Hypersensitivity reactions to chemo, monoclonal antibodies offer clues in cancer management

Identifying hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies may help clinicians improve management of patients with oncological diseases, suggests a study.

“Hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies may lead to discontinuation of first-line treatment options,” according to researchers. “Identification of these reactions can provide specific diagnosis and treatment by rapid drug desensitizations.”

In this observational study, the researchers assessed hypersensitivity reactions following the administration of anticancer chemotherapy and monoclonal antibodies in Mexico. They recorded the symptoms of initial reaction and their severity, as well as the result of skin tests.

Finally, the researchers reported the experience of the administration of 12-step (mild‒moderate reactions) and 16-step (severe reactions) desensitization protocols among participants.

A total of 93 patients received 335 rapid drug desensitization: 105 to taxanes, 115 to platinum drugs, 101 to monoclonal antibodies, and 15 to other anticancer chemotherapy. Hypersensitivity reactions to taxanes happened during the first or second administration, to platinum drugs after the sixth cycle, and to rituximab during the first cycle.

The most common symptoms were as follows: urticaria with carboplatin, back pain with paclitaxel, dyspnoea with oxaliplatin and docetaxel, and cardiovascular events with monoclonal antibodies. Skin tests turned out positive in 75 percent of patients in the carboplatin group and in just 16.7 percent of those in the docetaxel group.

A rapid drug desensitization success rate of 99.4 percent was observed, with 85.7 percent having no related hypersensitivity reaction.

“Our standardized desensitization protocol is safe and effective and can be reproduced in other centres to treat patients who need to maintain first-line treatment,” the researchers said.