Treatment Outcomes of Rapid Desensitisation Protocols for Chemotherapeutic Agents and Monoclonal Antibodies following Hypersensitivity Reactions. (#50)
Background: Hypersensitivity reactions (HSR) to chemotherapeutic agents and monoclonal antibodies are common and may hinder further therapeutic options. Drug desensitisation aims to induce a temporary clinical unresponsiveness to drug antigens so the causative drugs of HSR can continue to be administered. Desensitisation protocols typically involve gradual reintroduction of small doses of drug antigens at fixed time intervals. These can be time and resource consuming and are therefore not always offered or available in all institutions. Rapid desensitisation using standardised protocols has been conducted by the Department of Immunology at The Canberra Hospital for patients who developed HSR to chemotherapeutic agents and monoclonal antibodies.
Aims: This retrospective audit reviewed the safety and efficacy of the desensitisation protocols used for patients across the Capital Region Cancer Service (CRCS).
Methods: Patients across the CRCS who received rapid desensitisation were identified through a search of archived correspondence. Clinical files and pharmacy records were analysed to determine protocol safety and efficacy.
Results: From June 2006 to July 2013, thirteen patients underwent rapid desensitisation to oxaliplatin, carboplatin, docetaxel or rituximab in a tertiary chemotherapy day therapy ward with close monitoring and not a high dependency unit. A total of 25 desensitisations were conducted with 21 (84%) achieving full target dose without inducing recurrent HSR. As a result, nine patients were successfully desensitised and continued to receive treatment without any further HSR. Desensitisation was aborted in three patients due to recurrence of HSR, which was not of a greater severity than the initial HSR. Seven patients were able to resume the regular protocols with standard infusion rates, including four who returned to satellite or rural chemotherapy centres without requiring additional supervision.
Conclusion: Rapid desensitisation to chemotherapeutic agents and monoclonal antibodies with standardised protocols employed across the CRCS is safe and effective; it provides a feasible treatment option enabling continuation of effective regimens in the setting of HSR.