Calin Cainap1,2, Sanziana Cetean3*, Andrei Havasi1*, Ovidiu Crisan3*, Ovidiu Balacescu1*, Laura Ancuta Pop5*, Loredana Balacescu1*, Andra Piciu1,2*, Alexandru Mester6, Doina Piciu1*, Adina Stan8*, Alina Bereanu7*, Catalin Vlad1,2, Patriciu Achimas1,2*, Simona Cainap5
1”Prof Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania.
2Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
3Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
4Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
5Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
6Faculty of Dental Medicine “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
7Faculty of Medicine, “Lucian Blaga”University of Sibiu, Sibiu, Romania.
8Department of Neuroscience, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
*These authors contributed equally to this article.
Summary
Purpose: Systemic treatments among other adverse effects, could have allergic reaction, which are challenging for oncologists regarding the continuation of systemic chemotherapy. This prospective study established a new regimen of desensitization such as dilutions, time of infusions and delivery schedule, which could be used for inpatients or in ambulatory patients.
Methods: This was a prospective study of patients with moderate to severe allergic reaction to systemic treatment in our Oncological Institute “I. Chiricuta” Cluj-Napoca. A new protocol for desensitization procedure with a three-day regimen with hospitalization on Medical Oncology Department was proposed to these patients. Initial dilution for drug-related allergy was 1:1,000. The following infusion steps (concentrations) were multiplied by 10 if no severe allergic reaction occurred. Each day had 3 perfusions, each of one was passed in a timeframe of 2 h. The last step (dilution) of perfusion of the day 2 and 3 was 1:1 diluted.
Results: Eighty-two patients with a median age of 56 years formed the initial cohort. A platinum derivative containing regimen was the main cause for an allergic reaction for 75 out of 82 patients. Four of them had a personal history of previous allergic reactions to chemotherapy, and 56 had multiple lines of chemotherapy in their treatment. More than 594 desensitization procedures were administered to included patients, with a failure rate of less than 2%. The main reason for discontinuation was disease progression or adjuvant chemotherapy administration.
Conclusions: Having an allergic reaction does not preclude the administration of the responsible drug. A 3-day regimen with starting dilution of 1:1,000 could represent a successful strategy for continuing administration of an essential chemotherapy drug.
Key words: allergy, cancer, desensitization, systemic therapy, platinum derivatives.
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