Fever as the only manifestation of hypersensitivity reactions associated with oxaliplatin in a patient with colorectal cancer Oxaliplatin-induced hypersensitivity reaction

Saif, Muhammad Wasif; Roy, S.C.; Ledbetter, Leslie; Madison, Jennifer; Syrigos, Kostas

doi:10.3748/wjg.v13.i39.5277

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…At a median of 70 min, and an upper limit beyond 4 h in 1 individual, our patients’ events occurred later than those in most published studies, which noted reactions usually within the first 30 min [29, 32,35,36,37,38,39,40,41,42,43]. However, other investigators have also observed episodes at 1–2 h [14, 25, 30, 33, 44, 45], and recently a patient has been described who experienced reactions over 20 h after completing her oxaliplatin infusion [46]. …”

Section: Discussioncontrasting

confidence: 46%

Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and Literature Review

Kim

Bradley²,

Tai³

et al. 2009

Oncology

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Background: Hypersensitivity is a well-known complication of the platinum agents cisplatin and carboplatin. Although hypersensitivity to oxaliplatin has been noted, the incidence varies significantly in reports. Risk factors for developing reactions specifically to oxaliplatin have not been evaluated. We report the 5-year incidence of hypersensitivity to oxaliplatin in our clinical program, the patient and disease characteristics associated with its occurrence, and review the literature. Methods: Clinical information on all patients treated with oxaliplatin between September 2002 and August 2007 was retrospectively reviewed. Data from patients who experienced hypersensitivity were compared to patients treated with this agent who did not. Risk factors investigated included age, sex, diagnosis, disease stage, presence of preexisting allergies, chemotherapy received, and use of oxaliplatin in front-line versus salvage therapy. Results: 247 patients received oxaliplatin, with 29 experiencing hypersensitivity, for an incidence of 11.7% (95% CI 7.7–15.8). Grade 3/4 events occurred in 1.6%. Hypersensitivity was associated with younger mean age (54.9 ± 12.5 vs. 60.4 ± 12.4 years with reactions vs. those without, p = 0.02), female gender (17.2% of females vs. 6.4% of males, p = 0.01) and with use of oxaliplatin as salvage therapy (23.9% second-line or higher vs. 9.1% front-line, p = 0.01). Conclusions: Our data demonstrate an incidence of hypersensitivity to oxaliplatin of 11.7%, with grade 3/4 events in 1.6%. As use of this agent becomes more widespread, increased vigilance for this potentially serious complication should be high, especially amongst younger patients, females, and with the use of oxaliplatin as salvage therapy; three newly recognized potential risk factors.

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Section: Discussioncontrasting

confidence: 46%

Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and Literature Review

Kim

Bradley²,

Tai³

et al. 2009

Oncology

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“…As shown by other authors, allergic reactions constitute a serious problem in the management of patients treated according to the FOLFOX regimen; they are difficult to predict, and they may occur during any cycle of drug administration [11,12]. Among the patients in the present study they were observed during the 5 th -8 th chemotherapy cycle.…”

Section: Discussionmentioning

confidence: 49%

“…Petroli et al reported the incidence of peripheral neuropathy in 93.8% of patients, including 18.7% with CTCAE severity grade 3. According to those authors, prolonging oxaliplatin infusion time from 2 h (the routine duration of administration in the FOLFOX-4 regimen) to 6 h significantly diminishes the incidence of neurotoxicity with severity grade ≥ 2 (p = 0.02) [12]. Numerous reports in the literature state that the neuropathy associated with oxaliplatin has a transient character and is relieved upon the cessation of therapy [1,14].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Toxicity of Anticancer Chemotherapy in Patients with Colon Cancer

