Analysis of the pattern of hypersensitivity reactions in patients receiving carboplatin retreatment for recurrent ovarian cancer

Abstract

The aim of this paper was to assess hypersensitivity reactions in 69 patients who received carboplatin (CBDCA) retreatment for recurrent ovarian cancer. Hypersensitivity reactions developed in 15 (21.7%) patients and occurred during the second cycle of retreatment in 13 (86.7%) of them. Reactions consisted of skin rash, flushing, itching, or abdominal cramping in eight (53.3%) and severe respiratory or cardiovascular events in seven patients (46.7%). One patient had a chest pain, without any other symptoms suggestive of hypersensitivity, followed by cardiac arrest unresponsive to standard resuscitative measures. All the other cases promptly recovered from symptoms. Logistic regression analysis showed that allergy history and CBDCA retreatment interval (interval time between the last cycle of first-line chemotherapy and CBDCA retreatment) were independent predictive variables for the risk of hypersensitivity, whereas patient age, first-line chemotherapy, total CBDCA dose given during first-line treatment, recurrence treated with CBDCA (first versus other), and CBDCA regimen at recurrence had no predictive value. Hypersensitivity reaction rate was higher in patients with CBDCA retreatment interval longer than 23.4 months compared to those with a shorter interval (36.3% versus 8.3%, P = 0.0132). Nine patients were subsequently treated with cisplatin, and two (22.2%) still developed allergic reactions. In conclusion, hypersensitivity reactions to CBDCA retreatment can occur in approximately one fifth of the cases, and a CBDCA retreatment interval longer than 2 years appears to be the strongest predictive variable for the development of allergic reactions.

Management of Hypersensitivity to Platinum- and Taxane-Based Chemotherapy: cepo Review and Clinical Recommendations

“…An existing hypersensitivity to certain drugs and environmental factors has been associated with an increased risk of developing symptoms from carboplatin 13 . Among patients receiving carboplatin, the number of treatments and the total lifetime exposure to platinum drugs have been associated with the risk of developing hypersensitivity to carboplatin 10 .…”

“…Among patients receiving carboplatin, the number of treatments and the total lifetime exposure to platinum drugs have been associated with the risk of developing hypersensitivity to carboplatin 10 . The interval between the last cycle of the initial course of treatment and the first cycle of the second course is a predictive variable 13 . In this regard, Schwartz et al 14 showed that the risk of a severe reaction during carboplatin treatment was 47% if the interval between courses was more than 24 months and 6.5% when the interval was less than 12 months (n = 36).…”

A cohort study of hypersensitivity reaction in patients with epithelial ovarian cancer treated with carboplatin

“…A slow re-administration of the drug is more compatible with a graded challenge, than desensitization and is generally successful for taxanes, less so for platinum compounds 29. In addition, the clinical safety and prognosis of patients who switch to another platinum-based drug after experiencing a platinum-based hypersensitivity reaction require further assessments 9. It is suggested that cisplatin can be safely administered to patients with ovarian cancer with hypersensitivity to carboplatin 30.…”

An Experimental Biological Test to Diagnose Hypersensitivity Reactions to Carboplatin: New Horizons for an Old Problem

“…As with all platinum compounds, carboplatin can cause hypersensitivity reactions with prolonged use. The habitual schedules of chemotherapy plan six administrations of carboplatin; hence, most allergic reactions occur when the patient undergoes a retreatment for a relapse of the neoplasm (8). Mild reactions have an incidence of 60 -70%, which appear during chemotherapy, up to 3 days after the end of treatment and involve the skin.…”