Abstract
Goals
The most well-known adverse events of oxaliplatin are hematologic toxicity, gastrointestinal tract toxicity, and sensory neuropathy. However, hypersensitivity reaction of oxaliplatin, especially severe anaphylactic reactions (SAR), was less often reported.
Materials and methods
Three hundred and three patients with colon cancer treated by oxaliplatin-containing chemotherapy in one institution were analyzed. Patients were considered to have oxaliplatin-induced SAR if they suffered from at least one of the following symptoms after oxaliplatin infusion: symptomatic bronchospasm, allergy-related edema/angioedema, unstable blood pressure, or anaphylaxis. The reported cases in published literatures that met our definition were also reviewed.
Result
There were 4 out of 303 patients suffering from SAR after receiving oxaliplatin infusion, with an estimated incidence of 1.32%. Two of them became unconscious and had hypertensive crisis, and one patient had consciousness loss with hypotension. All four patients needed various level of oxygen support. Twenty-seven cases of oxaliplatin-induced SAR were found from Medline. Among the 31 reported cases, the most frequent SAR symptom was hypotension. However, we reported two unique SAR cases with hypertension crisis. In only four out of ten cases, patients could tolerate rechallenge of oxaliplatin. There is no association between the occurrence of oxaliplatin-induced SAR and metastatic sites.
Conclusion
Oxaliplatin-induced SAR is a rare but potentially fatal complication. Hypertension crisis can be one of the oxaliplatin anaphylactic reactions. Only few patients suffering this complication could tolerate subsequent treatment of oxaliplatin by prolonged infusion time or using a desensitization schedule, thus changing regimen might be a better alternative for them.
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References
Alliot C, Messouak D, Beets C, Rapin JP (2001) Severe anaphylactic reaction to oxaliplatin. Clin Oncol (R Coll Radiol) 13:236
Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I, de Gramont A (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350:2343–2351
Bhargava P, Gammon D, McCormick MJ (2004) Hypersensitivity and idiosyncratic reactions to oxaliplatin. Cancer 100:211–212
Brandi G, Pantaleo MA, Galli C, Falcone A, Antonuzzo A, Mordenti P, Di Marco MC, Biasco G (2003) Hypersensitivity reactions related to oxaliplatin (OHP). Br J Cancer 89:477–481
Cassidy J, Misset JL (2002) Oxaliplatin-related side effects: characteristics and management. Semin Oncol 29:11–20
de Gramont A, Vignoud J, Tournigand C, Louvet C, Andre T, Varette C, Raymond E, Moreau S, Le Bail N, Krulik M (1997) Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. Eur J Cancer 33:214–219
Frinkelman FD, Rothenberg ME, Brandt EB, Morris SC, Strait RT (2005) Molecular mechanism of anaphylaxis: lesions from studies with murine models. J Allergy Clin Immunol 115:449–457
Gammon D, Bhargava P, McCormick MJ (2004) Hypersensitivity reactions to oxaliplatin and the application of a desensitization protocol. Oncologist 9:546–549
Hsieh RK, Chao TY, Chen WS, Yang TS, Chen LT, Chen PM, Liu JH (2004) Oxaliplatin added to simplified bimonthly low-dose leucovorin and 5-FU for pretreated advanced colorectal cancer is effective and not affected by different previous 5-FU regimens. Cancer Invest 22:171–179
Isbister GK, Buckley NA (2005) The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clin Neuropharmacol 28:205–214
Larzilliere I, Brandissou S, Breton P, Lingoungou A, Gargot D, Ramain JP, Harnois C (1999) Anaphylactic reaction to oxaliplatin: a case report. Am J Gastroenterol 94:3387–3388
