Abstract 1892P
Background
Hypersensitivity reactions to antitumoral agents are increasing. Rapid Drug Desensitisation (RDD) is a technique that enables patients (pts) to receive the antitumoral they are allergic to. RDD induces temporary tolerance by a gradual introduction of increasing subthreshold doses of the culprit drug. RDD is cost-effective, and life-expectancy is similar in pts receiving chemotherapy with RDD when compared to non-allergic pts. RDD has optimal safety outcomes in the hands of multidisciplinary teams (MDT). Our aim was to audit our MDT performance, and to profile our drug-reactive pts.
Methods
We retrospectively analysed our MDT database. We collected data from pts reacting to their antitumoral therapy from April 2019 to April 2020. They underwent systematic allergy workup with skin testing (ST), risk stratification, in vitro tests. Pts with negative ST and favourable risk-assessment underwent drug challenge to rule out an allergy. Confirmed allergic pts or high-risk pts underwent RDD with validated protocols. These techniques were performed in a dedicated AllergoOncology Day Case Unit with the necessary safety measures.
Results
There were 104 pts. Pts characteristics shown in the table. Platins were most frequently involved (55%, n=57), followed by taxanes (29%, n=30), anti-HER-2 agents (4%, n=4), irinotecan (4%, n=4), rituximab (3%, n=3), anthracyclines (2%, n=2) and cetuximab (2%, n=2). 27 pts (26%) had no other treatment options. ST were positive in 43% (n=45) of pts. 64% (n=67) of pts underwent RDD, and only 35% (n=82) of the RDD procedures showed reactions, 98% of them were mild and did not jeopardise treatment completion. Table: 1892P
Baseline population clinical characteristics
| Age – yr | |
| Median | 61.5 |
| Range | 21-82 |
| Sex – no. (%) | |
| Male | 35 (33.7) |
| Female | 69 (66.3) |
| Tumor histologic type – no. (%) | |
| Colorrectal | 32 (30.8) |
| Ovarian | 20 (19.2) |
| Breast | 20 (19.2) |
| Lung | 6 (5.8) |
| Endometrial | 6 (5.8) |
| Other | 26 (25) |
| Disease stage – no. (%) | |
| Non-metastatic | 42 (40.4) |
| Metastatic | 56 (53.8) |
| Tumor biomarker characteristics – no. (%) | |
| Colorrectal RAS wt | 14 (46.6) |
| Breast luminal-like | 11 (55) |
| Breast HER2+ | 7 (35) |
| Lung PD-L1 >50% | 1 (20) |
| BRCA mutated | 6 (42.9 of tested) |
| Treatment line – no. (%) | |
| First | 73 (70.2) |
| Second | 13 (12.5) |
| Third or more | 18 (17.3) |
| Treatment intention – no. (%) | |
| Radical | 41 (39.4) |
| Palliative | 60 (57.7) |
Conclusions
Study and risk assessment by expert allergists in a dedicated space and MDT efforts enabled all the pts referred to our DDC in one year to safely receive their oncohematological therapy of choice (either by RDD or by ruling out an allergy after negative drug challenge), which was a first line therapy for 70% of them, and had radical treatment intention for 39%.
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.