Utility of Risk Stratification for Paclitaxel Hypersensitivity Reactions

Publication date: Available online 3 October 2017
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Iris M. Otani, Timothy Lax, Aidan A. Long, Benjamin R. Slawski, Carlos A. Camargo, Aleena Banerji
BackgroundHypersensitivity reactions (HSRs) are a common impediment to paclitaxel therapy. Management strategies to guide care after a paclitaxel-induced HSR are needed.ObjectiveThe objective was to evaluate the utility and safety of risk stratification on the basis of severity of the initial HSR.MethodsA risk stratification pathway was developed on the basis of a retrospective review of the management and outcome of 130 patients with paclitaxel-induced HSRs at Massachusetts General Hospital. This pathway was then studied prospectively in patients referred to Allergy/Immunology with paclitaxel-induced HSRs.ResultsThe study population (n = 35) had a mean age of 56.1 ± 12 years and most were women (n = 33 [94%]). All 5 patients (15%) with grade 1 initial HSRs were successfully reexposed to paclitaxel, 1 patient at the standard infusion rate and 4 patients at 50% of the standard infusion rate. Thirty patients (85%) with grade 2 to 4 initial HSRs underwent initial paclitaxel desensitization based on the risk stratification pathway. No patients developed severe HSRs using the pathway. Eleven (31%) patients had HSRs that were mild to moderate in nature (grade 1, n = 4 [11%]; grade 2, n = 6 [17%]; grade 3, n = 1 [3%]) during their first desensitization. Sixteen (46%) of the 35 patients safely returned to the outpatient infusion setting for paclitaxel treatment at 50% of the standard infusion rate. Seven (20%) discontinued paclitaxel before the completion of the risk stratification pathway because of disease progression, completion of therapy, or death.ConclusionsA management strategy using the initial HSR severity for risk stratification allowed patients to receive paclitaxel safely.