Tolerability and safety of a 3-step or 12-step chemotherapy desensitization protocol

Hypersensitivity reactions to chemotherapy impact treatment plans and patient outcomes, and there are no direct guidelines for management of this adverse effect. Desensitization to chemotherapy has become a standard practice at this institution to maintain preferred treatment in oncology patients. This study reports on the effectiveness and tolerability of chemotherapy desensitization in a large population and management of subsequent infusions following a breakthrough reaction.

A retrospective review was conducted of patients who received chemotherapy desensitization as a 3-step or 12-step infusion protocol at the University of Kansas Hospital from March 2011 to October 2023. The primary outcome was the desensitization infusion completion rate.

Among the 191 patients assessed, 151 met the inclusion criteria and were included in the final analysis. A total of 747 desensitization infusions were attempted, 735 of which were complete infusions (98.4%). Thirty-seven patients (24.5%) reacted to their first desensitization, and 17 patients were unable to complete the full infusion (11.3%). The mean number of desensitization infusions (treatment doses) in total completed per patient was 5 infusions (SD, 6), with a range of 0 to 52 infusions. While most patients were desensitized to a platinum or taxane agent, desensitizations were also completed for other agents including cisplatin, liposomal doxorubicin, irinotecan, methotrexate, and cabazitaxel.

Patients can safely tolerate desensitization infusions to chemotherapy, and many can continue with an agent until therapy completion. Breakthrough reactions can be mitigated through desensitization protocol modifications.