Background Desensitisation protocols (DP) are founded on the gradual reintroduction of small quantities of drug which caused a hypersensitivity reaction, administering it over long periods of time to achieve the therapeutic dose.
Purpose To elaborate a DP for cabazitaxel (CBZ) and describe our experience in a case report.
Material and methods For the development of the new protocol a Pubmed search was conducted with the following search terms: ‘desensitisation protocol AND (cabazitaxel or taxane)’; ‘desensitisation protocol AND chemotherapy’; and ‘cabazitaxel clinical case’.
No described clinical cases for CBZ-DP were found in the literature. The search revealed the standardised working procedures to develop a DP and other chemotherapy DP, such as platinum or taxane. The DP described in Cortijo-Cascajares et al’s study1 was taken as a reference to elaborate our protocol. The CBZ-DP consisted of 12 stages in which to administer the total dose (50 mg). Three solutions (250 ml) were prepared with dilutions 50/100 (A), 50/10 (B) and 50/1 (C). Every solution was administered in 4 stages increasing the administration rate every 15 min, starting with the lower concentration. The drug was administered in the intensive care unit. Prior to the desensitisation, the patient received oral dexchlorpheniramine and oral methylprednisolone.
Results The CBZ-DP was implemented in a 49-year-old man with metastatic hormone refractory prostate cancer. He previously received a total of 15 docetaxel-DP cycles because he suffered a hypersensitivity reaction type III with his first administration. After progression to docetaxel and other lines of treatment, abiraterona and enzalutamida, CBZ was prescribed.
The CBZ prick test was negative but given the patient’s medical history and the possibility of occurrence of cross reactivity between paclitaxel and docetaxel, the CBZ-DP was applied. A total of 6 cycles were administered safely until September 2015.
In the absence of protocols and clinical cases in the literature, our CBZ-DP is a considerable innovation for patients with taxane hypersensitivity reactions.
The protocol was safe and well tolerated by our patient and represented another line of treatment.
References and/or Acknowledgements
Review of hypersensitivity reactions to antineoplastic agents. Farm Hosp 2012;36:148-58
References and/or AcknowledgementsNo conflict of interest.
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