Drug Desensitizations for Chemotherapy: Safety and Efficacy in Preventing Anaphylaxis

Caiado, Joana; Castells, Mariana

doi:10.1007/s11882-021-01014-x

Cited by 21 publications

(28 citation statements)

References 124 publications

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“…This "non-responder" population is relatively low in prevalence at 5.8%, consistent with existing literature [28,76,79]. Furthermore, the BAT can be used for monitoring the progress of therapeutic agent desensitization [94,[98][99][100][101][102][103][104]. Drug hypersensitivity reactions (DHR) have been on the rise in recent times, which can ultimately restrict the choice of treatment options for patients and negatively impact prognosis.…”

Section: Basophil Activation Testing In Allergooncologysupporting

confidence: 68%

Clinical and Translational Significance of Basophils in Patients with Cancer

Chauhan

Stavraka

Grandits

et al. 2022

Cells

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Despite comprising a very small proportion of circulating blood leukocytes, basophils are potent immune effector cells. The high-affinity receptor for IgE (FcɛRI) is expressed on the basophil cell surface and powerful inflammatory mediators such as histamine, granzyme B, and cytokines are stored in dense cytoplasmic granules, ready to be secreted in response to a range of immune stimuli. Basophils play key roles in eliciting potent effector functions in allergic diseases and type 1 hypersensitivity. Beyond allergies, basophils can be recruited to tissues in chronic and autoimmune inflammation, and in response to parasitic, bacterial, and viral infections. While their activation states and functions can be influenced by Th2-biased inflammatory signals, which are also known features of several tumor types, basophils have received little attention in cancer. Here, we discuss the presence and functional significance of basophils in the circulation of cancer patients and in the tumor microenvironment (TME). Interrogating publicly available datasets, we conduct gene expression analyses to explore basophil signatures and associations with clinical outcomes in several cancers. Furthermore, we assess how basophils can be harnessed to predict hypersensitivity to cancer treatments and to monitor the desensitization of patients to oncology drugs, using assays such as the basophil activation test (BAT).

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Section: Basophil Activation Testing In Allergooncologysupporting

confidence: 68%

Clinical and Translational Significance of Basophils in Patients with Cancer

Chauhan

Stavraka

Grandits

et al. 2022

Cells

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“…Desensitization procedures for delayed drug reactions have been traditionally treated with slow desensitization protocols lasting over many days or even weeks (10)(11)(12)(13)(14). The introduction of rapid protocols represents a better approach to achieve therapeutic doses, thereby reducing patient visits and resources to a few hours, and maintaining patients on their most effective treatments (3,4,41).…”

Section: Discussionmentioning

confidence: 99%

“…It has proved to be a safe procedure when performed by experienced allergists. It has no additional costs and survival outcomes with no differences from those via standard administration ( 3 , 4 , 43 , 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…Rapid drug desensitization (RDD) has shown to be a safe and effective procedure for patients presenting with an immediate drug hypersensitivity reaction (DHR) (1). Chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb) have been administered by means of this procedure for many years, allowing patients to get their first-line therapies (2)(3)(4). Several protocols have been proposed and some modifications have been applied (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

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Use of Rapid Drug Desensitization in Delayed Hypersensitivity Reactions to Chemotherapy and Monoclonal Antibodies

2022

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Background:Rapid drug desensitization (RDD) allows first-line therapies in patients with immediate drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb). Desensitization in delayed drug reactions has traditionally used slow protocols extending up to several weeks; RDD protocols have been scarcely reported.Patients and Method:We retrospectively analyzed the patients referred to the Allergy Department, who had experienced a delayed DHR (> 6 h) related to a ChD or mAb and underwent an RDD protocol. The rate of successful administration of the offending drug and the presence of adverse reactions were evaluated.Results:A total of 93 RDDs were performed in 11 patients (including 6 men and 5 women, with a median age of 61 years). The primary DHR were maculopapular exanthema (MPE) (8), generalized delayed urticaria (1), MPE with pustulosis and facial edema (1), and facial edema with desquamative eczema (1). The meantime for the onset of symptoms was 3 days (range 1–16 days). RDD was performed using a protocol involving 8–13 steps, with temozolomide (25), bendamustine (4), rituximab (9), infliximab (24), gemcitabine (23), and docetaxel (8), within 4.6–6.5 h. Sixteen breakthrough reactions were reported during the RDD (17.2 %) in 5 patients; all were mild reactions including 11 delayed and 5 immediate reactions. All patients completed their treatment.Conclusions:RDD is a potentially safe and effective procedure in patients suffering from delayed reactions to ChD and mAb. It allows them to receive full treatment in a short period, thereby reducing time and hospital visits.

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“…It is able to provide a temporary immune tolerance to drugs, and it is highly recommended when switching to alternate products with equal efficacy is not possible. Drug desensitization is a method largely applied for chemotherapy ( 48 ) and more recently used also for a safe reintroduction of biologicals in reactive patients; DD allows the administration of the full therapeutic dose in relatively short time (4–12 h), during which the biological is administered at increasing concentrations and increasing rate of infusion. Although different protocols have been published until now, the most frequently applied is the 12-step protocol ( 49 ).…”

Section: Long-term Management Of Patients With Hsr To Biologicalsmentioning

confidence: 99%

How to Prevent and Mitigate Hypersensitivity Reactions to Biologicals Induced by Anti-Drug Antibodies?

et al. 2021

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Biologicals are widely used therapeutic agents for rheumatologic diseases, cancers, and other chronic inflammatory diseases. They are characterized by complex structures and content of variable amounts of foreign regions, which may lead to anti-drug antibodies (ADA) development. ADA onset may limit the clinical usage of biologicals because they may decrease their safety. In fact they are mainly associated with immediate hypersensitivity reactions (HSRs). Development of ADAs is reduced by concomitant immunosuppressive treatment, while it is increased by longer intervals between drug administrations; thus, regular infusion regimens should be preferred to reduce HSRs. Once ADAs have formed, some procedures can be implemented to reduce the risk of HSRs. ADAs may belong to different isotype; the detection of IgE ADA is advisable to be assessed when high and early ADAs are detected, in order to reduce the risk of severe HRs. In patients who need to reintroduce the biological culprit, as alternative therapies are not available, drug desensitization (DD) may be applied. Desensitization should be conceptually dedicated to patients with an IgE-mediated HSR; however, it can be performed also in patients who had developed non-IgE-mediated HSRs. Although the underlying mechanisms behind successful DD has not been fully clarified, the DD procedure is associated with the inhibition of mast cell degranulation and cytokine production. Additionally, some data are emerging about the inhibition of drug-specific immune responses during DD.

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Drug Desensitizations for Chemotherapy: Safety and Efficacy in Preventing Anaphylaxis

Cited by 21 publications

References 124 publications

Clinical and Translational Significance of Basophils in Patients with Cancer

Clinical and Translational Significance of Basophils in Patients with Cancer

Use of Rapid Drug Desensitization in Delayed Hypersensitivity Reactions to Chemotherapy and Monoclonal Antibodies

How to Prevent and Mitigate Hypersensitivity Reactions to Biologicals Induced by Anti-Drug Antibodies?

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