Hypersensitivity reaction to Abiraterone, successful desensitization protocol in prostate cancer patient

• Published in: Journal of oncology pharmacy practice 2024-06, Vol.30 (4), p.777-779
• Main Authors: González Díaz, Sandra N., Vidal Gutiérrez, Oscar, Rodríguez Román, José Carlos, López Henríquez, Raquel A., Macouzet Sánchez, Carlos, de Lira Quezada, Cindy E., Acuña Ortega, Natalhie
• Format: Article
• Language: English
• Subjects: Acetic acid; Androgens; Castration; Chemotherapy; Hepatotoxicity; Hypersensitivity; Hypokalemia; Metastases; Patients; Prostate cancer; Skin diseases; Skin lesions; Urticaria
• ISSN: 1078-1552; 1477-092X; 1477-092X
• DOI: 10.1177/10781552241234876

Introduction In prostate cancer, androgens are key in the growth of both normal prostate and cancer cells. Abiraterone acetate inhibits CYP17, an important target in prostate cancer given its central role in the production of adrenal and tumor-derived androgens. Although abiraterone is generally well tolerated, common adverse effects such as hypertension, hypokalemia, and hepatotoxicity have been reported. Clinical case We present the case of an 83-year-old Mexican man with high-volume EC IV prostate cancer resistant to castration, orchiectomy, and bone, liver, and lung metastases. First-line treatment with the CHAARTED scheme was indicated, by patient decision refuse chemotherapy treatment. On the fourth day of starting treatment, he developed pruritic erythematous macular skin lesions and urticaria on the posterior chest that resolved spontaneously. A generalized erythematous and pruritic maculopapular rash appeared 12 days after starting abiraterone, for which she was referred to allergies. Management and results An oral provocation test was performed for two days, presenting localized macular lesions eight hours after the administration of abiraterone. An oral desensitization protocol was carried out for ten days in which no hypersensitivity reactions were observed, thus achieving the successful administration of abiraterone.