Approach to hypersensitivity reactions to chemotherapeutics in patients with lung cancer

Background: Hypersensitivity reactions(HSRs) to chemotherapeutic drugs can be vital. Aim: To determine frequency of HSRs during chemotherapy and review current our approaches. Method: Medical records of patients received chemotherapy due to lung cancer in our clinic during 2012 examined retrospectively. Patients who developed immediate -according to Ring and Messmer classifications- or delayed HSRs were included into the study. The efficacy of a standardized 12-steps desensitization procedure was investigated in patients with immediate HSRs. Results: Total 1099 cycles of chemotherapy was given in 292 patients in one year. We observed 10 HSRs during 10 cycles in 10 patients. Two reactions were delayed type (one was proven with skin biopsy), while other 7 reactions were immediate with degree of Grade 2-3. The most frequent HSRs was observed among patients received docetaxel (2.6%/cycles) and pemetrexed (2.4%/cycles). Four of the patients with HSRs were changed protocol, one patient was continued the same carboplatin protocol after intensive premedication with slow infusion. Remain 5 patients were not able to tolerate chemotherapeutic drug despite intensive premedication and slow infusion. A standardized 12-steps desensitization procedure was performed in 19 cycles of those. No life-threatening HSRs or deaths occurred during the desensitization procedures, and all patients received their full target dose at the end. Conclusion: This study shows that HSRs to chemotherapeutics is not rare. In this case, a standardized desensitization protocol administered by an experienced team seems safe and effective for overcoming hypersensitivity and continuing treatment with preferred therapeutic agents.