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Does Rapid Drug Desensitization to chemotherapy affect survival outcomes?

Berges-Gimeno MP1*, Carpio-Escalona LV1*, Longo-Muñoz F2, Bernal-Rubio L1, Lopez-Gonzalez P1, Gehlhaar P1, Pachon V2, Ferreiro-Monteagudo R2, Madrigal-Burgaleta R1†, Alvarez-Cuesta E1

*These authors share first-author credit.
†These authors share last-author credit.

1Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain.
2Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain.

J Investig Allergol Clin Immunol 2020; Vol. 30(4)
doi: 10.18176/jiaci.0425

Background: Oxaliplatin hypersensitivity reactions may affect prognosis by jeopardizing the timely completion of the scheduled treatment sessions, or by forcing reactive patients into unexpected changes in therapy. Rapid Drug Desensitization (RDD) allows these patients to safely receive their first-choice treatments. However, the possible effects of RDD on the efficacy of oxaliplatin has never been studied.
Objective: The objective of this study is to evaluate the effect on survival rates of RDD in oxaliplatin-hypersensitive patients.
Methods: 7-year retrospective study comparing survival between oxaliplatin-hypersensitive case patients (receiving oxaliplatin by RDD) and non-allergic control patients (receiving standard oxaliplatin infusions). The primary endpoint of this study was Overall Survival (OS) in cases and controls (Kaplan-Meier method with log-rank test comparisons).
Results: OS was 23.7 months (95%CI:15.3-30.9) for the 67 cases who underwent 337 RDDs, while for controls (n=143) it was 34.5 months (95%CI:21.7-55.5). There were no significant differences between both groups (HR1.42;95%CI:0.93-2.17;p=0.104).
Conclusions: Survival outcomes of oxaliplatin-hypersensitive patients who received oxaliplatin via RDD were not significantly different compared to those of control patients who received oxaliplatin via standard administration. Receiving oxaliplatin by means of RDD might be an effective therapeutic alternative for oxaliplatin-hypersensitive patients.

Key words: Drug allergy, Desensitization, Survival study, Hypersensitivity, Oxaliplatin, Skin test, Drug provocation test, Chemotherapy