Oxaliplatin Hypersensitivity: Management and Comparison with Carbo/Cisplatin

RationaleOxaliplatin hypersensitivity management permits patients with responsive malignancies to receive treatment. Comparison with other common platinum agents revealed similarities and differences in hypersensitivity patterns and management.Methods58 patients with hypersensitivity to oxaliplatin (OXS), 95 to carboplatin (CAS), and 5 to cisplatin (CIS) were referred to the Allergy/Immunology Unit over the past 4 years. Their reaction patterns were analyzed and desensitizations were performed using 3 related continuous IV protocols.ResultsIn total, 181 desensitizations were completed for the 58 OXS, 284 desensitizations for the 95 CAS, and 14 desensitizations for 5 CIS using 3 related continuous intravenous desensitization protocols that were chosen based on skin test and previous desensitization results. OXS occurred predominantly in both males and females with GI adenocarcinoma, while CAS and CIS occurred predominantly in females with ovarian cancer. Hypersensitivity reactions (HSR) occurred earlier in a subgroup of OXS (during cycle 1-6), though the majority still occurred after >7 cycles, whereas all CAS and CIS occurred at >8 cycles after an abstinence period. HSR for all platinum chemotherapy-sensitive patients include cutaneous, vascular, pulmonary, and GI symptoms. Unique to OXS, 1 patient developed drug-induced hemolytic anemia (DIHA) and 1 patient developed drug-induced thrombocytopenia (DITP). Skin tests were positive for the majority of OXS, CAS, and CIS, correlating with a greater likelihood of reactions during subsequent desensitizations.ConclusionsOXS, CAS, and CIS have similar clinical features but distinct differences were noted in the onset of hypersensitivity, patient gender, tumor type, DIHA and DITP. Nearly all patients can be desensitized. RationaleOxaliplatin hypersensitivity management permits patients with responsive malignancies to receive treatment. Comparison with other common platinum agents revealed similarities and differences in hypersensitivity patterns and management. Oxaliplatin hypersensitivity management permits patients with responsive malignancies to receive treatment. Comparison with other common platinum agents revealed similarities and differences in hypersensitivity patterns and management. Methods58 patients with hypersensitivity to oxaliplatin (OXS), 95 to carboplatin (CAS), and 5 to cisplatin (CIS) were referred to the Allergy/Immunology Unit over the past 4 years. Their reaction patterns were analyzed and desensitizations were performed using 3 related continuous IV protocols. 58 patients with hypersensitivity to oxaliplatin (OXS), 95 to carboplatin (CAS), and 5 to cisplatin (CIS) were referred to the Allergy/Immunology Unit over the past 4 years. Their reaction patterns were analyzed and desensitizations were performed using 3 related continuous IV protocols. ResultsIn total, 181 desensitizations were completed for the 58 OXS, 284 desensitizations for the 95 CAS, and 14 desensitizations for 5 CIS using 3 related continuous intravenous desensitization protocols that were chosen based on skin test and previous desensitization results. OXS occurred predominantly in both males and females with GI adenocarcinoma, while CAS and CIS occurred predominantly in females with ovarian cancer. Hypersensitivity reactions (HSR) occurred earlier in a subgroup of OXS (during cycle 1-6), though the majority still occurred after >7 cycles, whereas all CAS and CIS occurred at >8 cycles after an abstinence period. HSR for all platinum chemotherapy-sensitive patients include cutaneous, vascular, pulmonary, and GI symptoms. Unique to OXS, 1 patient developed drug-induced hemolytic anemia (DIHA) and 1 patient developed drug-induced thrombocytopenia (DITP). Skin tests were positive for the majority of OXS, CAS, and CIS, correlating with a greater likelihood of reactions during subsequent desensitizations. In total, 181 desensitizations were completed for the 58 OXS, 284 desensitizations for the 95 CAS, and 14 desensitizations for 5 CIS using 3 related continuous intravenous desensitization protocols that were chosen based on skin test and previous desensitization results. OXS occurred predominantly in both males and females with GI adenocarcinoma, while CAS and CIS occurred predominantly in females with ovarian cancer. Hypersensitivity reactions (HSR) occurred earlier in a subgroup of OXS (during cycle 1-6), though the majority still occurred after >7 cycles, whereas all CAS and CIS occurred at >8 cycles after an abstinence period. HSR for all platinum chemotherapy-sensitive patients include cutaneous, vascular, pulmonary, and GI symptoms. Unique to OXS, 1 patient developed drug-induced hemolytic anemia (DIHA) and 1 patient developed drug-induced thrombocytopenia (DITP). Skin tests were positive for the majority of OXS, CAS, and CIS, correlating with a greater likelihood of reactions during subsequent desensitizations. ConclusionsOXS, CAS, and CIS have similar clinical features but distinct differences were noted in the onset of hypersensitivity, patient gender, tumor type, DIHA and DITP. Nearly all patients can be desensitized. OXS, CAS, and CIS have similar clinical features but distinct differences were noted in the onset of hypersensitivity, patient gender, tumor type, DIHA and DITP. Nearly all patients can be desensitized.