Flash: chemotherapie en allergie Karen Geboes UZ Gent 4 december 2015
Opbouw Herkennen/graderen Bij welke producten/wanneer Behandeling Preventie? 2
Herkennen/graderen 3
4
5
6
Allergy 2013 7
Bij welke producten/wanneer Alle middelen Med Clin North Am 2010 Allergy 2015 8
Ook leucovorin J Allergy Clin Immunol 2015 9
Voor ons vaak platinum-derivaten en taxanen 10
Curr Allergy Asthma 2015 11
Curr Allergy Asthma 2015 12
Behandelen Allergy 2013 13
Reintroductie met premedicatie en trager infuus Management of allergic reactions to oxaliplatin in colorectal cancer patients. Suenaga M, J Support Oncol. 2008 30/48 patients who experienced grade 1 or 2 allergic reactions subsequently received the secondary prevention regimen with a higher dose of dexamethasone and prolonged oxaliplatin infusion to allow continued treatment. Nineteen patients (63.3%) showed no reactions during at least 2 cycles; most could be treated for 4 months longer than could patients who did not respond to secondary prevention. Hypersensitivity reactions related to oxaliplatin (OHP). Brandi G, Br J Cancer. 2003 Seventeen patients (13%) showed hypersensitivity reactions: 8 patients developed a mild reaction, 9 patients showed a moderate-severe reaction. 6/17 were re-exposed to the drug with premedication of steroids and all except one developed the hypersensitivity reaction again. 14
Desensitisatie Curr Allergy Asthma 2014 15
Allergy 2013 Curr Allergy Asthma 2014 16
Allergy 2013 17
Desensitisatie-protocol Allergy 2013 18
Allergy 2013 19
Preventie Premedicatie bij taxanen, cetuximab, Paclitaxel Premedication Regimen: All patients should be premedicated prior to TAXOL administration in order to prevent severe hypersensitivity reactions. Such premedication may consist of dexamethasone 20 mg PO administered approximately 12 and 6 hours before TAXOL, diphenhydramine (or its equivalent) 50 mg IV 30 to 60 minutes prior to TAXOL, and cimetidine (300 mg) or ranitidine (50 mg) IV 30 to 60 minutes before TAXOL Docetaxel Premedication Regimen Premedicate patients with prostate cancer with dexamethasone 8 mg at 12, 3, and 1 h before docetaxel infusion. Premedicate all other patients with dexamethasone 8 mg twice daily for 3 days starting 1 day before docetaxel infusion. 20
J Oncol Pharm Pract 2012 Dexamethasone premedication for prophylaxis of taxane toxicities: can the doses be reduced when paclitaxel or docetaxel are given weekly? Schwartz. DATA EXTRACTION: The retrieved literature was reviewed to include all human clinical trials that recorded adverse effect information with weeklytaxanes utilizing reduced-dose or tapering dexamethasone schemas, either prospectively or retrospectively. CONCLUSIONS: Several predication strategies utilizing reduced doses of dexamethasone with weekly taxanes appear to be feasible and safe, and can be considered for patients experiencing, or at high risk for steroid-induced side effects. However, the optimal schedule is not yet determined; larger prospective clinical trials are needed. 21
Conclusion Herkennen verschillende types reacties Let op bij platinum-derivaten/ taxanen/antilichamen Leucovorin!!! Stoppen als niet strikt nodig Met voorbereiding en aan tragere snelheid herintroduceren eventueel Desensitisatieprotocols Sommige producten hebben specifieke voorbereiding 22