dr. Heike Rockmann-Helmbach, dermatoloog-allergoloog, UMC Utrecht

🎤Drug desensitization in oncology: Care organization, outcomes and risk factors
Drug hypersensitivity reactions (DHR) are common in oncology, mainly to platins, taxanes, and monoclonal antibodies (mAbs). Rapid drug desensitization (RDD) is an established immunotherapeutic approach enabling effective and safe continuation of highly indicated drug.
Drug desensitization is a breakthrough immunotherapy treatment modality allowing effective and safe continuation or reintroduction of a drug in patients with previous hypersensitivity reactions and can be performed for a variety of DHRs including IgE mediated type I reactions (Type I), cytokine release reactions (CRR), type-I/CRR mixed reactions and non-severe type IV reaction. Desensitization protocols dependent on the underlying mechanism of the DHR as determined by symptoms and severity of the initial reaction and outcomes of skin tests and serological tests (mainly tryptase and IL-6). The desensitization protocol consists of one or multiple solutions with multiple steps and increasing doses at fixed time intervals, resulting in temporary clinical tolerance when reaching the target dose. Since clinical tolerance after desensitization is temporary in most patients, desensitization treatment needs to be repeated each administration.
Desensitization treatment is shown to be safe and effective in many studies where most patients (61-71%) tolerate treatments without symptoms during the entire course of desensitizations. Breakthrough reactions (BTRs) occurring during desensitization are mostly mild (69-73%) with mainly cutaneous symptoms. However BTRs can present with moderate (26%) and severe (6%) symptoms including gastrointestinal, respiratory and cardiovascular impact. BTRs can be effectively managed by administrating medication according to the presented symptoms and pausing the infusion. Despite severe BTRs, nearly all patients (>99%) successfully complete the desensitization and received the drug target dose.  Data of a recent Dutch study will be presented.
Over the last decade desensitization treatment became standard care in many centers in The Netherlands, and the number of desensitizations increased over the years. A strong investment in high-quality organization of care with close collaboration between all involved professionals (allergists, oncologists/hematologists, nurses, pharmacists, and administrative staff) and securing reimbursement through the health insurance systems were essential ingredients for realization of successful implementation. Although desensitization protocols are well described in the literature, adaptation to local situation might be  necessary to enable practical implementation. Furthermore, given the rapid developments in the field, staying informed of the latest findings is essential to ensure high-quality and evidence-based practice.

Biografie
Dr. Heike Röckmann is a dermatologist and allergologist in the Department of Dermatology and Allergology at University Medical Center Utrecht, the Netherlands, and serves as Head of the local UCARE/ACARE Centre (Urticaria and Angioedema Center of Reference and Excellence).
She obtained her medical degree from Heidelberg University, Germany, and completed her doctoral research at the German Cancer Research Center (DKFZ).
Her main clinical interests include chronic urticaria, angioedema, anaphylaxis, mastocytosis, drug allergy, and drug desensitization. Her research focuses on improving the care of patients with drug hypersensitivity reactions, particularly through the optimization of drug desensitization protocols. A further area of research interest is the identification of predictors of treatment response and disease course in patients with chronic urticaria and angioedema.
Dr. Heike Röckmann is the author of numerous national and international scientific publications and has contributed to textbooks on drug allergy and urticaria. She is a member of the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), and the European Network for Drug Allergy (ENDA).