Outpatient rapid 4-step desensitization for gynecologic oncology patients with mild to low-risk, moderate hypersensitivity reactions to carboplatin/cisplatin

Li, Quan; Cohn, David E.; Waller, Allyson; Backes, Floor J.; Copeland, Larry J.; Fowler, Jeffrey M.; Salani, Ritu; O’Malley, David M.

doi:10.1016/j.ygyno.2014.07.104

Cited by 24 publications

(24 citation statements)

References 22 publications

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“…We uneventfully performed 28 out of 29 courses (96% success rate), which is consistent with results from other studies. 8,13,[16][17][18][19][20] Patient number 5 was administered two desensitization courses and then switched to olaparib successfully.…”

Section: Discussionmentioning

confidence: 99%

“…16 Similarly, on reviewing the literature, we found that if the rate of completion of the desensitization protocol was high (>80%), the reported incidence of no HSR symptoms during this protocol was lower, ranging from 67 to 88% (Table 4). 8,13,[16][17][18][19][20] It is controversial whether to continue the desensitization protocol after development of recurrent HSR. It is also controversial whether to continue treatment when initial HSR was severe such as grades 3 to 4.…”

Section: Discussionmentioning

confidence: 99%

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Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Toyohara

Sone

Nishida

et al. 2020

J of Obstet and Gynaecol

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Aim: Carboplatin is a key drug for gynecologic cancers. However, hypersensitivity reactions (HSR) are major adverse effects that might necessitate carboplatin discontinuation. Desensitization is an effective method in patients who developed initial HSR and further required carboplatin treatment. Here, we aimed to evaluate our experience with the use of the carboplatin desensitization protocol in five patients at the University of Tokyo Hospital. Methods: We established a four-step, 5-h desensitization protocol for our hospital. Observational and retrospective analyses were performed. Additionally, we have shared the patients' clinical information with the emergency department to ensure the safety of this protocol. Results: Five patients with recurrent gynecological cancer were treated using this protocol. Four of the five patients were treated effectively and 28 of 29 desensitization protocols were completed successfully. In one patient, we switched to olaparib successfully after two courses of our protocol. One patient who developed grade 4 HSR during initial carboplatin administration developed grade 2 HSR and we discontinued the protocol. Conclusion: The carboplatin desensitization protocol is very efficient. The outcome of our protocol was on a par with other protocols. To the best of our knowledge, this is the first study to indicate that switching to olaparib can be considered a suitable option in patients who develop HSR to carboplatin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Toyohara

Sone

Nishida

et al. 2020

J of Obstet and Gynaecol

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“…Hypersensitivity reactions to cisplatin resulting in cessation of protocol therapy occurred in 17.5% of patients, likely attributed to their prior cisplatin exposure during chemoradiation. In future clinical trials, desensitization protocols should be incorporated to avoid patients from missing out on potential clinical benefit from cisplatin in combination with other agents [21].…”

Section: Discussionmentioning

confidence: 99%

A phase I trial of paclitaxel, cisplatin, and veliparib in the treatment of persistent or recurrent carcinoma of the cervix: an NRG Oncology Study (NCT#01281852)

et al. 2017

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Background: Preclinical studies demonstrate poly(ADP-ribose) polymerase (PARP) inhibition augments apoptotic response and sensitizes cervical cancer cells to the effects of cisplatin. Given the use of cisplatin and paclitaxel as first-line treatment for persistent or recurrent cervical cancer, we aimed to estimate the maximum tolerated dose (MTD) of the PARP inhibitor veliparib when added to chemotherapy.Patients and methods: Women with persistent or recurrent cervical carcinoma not amenable to curative therapy were enrolled. Patients had to have received concurrent chemotherapy and radiation as well as possible consolidation chemotherapy; have adequate organ function. The trial utilized a standard 3 þ 3 phase I dose escalation with patients receiving paclitaxel 175 mg/m 2 on day 1, cisplatin 50 mg/m 2 on day 2, and escalating doses of veliparib ranging from 50 to 400 mg orally two times daily on days 1-7. Cycles occurred every 21 days until progression. Dose-limiting toxicities (DLTs) were assessed at first cycle. Fanconi anemia complementation group D2 (FANCD2) foci was evaluated in tissue specimens as a biomarker of response.Results: Thirty-four patients received treatment. DLTs (n ¼ 1) were a grade 4 dyspnea, a grade 3 neutropenia lasting !3 weeks, and febrile neutropenia. At 400 mg dose level (DL), one of the six patients had a DLT, so the MTD was not reached. Across DLs, the objective response rate (RR) for 29 patients with measurable disease was 34% [95% confidence interval (CI), 20%-53%]; at 400 mg DL, the RR was 60% (n ¼ 3/5; 95% CI, 23%-88%). Median progression-free survival was 6.2 months (95% CI, 2.9-10.1), and overall survival was 14.5 months (95% CI,. FANCD2 foci was negative or heterogeneous in 31% of patients and present in 69%. Objective RR were not associated with FANCD2 foci (P ¼ 0.53).Conclusions: Combining veliparib with paclitaxel and cisplatin as first-line treatment for persistent or recurrent cervical cancer patients is safe and feasible.Clinical trial information: NCT01281852.

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“…Platinum compounds, such as cisplatin, carboplatin and oxaliplatin, are useful antineoplastic agents used in a wide variety of cancers, particularly in gynaecological malignancies 21,22,23 . The first platinum drug approved by the United States Food and Drug Administration (FDA) as an anticancer agent was cisplatin in 1970, with carboplatin being approved almost twenty years later in 1989 17 .…”

Section: Platinum Compoundsmentioning

confidence: 99%

Key elements in hypersensitivity reactions to chemotherapy: experience with rapid drug desensitization in gynaecological cancer in a Tertiary Hospital

Coutinho

Sousa

Cunha

et al. 2022

Eur Ann Allergy Clin Immunol

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Rapid drug desensitization (RDD) is a procedure performed when no alternative drug is considered equally effective. The aim of our study is to describe the experience with RDD to cytostatics in patients being treated for gynaecological cancer in a tertiary hospital, over a period of 5 years. In this paper, we review 22 cases and 107 episodes of RDD; 86.3% of patients had advanced disease and the mortality rate at the time of data collection was 50.0%. RDD was performed on 81.8% patients for platinum, 13.6% for taxanes, and 4.5% for anthracyclines. The reintroduction of antineoplastic drugs in all patients with a previous history of immediate hypersensitivity reaction demonstrated the safety and efficacy of this procedure. There was serious complication (anaphylaxis) in only one case.

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Outpatient rapid 4-step desensitization for gynecologic oncology patients with mild to low-risk, moderate hypersensitivity reactions to carboplatin/cisplatin

Cited by 24 publications

References 22 publications

Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

A phase I trial of paclitaxel, cisplatin, and veliparib in the treatment of persistent or recurrent carcinoma of the cervix: an NRG Oncology Study (NCT#01281852)

Key elements in hypersensitivity reactions to chemotherapy: experience with rapid drug desensitization in gynaecological cancer in a Tertiary Hospital

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