Risk Factors for Oxaliplatin-Induced Hypersensitivity Reactions in Japanese Patients with Advanced Colorectal Cancer

Abstract

Objective: Previously, we suggested that oxaliplatin (L-OHP)-related grade 3/4 hypersensitivity reactions occurred immediately after the initiation, but grade 1/2 reactions did not. This study was conducted to clarify the risk factors for L-OHP-related hypersensitivity reactions.Methods: Clinical data from 108 Japanese patients with colorectal cancer were analyzed, who were treated with L-OHP-containing regimens, FOLFOX4 and/or mFOLFOX6. The risk factors examined included demographic data, preexisting allergies, laboratory test data, treatment regimen, treatment line of therapy, pretreatment with steroids, total number of cycles and cumulative amount of L-OHP.Results: The incidence of grade 1/2 and grade 3/4 hypersensitivity reactions were found at 13.0% (14/108) and 9.3% (10/108), respectively. Female (P=0.037), preexisting allergies (P=0.004) and lower level of lactate dehydrogenase (P=0.003) were risk factors for grade 1/2 hypersensitivity reactions, and higher neutrophil count (P=0.043) and lower monocyte count (P=0.007) were for grade 3/4 reactions. Total number of cycles were larger in the patients with grade 3/4 reactions than those without reactions (P=0.049).Conclusions: Further extensive examination with a large number of patients is needed to establish a patient management strategy.

Hypersensitivity to oxaliplatin: clinical features and risk factors

“…As previously described, age and female gender were identified as risk factors [7,9,13]. Interestingly, we showed that 94% of hypersensitive patients were women, finding which was not reported yet.…”

Hypersensitivity reactions associated with oxaliplatin and their clinical management

“…In a large Phase III clinical trial (MOSAIC) of oxaliplatin, allergic reactions were present only in 10.6% of the patients, and severe toxicity (grade III/IV) was present in 2.9% of them [14]. More recent data, however, present an HSR incidence ranging from 8.9 to 23.8% (Table 1) [10,[15][16][17][18][19][20][21], whereas severe anaphylactic reactions are present in a proportion < 2% [13,[22][23][24]. Shao et al [10] reported an incidence of 12.7% with a median of 10 infusions and the median time of onset from the start of infusion was 40 min.…”

“…The authors suggested that the association between HSRs and younger age and female gender could be attributed to a potential role of hormonal influences. In another study by Seki et al [16], a higher neutrophil count and a lower monocyte count were reported to be risk factors for grade III/IV HSRs in Japanese patients.…”

“…The extensive use of oxaliplatin has led to an increase of oxaliplatin-related HSRs during the last decade, with the incidence varying from 8.9 to 23.8% [10,[15][16][17][18]21]. HSRs usually occur after multiple infusions with the onset, usually between 6 and 10 treatment cycles [10,17,18,50].…”

Commentary: A systemic digestive allergic reaction imputable to docetaxel in a breast cancer patient

“…Most reported cases of chemotherapy-induced HSRs are either immediate and IgE-mediated (type I), or delayed and T-cell mediated (type IV), according to the Gell and Coombs classification [3][4][5][6][7][8][9] . In our daily oncological practice, these HSRs mainly involve platinum and taxane, and clinical manifestations range in severity from pruritus to anaphylactic shock.…”