Response letter to the editor

Abstract

Dear Editor, We thank Dr Lafay-Cousin for her interest in our study [1,2].Our study population was composed of 50 low-grade glioma (LGG) patients and 20 of them developed carboplatin-related hypersensitivity reactions (CHR). Four out of 19 re-exposed patients at first episode and two out of eight patients at second episode were started on corticosteroids as part of their modification regimen. Two of these six patients developed CHR again and their carboplatin therapy was terminated. As a summary, only four of 19 (21 %) patients (four of 50 (8 %) LGG patients) were given corticosteroids. In our manuscript [2], we also recommend antihistamines±desensitization protocol at first CHR episode and try to avoid routine administration of corticosteroids.Our study [2] is a retrospective evaluation of carboplatin hypersensitivity reactions in low-grade glioma patients treated between 1997 and 2008. The choice of chemotherapy during this period was a combination of carboplatin and vincristine. Fortunately, in the past few years, there have been many studies in the field of pediatric neurooncology, which indicate effectiveness of many second-line drugs such as cisplatin/etoposide, vinblastine, vinorelbine, temozolamide, etc. [2][3][4]. Today, we are lucky to have more therapy options in case of CHR. In accordance with this information, we recommended that carboplatin re-exposure could be tried especially in cases responding to therapy and the potential risks should not outweigh the benefits of continuing to carboplatin.The report from Children Oncology Group showed that LGG patients with NF1 electively treated with vincristine and carboplatin had significantly better EFS in comparison to those without NF1. Thus, better tumor control expectancy in NF1 patients validates continuation of carboplatin by means antihistamines and desensitization protocols in case of CHR [5].In conclusion, we agree that LGG is a chronic disease necessitating recurrent therapy episodes. In patients where carboplatin termination is a must-despite efforts of premedication and desensitization-choice of antineoplastic agent should be carefully entertained according to acute and chronic toxicity profiles and rate of tumor control.