Incidence of Carboplatin-Related Hypersensitivity Reactions in Japanese Patients With Gynecologic Malignancies

Abstract

Carboplatin is one of the most commonly used and well-tolerated agents for gynecologic malignancies. The rate of hypersensitivity reactions (HSRs) in the overall population of patients receiving carboplatin has been reported to increase after multiple doses of the agent. We retrospectively analyzed the incidence, clinical features, management, or outcome of carboplatin-related HSRs in 113 Japanese patients with gynecologic malignancies and the possibility of rechallenge with the drug. We intravenously administered carboplatin after paclitaxel or docetaxel. Mild HSRs are resolved by temporary interruption of carboplatin infusion, an additional antihistamine, and/or a corticosteroid. If HSRs arose, carboplatin was diluted, not exceeding 1 mg/mL, and slowly infused over 2 hours in subsequent cycles. Ten patients experienced carboplatin HSRs, with an overall incidence of 8.85%. The first HSR episode was mild in all cases. When retreated with carboplatin, 4 exhibited severe HSRs. More than 9 cycles and/or more than 5000 mg of carboplatin administration significantly increased the incidence of HSRs. In particular, carboplatin treatment beyond 15 cycles and/or 8000 mg increased the risk of severe HSRs (P < 0.0001). The incidence of HSRs in the ovarian carcinoma group was significantly greater than that in the uterine carcinoma group (P = 0.0046). Careful attention should be paid to HSRs during carboplatin treatment beyond 9 cycles and/or 5000 mg. The rate of severe HSRs greatly increases beyond 15 cycles and/or 8000 mg. Further studies are needed to identify potential risk factors that may contribute to the development of carboplatin HSRs and to decrease the risk of reactions.

Oxaliplatin Is a Safe Alternative Option for Patients With Recurrent Gynecologic Cancers After Hypersensitivity Reaction to Carboplatin

“…3Y5 The incidence of hypersensitivity to carboplatin typically peaks from 6 to 21 cycles; symptoms frequently range from mild pruritus and erythroderma to anaphylaxis. 3Y5 Severe reactions have been observed after a cumulative dose of 8000 mg. 6 Markman et al 3Y5 reported 27% of patients developing allergic reactions after the seventh cycle. Such high rates of hypersensitivity limit further administration of carboplatin to patients with platinum-sensitive disease.…”

Deleterious BRCA1/2 mutation is an independent risk factor for carboplatin hypersensitivity reactions

“…Reports of hypersensitivity reactions (HSRs) to carboplatin have increased with the rise in its repetitive use in many cancer patients. Incidence of carboplatin HSR ranges from 8 to 16% (Markman et al , 1999; Polyzos et al , 2001; Koshiba et al , 2009) and can be as high as 44% in the second- and third-line settings (Morgan et al , 1994). Symptoms and signs of this allergic reaction include mild rash to diffuse erythroderma, pruritus, urticaria, angioedema, tachycardia, chest tightness, bronchospasm, dyspnea, and at the severe end, cardiopulmonary collapse.…”

Evaluation of Basophil CD203c as a Predictor of Carboplatin-Related Hypersensitivity Reaction in Patients with Gynecologic Cancer

“…The reported incidence of HR in patients who received more than 7 courses of carboplatin is 26.7%, 1) which is similar to that reported previously by our group (23.2%) in patients with gynecologic cancer. 4) Although the risk of carboplatinrelated HR is thought to be associated with previous history of drug allergy, prolonged platinum-free interval or high dose of carboplatin, [2][3][4][5] these parameters are not very sensitive for the prediction of HR. Intradermal injection of carboplatin has also been used for the diagnosis of carboplatin-related HR, and the reported sensitivity and false-positivity of the test are 85.7% and 1.5%, respectively, in patients with gynecologic cancer.…”