1095 Management of paclitaxel associated hypersensitivity reactions in gynecological cancers: a single center retrospective analysis

Introduction/Background In the treatment of gynecological tumors, taxanes currently represent the main chemotherapeutic drugs to be used in clinical practice. A minority of patients experience allergic reactions limiting the possibilities for oncological treatment (1–10%). Several desensitization protocols were proposed to overcome the hypersensitivity and guarantee the appropriate treatment to the patients. We reviewed retrospectively the safety and efficacy of a rapid desensitization protocol in patients with gynecological cancers. Methodology We reported data of patients who experienced hypersensitivity reactions to paclitaxel occurring during or shortly (≤48 hours) from 2018 to 2020. The patients had premedication three days before the infusion with desensitization protocol (three solutions 1/100, 1/10 and 1/1 undiluted paclitaxel: 3 bags/12 steps). Results 80 patients experienced reaction to taxol: 61 ovarian cancer (76.25%), 12 endometrial cancer (15%), 3 cervical cancer (3.75%) and 4 synchronous ovarian/endometrial cancer (5%) with advanced stage at diagnosis in 62% of cases. Thirteen patients (16.25%) reported a personal history of drug allergy and seven patients (8.75%) of autoimmune diseases. More than 50% of the reactions recorded are moderate and severe in a median time of 11.24 minutes from the beginning of infusion (3–60). Most patients reacted on the first infusion (68%). The number of cycles before the hypersensitivity reaction is 1.64 (1–12 cycles). All patients performed skin tests (ST) after a median time of 18.5 days from reaction (2–90). 65% of patients underwent treatment based on desensitization protocol: 286 cycles were performed in all cohorts and only in sixteen cases we reported a reaction to paclitaxel despite premedication and desensitization schedule. In three patients with a positive ST a desensitization schedule was administered but only one completed therapy without further reactions. Conclusion Desensitization programs could manage hypersensitivity reactions to taxanes without limiting the possibilities of access to a primary standard of care in gynecological cancers. Disclosures The authors declare that they have no competing interests.