate discontinuation of the initial treatment. Rapid drug desensitization (RDD) is a proven, safe, and effective alternative strategy. However, a few patients still experience breakthrough reactions (BTRs) during RDD. Objective: To evaluate the clinical outcomes of RDD and identify risk factors for BTRs. Methods: We performed a retrospective analysis of patients with cancer treated at Severance Hospital from May 2014 to October 2023. All patients experienced immediate HSRs to chemotherapy or monoclonal antibodies and underwent either a 2-bag (for grade 1 reactions) or a 4-bag (for grade 2 to 3 reactions), 11-step RDD protocol. Results: A total of 1010 RDD procedures were performed on 213 patients (157 platinum-based drugs, 31 taxanes, 16 monoclonal antibodies, and 9 other drugs). Among them, 259 procedures used a 2-bag protocol and 751 used a 4-bag protocol. BTRs occurred in 207 procedures (20.4%), involving 113 patients (53%). Most BTRs (n = 91) were associated with platinum-based agents, resulting in discontinuation in 15 cases. Logistic regression revealed that severe initial HSRs (odds ratio = 2.101, 95% CI = 1.348-3.276, P = .001) and higher exposure frequency to chemotherapeutic agents (odds ratio = 1.075, 95% CI = 1.010-1.144, P = .023) significantly increased the risk of moderate-to-severe BTRs. Overall, 95.8% of patients completed 1 or more therapy cycles. Conclusion: This 11-step RDD protocol is safe and effective in a diverse population with cancer. It also demonstrated a direct association between more severe initial HSRs, previous high exposure to chemotherapeutic agents, and the occurrence of BTRs (c) 2025 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc.