Abstract 1715P
Background
Hypersensitivity reactions (HRSs) to cancer therapies can be unpredictable and lead to treatment discontinuation, with a negative impact on the patient's prognosis and quality of life. RDD has become a groundbreaking approach to the management of immediate HRSs. However, the lack of guidelines makes the use of RDD at the different cancer centers heterogenous. We present a 4-year experience with the use of RDD protocols at our Oncology Unit.
Methods
We conducted a retrospective review of clinical records from patients treated at the Oncology Unit of ASO “Ss. Antonio, Biagio e Cesare Arrigo” (Alessandria, Italy), who underwent desensitization from January 01, 2017 to December 31, 2020. Adult cancer patients with immediate HRS were included. Multiple demographic and clinical variables, about HRSs, RDD, and breakthrough reactions (BTRs), were collected.
Results
A total of 803 RDDs were performed on 75 patients. 53 patients (70.6%) received a 12 steps RDD, and 19 underwent a 4 to 8 steps regimen. Initial HRS was anaphylaxis in 4 cases (5.3%). Most of the initial HRSs were induced by platins (46.6%), followed by taxanes (40%). Immunotherapy was involved in 6.6% of cases, as was Cetuximab. RDD was carried out 5.5 ± 7.7 times per person (range 1- 68). 89.3% of patients underwent RDDs on our Outpatient Cancer Unit, 10.7% on the inpatient ward. 97.4% of RDDs (N = 782) were uneventful; of the 21 BTRs recorded, most were mild (23.8%) or moderate (38.1%), none were severe. No patients required hospitalization and no deaths were recorded. 5 out of 21 patients, despite BRT, were able to complete the planned treatment, reducing the infusion rate. No patients experienced subsequent BTR. At the time of this analysis, treatment is still ongoing in 6 patients.
Conclusions
In our analysis, RDD has been confirmed as a safe and effective procedure, also if performed in an outpatient setting. Only 2.6% of RDDs elicited BRTs, which were in most cases (61.9%) mild or moderate. Moreover, no cases of anaphylaxis or death during the RDDs were recorded. Overall, the RDD allowed 78.6% of patients to continue and complete the planned treatment, at the full target dose. Future investigations are needed to draw up dedicated guidelines, in order to improve and standardize existing protocols of RDDs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.