Retrospective evaluation of a rechallenge protocol in patients experiencing hypersensitivity reactions with prior chemotherapy in a tertiary hospital

Abstract

When encountering a hypersensitivity reaction to chemotherapy, a dilemma arises whether to continue the current regimen. In our institution, a standardized protocol has been developed. This study evaluated the effectiveness and safety of our rechallenge protocol in rechallenging patients with previous hypersensitivity reactions of grades 1 to 2 to paclitaxel, docetaxel, carboplatin and oxaliplatin. The protocol consisted of intensification of premedication and lengthening of infusion time. A retrospective review of electronic medical records was conducted. Patients who attempted rechallenge with paclitaxel, docetaxel, carboplatin and oxaliplatin under the protocol during the time period from August 2014 to December 2015 were included. Forty-six rechallenge cases were included (12 paclitaxel, 15 docetaxel, 5 carboplatin and 15 oxaliplatin cases). The first rechallenge cycle was completed successfully in 43/46 patients (93.5%) and 42/46 patients (91.3%) were hypersensitivity reaction-free throughout the treatment course under the rechallenge protocol. A total of 133/137 cycles (97.1%) were completed successfully under the protocol. Among patients who continued chemotherapy until disease progression or treatment completion, a median of three additional cycles (range: 1 to 9 cycles) were administered under the protocol. The four cases of recurrent hypersensitivity reactions responded well to infusion interruption and symptomatic treatment and all four patients were discharged uneventfully. Further rechallenge was not performed. Our study demonstrated that a combined strategy of intensification of premedication and lengthening of infusion duration is effective and probably safe in rechallenging patients with previous grades 1 to 2 hypersensitivity reaction to paclitaxel, docetaxel, carboplatin and oxaliplatin.