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Overcoming oxaliplatin hypersensitivity: different strategies are needed according to the severity and previous exposure

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Abstract

Purpose

This study investigated the characteristics of oxaliplatin-related hypersensitivity reactions (HSR) and evaluated the efficacy of premedication and desensitization administration for controlling HSR in patients with gastrointestinal malignancy.

Methods

This retrospective study includes oxaliplatin hypersensitivity cases reported to our in-hospital, adverse drug reaction monitoring system between May 2008 and April 2012. We analyzed administration histories of oxaliplatin and premedication treatments, chemotherapy cycle and severity of the initial HSR, and prophylactic measures and their outcomes in subsequent chemotherapy cycles.

Results

One hundred and seventy-three patients showed hypersensitivity to oxaliplatin-based chemotherapy. Oxaliplatin HSR developed after mean chemotherapy cycle 6.3 ± 0.3. Specifically, while HSR occurred at cycle 7.6 ± 0.3 in the case of patients previously unexposed to oxaliplatin-containing chemotherapy, it occurred at cycle 2.6 ± 0.3 in previously exposed patients. Of the 173 patients who exhibited HSR, premedication was administered in 134 patients and 71.6 % of them succeeded in preventing HSR. Desensitization was attempted in 38 patients, including 20 patients in whom premedication administration was unsuccessful, and 89 % of desensitized patients successfully underwent oxaliplatin chemotherapy without HSR. As severity of HSR increased, the success rate by premedication decreased and the percentage of patients that underwent desensitization increased.

Conclusions

Attention should be paid to patients with any prior exposure to oxaliplatin, especially during early chemotherapy cycles. Given the high success rate of preventing HSR by desensitization administration and its apparent safety profile, we suggest that desensitization be considered as the first option for the treatment of grades 3 and 4 HSR cases.

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Abbreviations

HSR:

Hypersensitivity reactions

FOLFOX:

Folinic acid, fluorouracil, and oxaliplatin

XELOX:

Capecitabine and oxaliplatin

CTCAE:

Common Terminology Criteria for Adverse Events

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Conflict of interest

The authors have no financial disclosures or conflict of interests to report.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Suh-Young Lee, Hye-Ryun Kang, Woo-Jung Song, Kyung-Hun Lee, Sae-Won Han & Sang Heon Cho

  2. Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea

    Suh-Young Lee, Hye-Ryun Kang, Woo-Jung Song & Sang Heon Cho

  3. Seoul National University Hospital Drug Safety Monitoring Center, Seoul, Korea

    Suh-Young Lee, Hye-Ryun Kang & Sang Heon Cho

  4. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Suh-Young Lee

  5. Cancer Research Institute, Seoul National University, Seoul, Korea

    Kyung-Hun Lee & Sae-Won Han

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  1. Suh-Young Lee
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  2. Hye-Ryun Kang
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  3. Woo-Jung Song
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  4. Kyung-Hun Lee
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Correspondence to Sang Heon Cho.

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Lee, SY., Kang, HR., Song, WJ. et al. Overcoming oxaliplatin hypersensitivity: different strategies are needed according to the severity and previous exposure. Cancer Chemother Pharmacol 73, 1021–1029 (2014). https://doi.org/10.1007/s00280-014-2437-5

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  • DOI: https://doi.org/10.1007/s00280-014-2437-5

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