Villarreal-González Rosalaura Virginia, González-Díaz Sandra, Vidal-Gutiérrez Oscar, Canel-Paredes Alejandra, de la Cruz-de la Cruz Carlos, García-Campa Mariano, López-Méndez Alfonso, Alvarado-Ruiz Sofía, Castells Mariana
Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Oncology Service. Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México.
Faculty of Medicine, Regional Center of Allergy and Clinical Immunology, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr., José Eleuterio González", Monterrey, Nuevo León, México.
Clin Rev Allergy Immunol. 2023 Oct;65(2):231-250. doi: 10.1007/s12016-023-08968-y. Epub 2023 Aug 17.
Taxanes in the treatment of cancer are associated with a significant incidence of hypersensitivity reactions, which may preclude their use in patients in need of first line therapy. Drug desensitization induces transient immunological tolerance and has allowed the reintroduction of taxanes in highly allergic patients. Increase the knowledge of hypersensitivity reactions (HSR) during the administration of taxanes. A systematic review regarding the safety and efficacy of rapid drug desensitization (RDD) for taxanes HSR. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was registered in PROSPERO(CRD42021242324) and a comprehensive search was conducted in Medline, Embase, Web of Science and Scopus databases. 25 studies encompassing 10 countries were identified and 976 patients with initial HSR to paclitaxel (n = 707) and docetaxel (n = 284), that underwent a total of 2,396 desensitizations. The most common symptoms were cutaneous (74.6%) with paclitaxel and respiratory (72.6%) with docetaxel. Severe initial hypersensitivity reactions including anaphylaxis occurred in 39.6% and 13% of paclitaxel and docetaxel cases respectively and during the first (87.4%) or second exposure (81.5%). Patients tolerated well RDD and breakthrough reactions (BTR) occurred in 32.2% of paclitaxel-treated patients and in 20.6% of docetaxel treated patients. Premedications included corticosteroids, antihistamines and leukotriene receptor antagonists. The most commonly used protocol was the BWH 3 bags 12 steps, all protocols showed a success rate between 95-100%, with no reported deaths. RDD is a safe and effective procedure in patients with HSR to taxanes and protocols should be standardized for wide range implementation.
紫杉烷类药物用于癌症治疗时，过敏反应发生率较高，这可能会使它们无法用于需要一线治疗的患者。药物脱敏可诱导短暂的免疫耐受，并使得高度过敏的患者能够重新使用紫杉烷类药物。增加对紫杉烷类药物给药过程中过敏反应（HSR）的了解。一项关于紫杉烷类药物HSR快速药物脱敏（RDD）安全性和有效性的系统评价。该研究遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42021242324）注册，并在Medline、Embase、Web of Science和Scopus数据库中进行了全面检索。共纳入来自10个国家的25项研究，976例最初对紫杉醇（n = 707）和多西他赛（n = 284）发生HSR的患者，总共进行了2396次脱敏治疗。最常见的症状在使用紫杉醇时为皮肤症状（74.6%），使用多西他赛时为呼吸道症状（72.6%）。严重的初始过敏反应包括过敏反应，分别在39.6%的紫杉醇病例和13%的多西他赛病例中发生，且多发生在首次（87.4%）或第二次暴露时（81.5%）。患者对RDD耐受性良好，突破性反应（BTR）在32.2%的紫杉醇治疗患者和20.6%的多西他赛治疗患者中发生。预处理药物包括皮质类固醇、抗组胺药和白三烯受体拮抗剂。最常用的方案是布莱根妇女医院（BWH）3袋12步方案，所有方案的成功率均在95%至100%之间，且无死亡报告。对于紫杉烷类药物HSR患者，RDD是一种安全有效的方法，应将方案标准化以便广泛实施。
