Successful desensitization in a patient with recurrent anaplastic oligodendroglioma presenting with procarbazine-mediated anaphylaxis

• Published in: Journal of oncology pharmacy practice Vol. 30; no. 5; pp. 937 - 940
• Main Authors: Kayikçi, Hazal, Can Bostan, Özge, Tuncay, Gülseren, Cihanbeylerden, Melek, Tüccar, Çise, Damadoglu, Ebru, Karakaya, Gül, Kalyoncu, Ali Fuat
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-08-2024; Sage Publications Ltd
• Subjects: Anaphylaxis; Anaphylaxis - chemically induced; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brain cancer; Brain Neoplasms - drug therapy; Brain tumors; Chemotherapy; Desensitization, Immunologic - methods; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - therapy; Humans; Hypersensitivity; Male; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Oligodendroglioma; Oligodendroglioma - drug therapy; Procarbazine; Procarbazine - administration & dosage; Procarbazine - therapeutic use; Vincristine; anaplastic oligodendroglioma; Anaphylaxis; procarbazine desensitization
• ISSN: 1078-1552; 1477-092X; 1477-092X
• DOI: 10.1177/10781552241226861

Introduction
Procarbazine is an oral chemotherapeutic agent used in the treatment of brain malignancies and is associated with hypersensitivity reactions. In case of grade 4 reactions, rechallenge should be avoided, and the agent should be replaced, unless the treatment is curative, in which case the application of a desensitization protocol should be considered. We present a successful case of desensitization in procarbazine anaphylaxis.
Case report
A 53-year-old male patient was diagnosed with recurrent anaplastic oligodendroglioblastoma. The patient received three cycles of procarbazine, lomustine, and vincristine chemotherapy for malignancy recurrence. In the fourth cycle, on the 12th day of procarbazine treatment, the patient developed anaphylaxis. Procarbazine was given together with premedication as part of the 12-step desensitization process, and the fourth cycle was successfully completed.
Management and outcome
Procarbazine hypersensitivity reactions are observed less frequently than reactions to other chemotherapeutics. We presented a case of procarbazine-associated severe anaphylaxis that was able to continue procarbazine chemotherapy with successful desensitization. This case is important in terms of confirming the procarbazine desensitization protocol.
Discussion
In literature there is only one protocol developed was successfully applied in one patient with procarbazine anaphylaxis. In the current case, we took this protocol into consideration in the management of our patient. Following the use of this protocol, the patient was able to continue procarbazine chemotherapy successfully. Procarbazine anaphylaxis is rare, and more cases are needed to be reported to confirm the desensitization protocol and when to continue procarbazine treatment.