Published Online: December 26, 2016
New cases of cancer are expected to increase by 70% over the next 2 decades, with more than 8 million people dying each year from the disease, an estimated 13% of all deaths worldwide. Several new chemotherapeutic agents have been rapidly developed and approved, many of them through a fast track process with the purpose of getting important new drugs to the patient earlier. In parallel, adverse reactions to chemotherapy have increased dramatically worldwide, frequently preventing the use of first-line therapy for cancer and jeopardizing patients’ treatment outcomes. Rapid Drug Desensitization (RDD) has become a cornerstone in the management of anaphylaxis to chemotherapeutic agents, but biomarkers to predict patients at risk of developing reactions during the procedure are needed.
In a study recently published in The Journal of Allergy & Clinical Immunology: In Practice, Giavina-Bianchi and colleagues evaluated oncologic patients aged 18-80 years old, allergic to platinum-based chemotherapeutic agents and undergoing RDD to the culprit drug. All included patients had documented histories of anaphylaxis and positive immediate skin tests, and were considered allergic. Patients were assessed through clinical history, skin testing, serum tryptase levels and basophil activation test (BAT). BAT is an in vitro test consisting of exposing blood basophils to allergens and measuring their activation. Control groups included oncologic patients tolerant to the chemotherapeutic agents and healthy volunteers.
BAT identified allergic patients to platinum-based chemotherapeutic agents with an increased risk of reactions during RDD. The test also identified the patients who had presented the more severe initial anaphylatic reactions. RDDs to platinum compounds did not induce a persistent hyporesponsiveness state, and the procedure had to be repeated every time the drug was administered.
BAT identifies allergic patients to chemotherapeutic agents and predicts outcomes of rapid drug desensitization, being a potential biomarker for this procedure.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.