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

Abstract

Objective The aim of this study was to determine the tolerability and efficacy of oxaliplatin in patientswith recurrent gynecologic malignancies after carboplatin hypersensitivity reactions in comparison with conventionally used cisplatin. Methods Forty-six patients were treated with platinum-based chemotherapy from 2006 to 2011 and developed hypersensitivity reactions to carboplatin. Oxaliplatin was administered to 27 patients; 19 patients received cisplatin. Clinicopathologic variables, toxicity, and time-to-failure were analyzed retrospectively using descriptive statistics, Fisher exact, and independent sample permutation t tests. Results The median number of carboplatin cycles and cumulative dose before reaction were similar in the oxaliplatin and cisplatin groups, respectively (6 vs 7.5 cycles, P = 0.93; 980 [662] mg vs 686 [579.6] mg, P = 0.49). Non–life-threatening hypersensitivity reaction to oxaliplatin developed in 2 of 27 patients. No reactions to cisplatin occurred. The median number of oxaliplatin/cisplatin cycles was 6 in both groups. Complete response to therapy was 34.6% (oxaliplatin) and 31.6% (cisplatin); stable disease was seen in 50.0% and 36.8% of oxaliplatin- and cisplatin-treated patients, respectively (P = 0.46). Exposure to oxaliplatin resulted in less neurotoxicity than cisplatin (25.9% vs 68.4%, P = 0.01). The median number of prior chemotherapy lines in both groups was 2. The median time-to-failure was 10.8 months in oxaliplatin group and 9.8 months in cisplatin group (P = 0.86). Conclusions Salvage therapy with oxaliplatin after hypersensitivity reaction to carboplatin is associated with excellent tolerability and time-to-failure comparable to cisplatin. When further administration of carboplatin is precluded, oxaliplatin represents a safe and effective treatment strategy in the platinum-sensitive relapse setting. The significantly lower neurotoxicity profile makes it an attractive alternative to cisplatin.

Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database

“…Although a recent study from Nonna et al found that for patients with carboplatin induced hypersensitivity reaction, the use of oxaliplatin maybe a safer alternative [ 29 ], patients should be carefully monitored for signs and symptoms of anaphylaxis with any platinum-based chemotherapeutic agent.…”

Metabolic interrogation as a tool to optimize chemotherapeutic regimens

“…Third, development of predictive biomarkers of actual drug response must be completed to allow for individualized therapeutic regimens. Platinum chemistry has been continuously refined over the last few decades resulting in multiple, clinically-approved derivatives with variable toxicity profiles and pharmacokinetics [ 10 , 14 , 42 ]. The continued development of newer agents is likely to further increase the availability of Pt agents for improved therapeutic regimens [ 43 , 44 ].…”

Oxaliplatin for the treatment of ovarian cancer

“…Disease response (partial or complete) was observed in 43.2% of patients and 36.8% of responders who had a prior platinum hypersensitivity reaction and were not candidates for other platinum-containing regimens. Another recent study by Kolomeyevskaya et al explored the tolerability and efficacy of oxaliplatin in recurrent gynecologic malignancies setting after carboplatin hypersensitivity in comparison with cisplatin [64]. Forty-six patients with ovarian, endometrial and cervical cancers who developed hypersensitivity reaction to carboplatin were retrospectively analyzed.…”