MANAGEMENT OF HYPERSENSITIVITY REACTIONS TO PLATINUM
CHEMOTHERAPY USING A DESENSITISATION PROTOCOL
Authors
Jane Ashton, GI Specialist Pharmacist, Dr. Nikil Oommen,
Research Fellow
Royal Marsden NHS Foundation Trust
Background
The incidence of hypersensitivity reactions (HSR) to carboplatin is less than 8%1,
cisplatin 1-20%1 and oxaliplatin 2%2. The incidence increases after many
courses of these drugs and usually occurs after 4-6 courses2. Colon cancer
patients are now treated with oxaliplatin earlier in the disease which is likely to
increase exposure to these agents. NICE approved oxaliplatin in the adjuvant
setting in April 2006. Oxaliplatin has been the mainstay of treatment for
metastatic colorectal cancer patients. A significant risk factor to hypersensitivity is
prior exposure. The HSR reaction has not been adequately studied
predominantly because they are rare and the drugs are not usually administered
in isolation. Also, due to the immunological mechanism, corticosteroids and
antihistamines are introduced to reduce the risk of hypersensitivity. The HSR has
a wide spectrum of clinical severity ranging from an asymptomatic rash to severe
anaphylaxis. A desensitisation protocol using serial dilutions is currently used at
The Royal Marsden Hospital based on limited case reports in the literature. This
audit aims to determine the efficacy of a desensitisation protocol in order to
develop a guideline for the management of HSR to platinum chemotherapy.
Methods
A retrospective analysis of 19 patients who received the desensitisation protocol
between june 2006 and march 2008 was carried out. The following information
was noted: history of drug allergies, prior platinum exposure, number of cycles
before HSR and number of cycles re-challenged. The medical notes were
reviewed by a physician to assess efficacy.
Results
There appears to be no correlation between documented allergy status and the
risk of a hypersensitivity reaction. Patients received much higher cumulative
doses of carboplatin before reacting compared with oxaliplatin. 16 out of 17
patients tolerated all dilutions of carboplatin and 2 out of 3 patients tolerated all
dilutional bags of oxaliplatin.
Conclusion
The desensitisation protocol can be safely used in an outpatient setting. It is
hoped that a guideline for the prophylaxis and treatment of HSR can be
recommended for use in clinical practice.
References
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MANAGEMENT OF HYPERSENSITIVITY REACTIONS TO
CHEMOTHERAPY USING A DESENSITISATION PROTOCOL
Jane Ashton, GI Specialist Pharmacist
Royal Marsden NHS Foundation Trust
Downs Road, Sutton, Surrey. SM2 5PT
Tel: 0208 642 6011 x 1356
Email: jane.ashton@rmh.nhs.uk
PLATINUM