D3.384 - Assessment of the role of Rapid Drug Desensitization to treat cancer patient with infusion-related allergic reactions. Italian experience

Rapid Drug Desensitization (RDD) is based on progressively increasing concentrations and infusion rates of the drug under close monitoring, inducing temporary drug tolerance.

To assess the role of Rapid Drug Desensitization (RDD) to treat cancer patient with infusion-related allergic reactions (IRRs) we planned an observational trial in 2021.

From 2021 to 2025 all patients experiencing IRRs at the Rimini Oncology Unit, after an allergological evaluation, were treated according to the Castells desensitization protocol until the end of 2024.

Starting in 2025,and following a meeting between oncologists, pharmacists, and allergists from the Romagna Local Health Authority, we developed a subsequent protocol in which we provided for the following steps, based on Brown's classification:

Brown 1: challenge with suspected chemotherapeutic agent

Brown 2: desensitization with single bag protocol (Park HK 2020)

Brown 3: desensitization with classic Castells protocol (3 bags)

We analyzed the safety of this apporach as well as the treatment discontiunation rate. The IRR severity was classified (grade 1-3) using the Brown classification from 2004.

A total of 155 patients were treated with RDD. Among drugs administered using a desensitization protocol, drugs administered with the RDD were paclitaxel (38.06%), oxaliplatin (25.80%), docetaxel (14.10%), and carboplatin (12.9%), irinotecan (1.94%), etoposide (1.94%), liposomal doxorubicin (1.29%), trastuzumab (1.29%), atezolizumab (0.65%), cetuximab (0.65%), cyclophosphamide (0.65%), and cisplatin (0.65%).

The RDD protocol is safe and permits to maintain the original schedule in the most part of cancer patients that present a major allergic reaction during chemotherapy. Further trials are probably needed to better define the role of RDD and the drugs primarily candidate to the desensitization protocol.