Published Online: December 22, 2015
Taxanes are chemotherapy agents used for treating different types of cancer. They cause hypersensitivity reactions (HSRs) that can be life-threatening in around 10% of patients. Since alternative chemotherapy agents are often less efficacious and/or more toxic, re-exposure to taxanes after a HSR is frequently considered. Desensitization protocols, which consist in the progressive administration of the medication over 5 to 6 hours, allow almost all patients to be safely re-treated with taxanes after a HSR. Yet this method may not be required for all patients who suffered a taxane-induced HSR since many of those can tolerate a regular or slowed infusion.
In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Picard and colleagues studied the safety of using risk stratification based on the severity of the initial HSR and skin testing to guide re-exposure in patients with a taxane-induced HSR. They used data collected on 164 patients treated for a taxane-induced HSR from April 2011 to August 2014 at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. During this period, patients were re-exposed to taxanes either through desensitization, challenge or regular infusion based on the severity of the initial HSR and skin test result. Depending on the initial risk stratification and tolerance to re-exposure, patients were then treated with shorter desensitization protocols and/or challenge with the aim of resuming regular infusions except in patients with a severe initial HSR.
The authors found that this approach was safe as no patient had a severe HSR on re-exposure and none had to discontinue his or her treatment because of recurrent HSRs. Importantly, the risk of HSR decreased with repeated exposures arguing for a progressive approach to taxane reintroduction starting with the safest method for re-exposure (desensitization) when the risk is highest and progressively shortening the protocol or proceeding with challenge with the aim of resuming regular infusions as the risk decreases. Ultimately, a significant percentage of patients (22%) were able to resume regular infusions. The authors also found that 71% of patients had a positive skin test response to taxanes and that atopy was a risk factor for a recurrent HSR, raising the possibility that some HSRs to taxanes might be IgE-mediated.
This study provides a new approach to guide re-exposure in patients with a taxane-induced HSR that maximizes safety while allowing a significant number of patients to resume regular infusions. It also raises the possibility that some taxane-induced HSRs may be IgE-mediated.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.