Incidence of oxaliplatin hypersensitivity reaction among colorectal cancer patients: A 5-year retrospective study

Abstract

Background: Oxaliplatin is a third-generation platinum compound that has efficacy against colorectal cancer. Hypersensitivity reactions during oxaliplatin infusion are a key problem during its use, with the varying incidences and deficiencies of clearly identified risk factors. Objective: To determine the incidence, severity and risk factors of oxaliplatin-related hypersensitivity reaction (HSR). Method: This retrospective study investigated 245 colorectal cancer patients (1,690 treatment cycles) receiving care at King Chulalongkorn Memorial Hospital, Thai Red Cross society between January 1, 2015 and December 31, 2019. The patients’ demographic data, laboratory data and clinical features suggesting hypersensitivity reactions to oxaliplatin were reviewed. The Fisher’s Exact test and unpaired t-test were used to determine the differences among patients with and without oxaliplatin HSR. The potential risk factors for oxaliplatin HSR were analyzed for statistical significance by logistic regression. Results: A total of 245 colorectal cancer patients (1,690 treatment cycles) were included in this study. The incidence of oxaliplatin HSR was 37.96%, according to the US National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (NTCAE) version 5.0, grade 1, grade 2 and higher grades were 27.35% (67 patients), 6.53% (16 patients) and 4.08% (10 patients), respectively. The proportion of male patients and patients with a history of prior exposure to platinum-based chemotherapy were statistically higher in the HSR group. The eosinophil count and serum creatinine level were also significantly greater in the HSR group. On the contrary, the total lymphocyte count and serum albumin level were significantly lower in the HSR group. The multivariate logistic regression found 5 risk factors with a significant difference. Male gender, prior exposure to platinum-based chemotherapy and elevated eosinophil count were associated with increased risk of oxaliplatin HSR, whereas elevated monocyte count and elevated serum albumin were protective factors for the development of oxaliplatin HSR. Conclusion: Colorectal cancer patients treated with an oxaliplatin-based regimen with male gender, prior exposure to platinum-based chemotherapy and elevated eosinophil count have a greater risk of oxaliplatin related hypersensitivity reactions.

Oxaliplatin-Related Hypersensitivity Reactions: A Single Institution Series and Literature Review

“…Taking into consideration the literature available on oxaliplatin-related HSRs, we found articles and reviews from 2003 [ 21 ] to 2022 [ 6 ]. Among the total number of patients treated with oxaliplatin in every disease setting, the incidence rate of HSRs is very heterogeneous across different reports, with a median value of 15% (range 1.8–37.96).…”

“…This percentage is in line with the data of our case series (11%) [ 22 , 23 ]. Park et al [ 19 ] observed the presence of two peaks of occurrence for the first HSRs at the third and sixth cycle of treatment with oxaliplatin, while other authors individuate the eighth (range 3–10) as the median cycle of HSR occurrence [ 1 , 2 , 3 , 5 , 6 , 15 , 16 , 24 , 25 , 26 , 27 , 28 ]. At our center, we observed HSRs occurring after a median of two cycles (range 1–11), earlier compared to the literature data.…”

“…There is no sufficient evidence supporting that both sex and age might influence the risk of HSR onset. Many reports [ 3 , 15 , 24 ] individuate an increased risk of HSR among female patients, while others found an increased incidence in male patients [ 4 , 6 , 19 , 25 , 29 ]. Median age of HSR onset was 56.2 years in historical data and 69 years in our series.…”

“…Oxaliplatin is associated with common adverse events such as peripheral neuropathy, vomiting, nausea, diarrhea, fatigue and cytopenias, but hypersensitivity reactions (HSRs) have also been described [ 2 , 3 , 5 , 6 , 7 , 8 ]. Drug-related toxicity frequently results in the interruption and/or delay of treatment administration, dose decrease and drug withdrawal, impeding progress toward cancer treatment.…”