Successful olaparib desensitization using a novel one-day protocol
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Allergy, Asthma & Clinical Immunology Open Access
CASE REPORT
Successful olaparib desensitization using a novel one‑day protocol Rongbo Zhu1* , Stephen Welch2 and Hannah Roberts1
Abstract Background: Olaparib is a revolutionary treatment for patients with ovarian and breast cancer. Currently, there is no established 1-day drug desensitization protocol for patients with olaparib type-1 hypersensitivity reactions despite well documented IgE-mediated adverse reactions occurring with olaparib. Case presentation: We report a 58-year-old female with immediate, reproducible IgE-mediated adverse reactions to olaparib tablets with implementation of a 1-day novel desensitization protocol to olaparib. Following desensitization, the patient was successfully transitioned from olaparib capsules to tablets with no loss of tolerance. Conclusions: To our knowledge, this is the first reported case of successful olaparib desensitization using a novel 1-day desensitization protocol, and will contribute to drug allergy knowledge, in an area where robust data is lacking. This case demonstrates the important role for drug desensitization in patients with immediate hypersensitivity reactions to chemotherapeutic agents. Furthermore, as olaparib capsules are being phased out in favour of olaparib tablets, we provide a clear case that transitioning from capsule to tablet form did not cause a loss of tolerance. Keywords: Olaparib, Drug desensitization, Drug allergy, Chemotherapy agent Background Cancer is a leading cause of death in Canada and has a major impact on the health care system [1]. Breast and ovarian cancer are the second and fifth leading cause of cancer related death among Canadian women [1]. Treatments for both cancers generally require aggressive multimodal interventions including surgery, cytotoxic chemotherapy, radiation and biologic therapy [2]. Olaparib is a poly (adenosine diphosphate (ADP)ribose) polymerase (PARP) inhibitor that is an effective maintenance therapy for patients with platinum sensitive, relapsed ovarian cancer and has provided significant progression-free survival [3]. Following its efficacy in ovarian cancer, it was approved as a novel agent for germline BRCA-mutated, HER2-negative, metastatic breast cancer [4] and very recently, it was approved in *Correspondence: [email protected] 1 Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada Full list of author information is available at the end of the article
North America as a therapy for germline BRCA-mutated metastatic pancreatic cancer [5]. IgE-mediated adverse drug reactions to olaparib are rare, but have been reported [6, 7]. Drug desensitization is a safe and effective way to achieve temporary tolerance in individuals with IgE- mediated reactions to chemotherapy agents to ensure provision of optimal therapy [8, 9]. There is only one report in the literature of successful olaparib desensitization, using a 2-day protocol with olaparib capsules [10]. Maintenance therapy on olaparib capsule
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