et al. 2015

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Background. Modern anticancer chemotherapy can cause numerous adverse effects in the organism, whose functioning has already been disrupted by the neoplastic process itself. Objectives. The aim of the study was to evaluate and compare the frequency and severity of the toxicity of FOLFOX-4 and CLF-1 anticancer therapy in patients with colon cancer, and to analyze certain factors that might have increased the toxicity of the chemotherapy. Material and Methods. The study involved 64 patients suffering from generalized colon cancer, including 48 patients treated according to the FOLFOX-4 regimen and 16 patients treated according to the CLF-1 regimen. The toxicity of each regimen was analyzed on the basis of a confidential questionnaire formulated by the authors and laboratory research according to the extended WHO toxicity criteria. Results. The analysis of the symptoms of toxicity symptoms associated with the use of the FOLFOX-4 and CLF-1 therapeutic regimens revealed that the most common side effects included nausea and vomiting, despite ondansetron premedication, and neurotoxicity. Disruption of the functioning of the nervous system under the FOLFOX-4 regimen statistically significant exacerbation that increased with the number of chemotherapy cycles administered; this was more common and more severe in women. Paresthesia was also revealed to be a neurotoxic effect of the FOLFOX-4 regimen after termination of therapy. A statistically significant relationship was observed between the use of vitamin supplements and the incidence and severity of the toxicity of the FOLFOX-4 regimen. Conclusions. The findings of the current study regarding the toxicity of the FOLFOX-4 and CLF-1 therapy regimens should be taken into consideration when monitoring chemotherapy safety in colon cancer. The patients' tolerance of the administered medication and the side effects reported by patients should be constantly evaluated, which will help prevent these side effects, apply appropriate therapy and contribute to the improvement of the patients' quality of life. The functioning of the central nervous system should be carefully evaluated when planning the anticancer therapy, especially if repeated administration of neurotoxic drugs is necessary in cases of a recurrence of the disease. Chemotherapy should be thoroughly monitored for safety, especially in women over 65 years of age suffering from coexisting diseases. Colon cancer patients and their families should be informed of the risks of nutritional supplements before the start of the anticancer chemotherapy, and may need to dispense with their use (Adv Clin Exp Med 2015, 24, 1, 103-111).

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“…However, we most commonly observed fever, which is one of the diagnostic criteria for adverse HSR events. Saif et al [20] reported that fever alone is not a typical symptom of oxaliplatin hypersensitivity. However, we observed that fever was the only manifestation of an HSR during the first treatment episode in about 40% of patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Reintroducing Oxaliplatin to Patients with Colorectal Cancer after Mild Hypersensitivity Reactions

et al. 2013

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Objective: We aimed to evaluate the clinical outcomes of reintroducing oxaliplatin to patients with colorectal cancer who developed mild hypersensitivity reactions (HSRs). Methods: A retrospective review was performed of 204 patients who received oxaliplatin-based chemotherapies between January 2003 and August 2009. Desensitization was not used. Results: A total of 44 patients (21.6%) were found to have developed HSRs to oxaliplatin. After the occurrence of an HSR, a mean of three courses of oxaliplatin (range 1-8) were introduced. Following the initial episode, oxaliplatin was reintroduced to 39 patients, resulting in HSR relapse in 89.7% of the patients, including 4 patients (10.3%) with grade 3 reactions. After the second re-exposure of oxaliplatin to 22 patients, HSRs were exhibited in 81.8%, including 2 patients (9.1%) who developed grade 3 reactions. After the third and subsequent re-exposures in 12 patients, all except 1 of the patients developed mild reactions. A total of 7 patients (17.9%) exhibited severe reactions along with the progress of re-exposure. Conclusion: We observed that the majority of patients who experienced mild HSRs to oxaliplatin developed mild reactions on multiple re-exposures, suggesting that it may be feasible to continue oxaliplatin without using desensitization when tolerable after mild reactions.

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Fever as the only manifestation of hypersensitivity reactions associated with oxaliplatin in a patient with colorectal cancer Oxaliplatin-induced hypersensitivity reaction

Cited by 16 publications

References 24 publications

Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and Literature Review

Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and Literature Review

Evaluation of the Toxicity of Anticancer Chemotherapy in Patients with Colon Cancer

Clinical Outcomes of Reintroducing Oxaliplatin to Patients with Colorectal Cancer after Mild Hypersensitivity Reactions

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