Hypersensitivity and idiosyncratic reactions to oxaliplatin

Abstract

BACKGROUND Oxaliplatin is a third‐generation platinum analog that is used to treat a variety of solid tumors, particularly colorectal carcinoma. Patients may develop hypersensitivity reactions, although this complication occurs infrequently. METHODS Three patients developed hypersensitivity reactions to oxaliplatin while undergoing treatment on a Phase I trial of oxaliplatin and capecitabine. An Entrez PUBMED search was performed to identify other cases. RESULTS Two patients experienced the abrupt onset of erythema alone or with pruritis during the 9th and 11th infusions of oxaliplatin, whereas the other patient developed fever and mild dyspnea a few hours after the 9th oxaliplatin infusion. All 3 patients were rechallenged successfully for at least 1 additional oxaliplatin infusion by using oral dexamethasone, 20 mg orally, 6 and 12 hours before the administration of oxaliplatin and by administering intravenously 125 mg of solumedrol, 50 mg of diphenhydramine, and 50 mg of cimetidine 30 minutes before oxaliplatin. The literature review suggests two distinct patterns of reactions: classic hypersensitivity (as experienced by the first two patients) and idiosyncratic reactions (as experienced by the third patient). CONCLUSIONS Patients who develop mild to moderate hypersensitivity to oxaliplatin may be pretreated with steroids and antagonists of Type 1 and 2 histamine receptors, whereas patients who develop severe reactions are unlikely to tolerate further therapy. Cancer 2003;97:2301–7. Published 2003 American Cancer Society. DOI 10.1002/cncr.11379

Hypersensitivity Reactions to Oxaliplatin: Clinical Features and Risk Factors in Koreans

“…The prevalence of hypersensitivity reactions was 10.7%, and this prevalence was consistent with previous studies with rate of 3.6%-25% (Andre et al, 2004;Brandi et al, 2003;Gowda et al, 2004;Maindrault-Goebel et al, 2005;Siu et al, 2006;Thomas et al, 2003). Most common events were cutaneous symptoms including rash and/or urticaria, and most symptoms were not severe: these results were also similar to results of previous studies (Shao et al, 2010).…”

“…Patients who received less than 20mg dose of dexamethasone also had more risk of oxaliplatin hypersensitivity with adjusting age, sex, purpose of chemotherapy and oxaliplatin infusion dose. It has been reported that prophylactic regimens with corticosteroids and antihistamines are successful although effective prophylactic regimen of dexamethasone has not been determined (Bhargava et al, 2004;Brandi et al, 2003;Gowda et al, 2004;Lim et al, 2004;Maindrault-Goebel et al, 2005;Thomas et al, 2003). In a recent study, it has been reported that high dose dexamethasone plus antihistamine prevented colorectal cancer patients treated with modified FOLFOX-6 from hypersensitivity reaction to oxaliplatin (Kidera et al, 2011).…”

“…Oxaliplatin has shown activity in a wide variety of tumor types, including colorectal, pancreatic, biliary, gastroesophageal, and gynecologic malignancies (Gowda et al, 2004). In recent years, oxaliplatin has been extensively used, which led to an increased prevalence of oxaliplatin related hypersensitivity reactions (Brandi et al, 2003;Thomas et al, 2003;Gowda et al, 2004;Maindrault-Goebel et al, 2005;Siu et al, 2006;Lee et al, 2007).…”

Hypersensitivity Reactions to Oxaliplatin and the Application of a Desensitization Protocol

“…Platinum-containing agents are associated with hypersensitivity reactions, which have been reported to occur in 10% to 27% of patients treated with cisplatin or carboplatin [6]. The incidence of hypersensitivity reactions increases with multiple courses of the drugs and generally occurs after four to six courses [6,7]. Symptoms of hypersensitivity reactions to platinum-containing agents, which usually occur within minutes of administration in patients with prior exposure, include facial edema, bronchospasm, hypotension, tachycardia, pruritis, and erythema [6].…”

Comparative Assessment of Skin and Subcutaneous Toxicity in Patients of Advanced Colorectal Carcinoma Treated with Different Schedules of FOLFOX

“…Incidence rate allergic reactions is 0.55% in patients of advanced colorectal carcinoma ,who had received oxaliplatin 2 hrs infusion in combination with 5FU/LV (Thomas et al, 2003).It is argued that Patients with severe allergic manifestations should not be rechallenged to oxaliplatin exposure even is if appropriate symptomatic management is given/planned (Polyzos et al, 2001), whereas other studies advocate that the re-challenge protocol is effective treatment opinion in patients implicated with hypersensitivity and treated with Oxaliplatin (Yanai et al, 2012). Cheng et al (2008), reported 25 (11 females and 14 males) cases of allergic reactions in a prospective study in patients receiving FOLFOX 4 for colorectal carcinoma.…”