TY - JOUR
T1 - Rechallenges without desensitization following platinum-based chemotherapy reactions
AU - Young, Fernanda D.
AU - Aung, Sidney
AU - Tang, Monica
AU - Anstey, Karen M.
AU - Lee, Michael C.
AU - Alfaro, Emely
AU - Cinar, Pelin
AU - Ho, Hansen
AU - Otani, Iris M.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Background: There is increasing interest in non-desensitization protocols as a potential way to reintroduce chemotherapy following hypersensitivity reactions (HSR). Objective: To provide insight into the potential utility of non-desensitization reintroduction, particularly at institutions where allergy consultation may not be available. Methods: For 70 patients with platinum HSR who underwent rechallenge with standard (≤2 hours), extended (1-bag, 1-step, 4–6 hours), or titrated (4-to-5-bag and -step, 6–7.5 hours) infusions between 1/2014 and 7/2019, demographics and clinical characteristics were reviewed and initial and breakthrough reactions (BTR) were graded using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Tolerance (no BTR) and completion (dose completed despite BTR) were compared using Fisher's exact test. Results: Patients (mean [standard deviation] age 57 [13] years, initial HSR grade 2 [1]), were rechallenged with standard (n = 8), extended (n = 23), or titrated (n = 22) infusions after oxaliplatin HSR; and standard (n = 5) or titrated (n = 12) after carboplatin HSR. Tolerance and completion were higher for extended versus (vs) standard (tolerance-87%-vs-8%, p < 0.005; completion-96%-vs-38%, p < 0.005) and titrated versus standard (tolerance-76%-vs-8%, p < 0.005; completion-79%-vs-38%, p < 0.05) infusions. Conclusions: Extended and titrated infusions may increase reintroduction safety compared to standard infusions. Further investigation into extended infusions may provide a safe alternative to standard infusions in patients who may not have access to desensitization at their institution.
AB - Background: There is increasing interest in non-desensitization protocols as a potential way to reintroduce chemotherapy following hypersensitivity reactions (HSR). Objective: To provide insight into the potential utility of non-desensitization reintroduction, particularly at institutions where allergy consultation may not be available. Methods: For 70 patients with platinum HSR who underwent rechallenge with standard (≤2 hours), extended (1-bag, 1-step, 4–6 hours), or titrated (4-to-5-bag and -step, 6–7.5 hours) infusions between 1/2014 and 7/2019, demographics and clinical characteristics were reviewed and initial and breakthrough reactions (BTR) were graded using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Tolerance (no BTR) and completion (dose completed despite BTR) were compared using Fisher's exact test. Results: Patients (mean [standard deviation] age 57 [13] years, initial HSR grade 2 [1]), were rechallenged with standard (n = 8), extended (n = 23), or titrated (n = 22) infusions after oxaliplatin HSR; and standard (n = 5) or titrated (n = 12) after carboplatin HSR. Tolerance and completion were higher for extended versus (vs) standard (tolerance-87%-vs-8%, p < 0.005; completion-96%-vs-38%, p < 0.005) and titrated versus standard (tolerance-76%-vs-8%, p < 0.005; completion-79%-vs-38%, p < 0.05) infusions. Conclusions: Extended and titrated infusions may increase reintroduction safety compared to standard infusions. Further investigation into extended infusions may provide a safe alternative to standard infusions in patients who may not have access to desensitization at their institution.
KW - Chemotherapy reactions
KW - extended infusions
KW - platinum chemotherapy
KW - rechallenge
KW - titrated infusions
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U2 - 10.1177/10781552241229024
DO - 10.1177/10781552241229024
M3 - Article
C2 - 38347725
AN - SCOPUS:85185676423
SN - 1078-1552
JO - Journal of Oncology Pharmacy Practice
JF - Journal of Oncology Pharmacy Practice
ER -