Lenz G, Hacker UT, Kern W, Schalhorn A, Hiddemann W (2003) Adverse reactions to oxaliplatin: a retrospective study of 25 patients treated in one institution. Anticancer Drugs 14:731–733
Levi F, Zidani R, Misset JL (1997) Randomised multicentre trial of chronotherapy with oxaliplatin, fluorouracil, and folinic acid in metastatic colorectal cancer. International Organization for Cancer Chronotherapy. Lancet 350:681–686
Lim KH, Huang MJ, Lin HC, Su YW, Chang YF, Lin J, Chang MC, Hsieh RK (2004) Hypersensitivity reactions to oxaliplatin: a case report and the success of a continuous infusional desensitization schedule. Anticancer Drugs 15:605–607
Maindrault-Goebel F, Andre T, Tournigand C, Louvet C, Perez-Staub N, Zeghib N, De Gramont A (2005) Allergic-type reactions to oxaliplatin: retrospective analysis of 42 patients. Eur J Cancer 41:2262–2267
Markman M, Kennedy A, Webster K, Elson P, Peterson G, Kulp B, Belinson J (1999) Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 17:1141
Medioni J, Coulon MA, Morere JF, Hennebelle F, Piperno-Neumann S, Breau JL (1999) Anaphylaxis after oxaliplatin. Ann Oncol 10:610
Mis L, Fernando NH, Hurwitz HI, Morse MA (2005) Successful desensitization to oxaliplatin. Ann Pharmacother 39:966–999
Misset JL (1998) Oxaliplatin in practice. Br J Cancer 77(Suppl 4):4–7
Newman Taylor AJ, Cullinan P, Lympany PA, Harris JM, Dowdeswell RJ, du Bois RM (1999) Interaction of HLA phenotype and exposure intensity in sensitization to complex platinum salts. Am J Respir Crit Care Med 160:435–438
Perez JF, Sanderson MJ (2005) The frequency of calcium oscillations induced by 5-HT, ACH, and KCL determine the contraction of smooth muscle cells of intrapulmonary bronchioles. J Gen Physiol 125:555–567
Polyzos A, Tsavaris N, Kosmas C, Arnaouti T, Kalahanis N, Tsigris C, Giannopoulos A, Karatzas G, Giannikos L, Sfikakis PP (2001) Hypersensitivity reactions to carboplatin administration are common but not always severe: a 10-year experience. Oncology 61:129–133
Santini D, Tonini G, Salerno A, Vincenzi B, Patti G, Battistoni F, Dicuonzo G, Labianca R (2001) Idiosyncratic reaction after oxaliplatin infusion. Ann Oncol 12:132–133
Schull B, Kornek GV, Scheithauer W (2001) Idiosyncratic reaction after oxaliplatin: circumvention by use of a continuous infusional administration schedule. Ann Oncol 12:1653–1654
Siu SW, Chan RT, Au GK (2006) Hypersensitivity reactions to oxaliplatin: experience in a single institute. Ann Oncol 17:259–261
Stahl M, Koster W, Wilke H (2001) Reaction after oxaliplatin-prevention with corticosteroids? Ann Oncol 12:874
Strait RT, Morris SC, Finkelmen FD (2004) Cytokine enhancement of anaphylaxis. Novartis Found Symp 257:80–91
Thomas RR, Quinn MG, Schuler B, Grem JL (2003) Hypersensitivity and idiosyncratic reactions to oxaliplatin. Cancer 97:2301–2307
Tournigand C, Maindrault-Goebel F, Louvet C, de Gramont A, Krulik M (1998) Severe anaphylactic reactions to oxaliplatin. Eur J Cancer 34:1297–1298
Watts SW (2005) 5-HT in systemic hypertension: foe, friend or fantasy? Clin Sci (Lond) 108:399–412
Acknowledgements
This work was supported by a grant from Taiwan Cancer Clinic Research Foundation. We also thank Mio-Keng I (Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital) for data management.
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Lee, MY., Yang, MH., Liu, JH. et al. Severe anaphylactic reactions in patients receiving oxaliplatin therapy: a rare but potentially fatal complication. Support Care Cancer 15, 89–93 (2007). https://doi.org/10.1007/s00520-006-0107-9
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DOI: https://doi.org/10.1007/s00520-006-0107-9