Delayed hypersensitivity to oxaliplatin in a nigerian patient with colorectal cancer—A case report

Abstract

Introduction Oxaliplatin is a third generation anti-neoplastic platinum compound (organo-platinum complex) used in the treatment of several solid tumours either as a single agent or in combination with other chemotherapy drugs. Hypersensitivity reactions to oxaliplatin are uncommon, with most reports indicating an incidence of 1–5%. The severity of reactions may vary from grade 1 side effect in line of skin flushing and/or rashes to very severe, life-threatening systemic anaphylaxis (grade 3/4). Following mild to moderate hypersensitivity reactions, steroids and/or antihistamines could be administered, after which the patient can be re-exposed to the drug. In severe hypersensitivity reactions however, oxaliplatin must be discontinued while alternative chemotherapeutic regimen or even other forms of therapy should be considered. Case report A 56 year old woman with colorectal cancer who was commenced on adjuvant oxaliplatin therapy developed Hypersensitivity reaction about 2 hours of the first oxaliplatin administration, for which the drug was discontinued and the symptoms improved. She had similar reactions in 2 subsequent attempts at administering same drug, after which the drug was changed. A placebo infusion was administered twice with no untoward reactions. Management and outcome: With each reaction, the drug was immediately discontinued and she was promptly given intranasal oxygen and corticosteroids. She was premedicated with anti-histamines and corticosteroids prior to subsequent cycles. Oxaliplatin was consequently discontinued and she experienced no further hypersensitivity reaction to the subsequent drug regimen. Discussion Hypersensitivity reactions to oxaliplatin, though a rare occurrence, are more likely idiosyncratic; with more cases being reported in recent times.

Oxaliplatin-associated shock in stage III colorectal cancer patients: real-world evidence in Taiwan

“…Reports on oxaliplatin-associated HSR and anaphylactic shock have increased in recent years. 1 , 2 , 34 Current study depicted the cycle-to-shock, in most cases, at later cycles, which implied that the mechanism of oxaliplatin-associated life-threatening severe anaphylactic shock might not be the IgE-mediated HSR ( Figure 5 ). The late-peak pattern was like that reported in previous case reports.…”

“…Oxaliplatin is widely used to treat stage III and stage IV CRC patients but is not used for stage I to stage II patients following the National Cancer Comprehensive Network (NCCN) guidelines. 1 , 2 However, stage IV patients with multiple metastases and poor physical conditions might administer more chemotherapy agents. Therefore, the current study focused on stage III CRC patients with oxaliplatin treatment.…”

“…Oxaliplatin-associated common adverse events include alopecia, diarrhea, nausea, vomiting, and late effects, such as multiple neuropathies. 1 Hypersensitivity reactions (HSR) and anaphylaxis may damage the nervous system and occasionally be fatal. 2 , 4 The incidence of HRS due to oxaliplatin is increasing and ranges from 8% to 20%.…”