4-step, 2-h carboplatin desensitization in Japanese patients with ovarian cancer: a prospective study

Abstract

Background Carboplatin is a key drug for ovarian cancer. However, it sometimes induces hypersensitivity reactions (HSRs) that result in the discontinuation of the treatment. Although various desensitization protocols have been reported in previous retrospective studies, a limited number of prospective studies have analyzed these protocols. Methods Patients with platinum-sensitive relapsed ovarian cancer who experienced carboplatin-induced HSRs were treated with diluted solutions of 1/1000, 1/100, 1/10 and an undiluted solution of carboplatin over a 1-h period. If no HSRs occurred within the first two cycles, a short protocol regimen over a 30-min period per solution was followed. The primary endpoint was treatment completion rate. Results Between May 2015 and September 2018, 21 patients were enrolled from two institutions. One patient experienced platinum-sensitive recurrence after the desensitization protocol; thus, 22 sessions were analyzed. Epinephrine use, treatment-related death, and intensive care unit (ICU) admissions did not occur. The median number of desensitization cycles was 6 (range 1–6). Two sessions were discontinued early because of grade 2 dysgeusia and grade 2 malaise. Treatment in two (9.1%) patients was discontinued because of HSR development. The treatment completion rate was 90.9%. Six (27.3%) sessions met the criteria for transition to the short protocol regimen. In 14 (63.6%) sessions, HSRs were observed during infusion of the undiluted solution. The median progression-free survival and overall survival were 14.8 and 23.8 months, respectively. Conclusion This 4-step, 2-h carboplatin desensitization protocol is safe and feasible. Patients require careful monitoring with a rapid response to HSRs, especially during the administration of undiluted solutions.

Toxicity management and efficacy of carboplatin desensitization therapy for recurrent epithelial ovarian carcinoma: A real-world study

“…Our findings are consistent with the results of previous studies. [14–19] In our study, OS2 (from the desensitization procedure) was 42.2 months (range: 25.3–59.1), and the 1-, 2-, and 5-year survival rates were 92.6%, 75.6% and 47.2%, respectively. Overall, these results support the effectiveness of CP-D in treating recurrent EOC.…”

“…In a prospective study conducted by Nishimura et al in 2021, a 4-step 2-hour rapid desensitization protocol was applied to 22 patients with 90.9% success, and ORR and OS were 63.6 months and 23.8 months, respectively. [18] An interesting aspect of that study was that no treatment-related deaths were observed in patients who developed a grade 3 reaction and were not treated with adrenaline. Similarly, our study showed that severe (grade 3) side effects, although observed less frequently, were controlled with fluid replacement and steroid and antihistamine treatment, without using adrenaline.…”

“…[10] Carboplatin desensitization has been used in the treatment of gynecological cancer for many years, and many different desensitization protocols have been developed. Previous studies have shown that desensitization is effective and safe [10,11,[14][15][16][17][18][19] ; however, studies evaluating the efficacy and safety of carboplatin in the treatment of recurrent ovarian cancer are limited. Table 2 Grading system for allergic reactions and anaphylaxis based on the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0.…”

“…In our study, the desensitization completion rate was similar to the 1 stated in previous studies. [14][15][16][17][18][19] This study has several limitations. First, its retrospective design may have led to biases in patient and treatment choices.…”

The Role of Skin Tests in the Prevention and Diagnosis of Hypersensitivity Reactions to Platinum Agents in Gynecological Cancer: A Single-Center Italian Retrospective Study

“…In our experience, this approach identified a cross-reactivity between these platinum agents in 18% of cases and helped to identify an alternative therapeutic approach. Consequently, if the therapy with platinum is strongly indicated despite immediate-HSRs, the following treatment will be performed administering the platinum agent, following recent protocols of desensitization [23,[27][28][29][30].…”