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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.