The Importance of Drug Desensitization in Cancer

Drug hypersensitivity reactions (HSRs) to antineoplastic agents have increased in the 21st century with the emergence of new therapeutic agents. Rapid drug desensitization (RDD) to chemotherapeutic agents and monoclonal antibodies (mAbs) has emerged as a safe and effective strategy for those patients who develop HSRs to their necessary medication, given their limited therapeutic options. Drug desensitization (DS) induces a temporary tolerance to the drug, allowing the patient with an HSR to safely receive an uninterrupted course of medication. The knowledge of the recently described new phenotypes, within HSRs, with their corresponding endotypes and biomarkers, provides a better diagnostic approach and more accurate risk stratification for a more secure and effective desensitization protocol. In addition, premedication can be tailored according to the phenotype, endotype and biomarkers of the reaction. Any desensitization should always be carried out with maximum safety in mind and adapted to the care organization of each allergy department. Desensitization is a temporary process, once the medication is discontinued the patient's hypersensitivity to the medication returns. Objective: The aim of this review is to briefly summarize updated information on the mechanisms of desensitization, indications, contraindications, risk stratification and treatment of reactions during desensitization to chemotherapeutic drugs and mAbs. Also to emphasize the importance of maintaining the first-line of treatment in cancer patients, thus improving the patient's life expectancy and quality of life.