Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low‐Grade Glioma

Shah, Anish A.; Minturn, Jane E.; Li, Yimei; Belasco, Jean B.; Phillips, Peter C.B.; Kang, Tammy I.; Cole, Kristina A.; Waanders, Angela J.; Pollack, Rosanna; DiDomenico, Concetta; Wildes, Cynthia; Fisher, Michael J.

doi:10.1002/pbc.25697

Cited by 21 publications

(20 citation statements)

References 20 publications

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“…This difference could be due to the different patterns of desensitization used. The main variables influencing the success of re-exposure appear to be: the starting dose, the infusion rate and the number of increments (Lafay-Cousin et al, 2005; Ruggiero et al, 2013a; Dodgshun et al, 2016; Shah et al, 2016). A lower starting dose, a slow infusion, and a number of increments greater than or equal to 4, are associated with a greater probability of success.…”

Section: Discussionmentioning

confidence: 99%

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

et al. 2017

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Background: Carboplatin based regimens have demonstrated activity in pediatric patients with low grade gliomas (LGG). However, carboplatin hypersensitivity reactions (CHRs) may be a major problem leading to premature cessation of an effective therapy. The objectives of this study were to describe the prevalence, characteristics and management of CHR.Methods: We performed a retrospective review of children with LGG treated between January 1994 and July 2015 with carboplatin and vincristine who had a documented CHR. We identified two groups: the first was treated following the schema proposed by Packer et al., and re-exposed to carboplatin using a desensitization protocol; the second was treated according to protocol SIOP LGG 2004 and re-exposed with the infusion time prolonged.Results: CHRs were observed in 16 patients (34%) out of 47. Hypersensitivity reactions occurred in 6 patients (20.7%) of the first, and 10 patients (55.5%) of the second group, respectively. The grade 2 reactions were the most common. The median number of carboplatin doses administered at the first episode of CHR was 7 (range, 3–9) for the first group, and 8.5 (range, 5–11) for the second, respectively. Six patients were re-exposed to carboplatin using a desensitization protocol; 10 with a prolonged infusion time. Overall success rate for re-exposition was 43.75% (100% and 10%, respectively) (P = 0.001).Conclusions: Our results show that re-exposure is a safe alternative to abandoning carboplatin. Desensitization showed greater effectiveness compared to a prolonged infusion time, which allowed the patients to receive effective treatment without adverse reactions.

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Section: Discussionmentioning

confidence: 99%

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

et al. 2017

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“…However, a current study reported low efficacy with desensitization protocol 17 . Shah et al 18 , proposed a clinical algorithm using carboplatin rechallange with H1 and H2 antagonists, corticosteroids and prolonged infusion instead of abandoning carboplatin.…”

Section: Discussionmentioning

confidence: 99%

Carboplatin hypersensitivity in children with glial tumors: a report of two cases

Kazgan¹,

Ilhan²,

Durmaz³

et al. 2016

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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AbstractÖz Carboplatin, commonly used chemotherapeutic agent in treatment of pediatric cancers, can cause life-threatening hypersensitivty reactions. Carboplatin hypersensitivity is protocol-specific and associated with repeated doses and prolonged use of the drug. Vincristin and carboplatin combination is used efficiently in treatment of pediatric low-grade gliomas. However, hypersensitivity reactions are frequently observed during usage of this protocol. Desensitization strategies with variable success rates were reported. Failure of these strategies may lead to cessation of carboplatin Here, we report two cases with carboplatin hypersensitivity treated with epinephrine administration, in whom carboplatin was discontinued after hypersensitivity reaction.Pediatrik kanserlerin tedavisinde sıklıkla kullanılan kemoterapi ajanlarından biri olan karboplatin, yaşamı tehdit edici hipersensitivite reaksiyonlarına neden olabilir. Karboplatin hipersensitivitesi protokole özgü olup, ilacın uzun süreli ve tekrarlı dozlarda kullanımı ile ilişkilidir. Karboplatin ve vinkristin kombinasyonu pediatrik düşük gradeli gliomların tedavisinde etkin bir şekilde kullanılmaktadır. Ancak, bu protokolün kullanımı sırasında hipersensitivite reaksiyonları sıklıkla gözlenmektedir. Değişen oranlarda başarı elde edilen desensitizasyon stratejileri bildirilmiştir. Bu stratejilerin başarısız olması durumunda karboplatin tedavisinin kesilmesi söz konusu olabilir. Burada, epinefrin uygulaması ile tedavi edilen ve hipersensitivite reaksiyonu gelişmesi sonrasında karboplatin tedavilerine devam edilemeyen iki karboplatin hipersensitivitesi olgusu sunulmuştur.

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“…Genc et al (2012) observed a frequency of 40% in their study. Recently, carboplatin hypersensitivity was documented in 47% of patients by Dodgshun et al (2016), and in the study by Shah et al (2016) of 144 children with LGG treated with carboplatin and vincristine, 56 (39%) experienced an HSR to carboplatin.…”

Section: Incidencementioning

confidence: 99%

“…Dodgshun et al (2016) reported grade III reactions on rechallenge in two patients who initially experienced grade I and II reactions. In the study by Shah et al (2016), 19 patients experienced a subsequent high-grade HSR (Grade III or IV) after initiating carboplatin rechallenge. In any case, Chang et al (1995) did not document any increase in severity of HSR after re-exposure.…”

Section: Risk Factorsmentioning

confidence: 99%

Hypersensitivity to Carboplatin in Children with Malignancy

et al. 2017

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Purpose: Carboplatin-based regimens have proven efficacy in children with cancer. However, the development of hypersensitivity reactions (HSRs) may have a negative impact on treatment intensity and patients’ outcome. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring in children with cancer treated with carboplatin and their impact on treatment efficacy.Methods: Data were collected by searching for relevant studies on the incidence, clinical features and management of possible side effects about the use of carboplatin in children, published from March 1987 to October 2016 in the PubMed database.Results: Carboplatin HSRs present with mild/moderate to severe clinical patterns. The risk of HSR is related to the cumulative number of infusions. Moreover, a greater risk of developing an HSR has been observed in younger patients than in older age groups of children; risk is also greater in girls and in patients with a prior history of allergy to other drugs. Management options include cessation of carboplatin and switching to another agent, premedication with antihistamines and/or corticosteroids, and carboplatin desensitization. For sensitized patients who have obtained benefits from carboplatin, the continuation of the treatment is desirable and desensitization protocols have showed promising results.Conclusion: Clinicians must not underestimate the potential risk and occurrence of carboplatin HSRs in the pediatric population in order to outline adequate management strategies. Desensitization protocols should be considered for patients sensitive to carboplatin in order to avoid having to discontinue an effective chemotherapy.

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Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low‐Grade Glioma

Abstract: Our results demonstrate re-exposure to be a safe alternative to abandoning carboplatin for patients with a hypersensitivity reaction. We propose a clinical algorithm for treatment.

Cited by 21 publications

References 20 publications

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

Carboplatin hypersensitivity in children with glial tumors: a report of two cases

Hypersensitivity to Carboplatin in Children with Malignancy

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