000339 - Successful Case Series of Desensitization Shortening for Chemotherapy-Induced Hypersensitivity

Chemotherapy plays a crucial role in treating many cancer patients; however, drug hypersensitivity reactions (HSRs) can complicate treatment. Desensitization offers a viable therapeutic approach in such cases, and employing a desensitization shortening protocol can accelerate the overall time-consuming process. This case series describes successful desensitization shortening in 21 patients with hypersensitivity to various chemotherapeutic drugs. 

This report includes cancer patients who experienced hypersensitivity reactions following the administration of chemotherapeutic drugs and subsequently underwent successful desensitization shortening at Seoul National University Hospital. We conducted a retrospective analysis of clinical characteristics, including age, sex, initial severity, skin test results, allergic history, use of premedication, and types of administered chemotherapeutic agents.

Twenty-one patients successfully resumed conventional chemotherapy infusion following the repeated desensitization shortening. Chemotherapeutic drugs responsible for HSRs included: cetuximab (4 cases), oxaliplatin (4 cases), folinate (4 cases), paclitaxel (4 cases), gemcitabine (3 cases), and one case each of durvalumab and irinotecan. The average desensitization cycle until completion was 13.1±5.0 cycles, with a mean initial HSR severity index of CTCAE grade 2.6±0.9. Six patients experienced breakthrough reactions (BTRs) during desensitization, all classified as CTCAE grade 1 or 2. Fourteen patients underwent skin tests for culprit chemotherapeutic drugs, with 66.7% testing positive.

Drug hypersensitivity reactions to chemotherapy drugs pose significant challenges for cancer patients. Nonetheless, employing an individualized step-wise drug desensitization shortening protocol, regardless of skin test results, may facilitate the development of tolerance to these drugs, thereby enabling patients to sustain essential treatment regimens and return to the conventional infusion.