Current situation of carboplatin desensitisation protocols in the hospitals of Spain

Abstract

Desensitisation protocols allow the continuation of treatment in patients who have presented hypersensitivity reactions. Carboplatin desensitisation solutions are usually prepared in the chemotherapy centralised units of hospital pharmacies and they are diluted under the established concentration limit to guarantee the stability of the preparation. An online survey was sent to hospital pharmacies, inquiring about local desensitisation protocols: reasons for use of desensitisation protocols, the protocols used and the stability given to carboplatin solutions. An important variability among the hospitals in carboplatin desensitisation practice was detected. Six different carboplatin desensitisation protocols were described and discordance with the storage period of the carboplatin solutions was observed. The lack of consensus on which protocol must be followed and data supporting the stability of the diluted product, contribute to distrust of carboplatin desensitisation protocols. Although the efficacy and safety of carboplatin desensitisation protocols has been widely demonstrated, many professionals still have concerns.

Immune Reactions in Major Types of Oncological Treatment

“…The desensitization procedure requires continuous exposure to the drug; therefore, it involves the implementation of multi-stage protocols, assuming the administration of drug solutions of different concentrations with increasing doses and flow rates [35,52]. It is necessary to maintain constant intervals of 15-20 min in order to stabilize the pharmacokinetics of the drug.…”

“…The most common is the 12-step protocol with three bags of solution. Most protocols allow the full therapeutic dose to be administered in 4-12 h, although this may be extended in the event of a breakthrough reaction (BTR) [44,45,52,53]. The procedure requires individualization-in patients at high risk of anaphylaxis, 16-and 20-step protocols are proposed to minimize it, while in patients with HSR grades I and II, a 12-step protocol is most often implemented [51,54].…”