Platinum hypersensitivity and desensitization

Miyamoto, Shingo; Okada, Rika; Ando, K.

doi:10.1093/jjco/hyv081

Cited by 25 publications

(39 citation statements)

References 105 publications

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“…Desensitization is based on the mechanisms that small incremental antigen levels can lead mast cells and basophils to induce inhibitory pathways, attenuating signal transduction and mediator release. 15,23,24 According to other reports, if recurrent HSR occurred during desensitization protocols, its symptoms tended to be less severe than the initial one, which are associated with those mechanisms. 8,17 In other studies, desensitization protocols were continued by administering medications such as steroids and antihistamines when patients developed recurrent HSR.…”

Section: Discussionmentioning

confidence: 96%

“…The rate of success in carboplatin desensitization protocol is over 80%. 15 We successfully administered the desensitization protocol to four of five patients. We uneventfully performed 28 out of 29 courses (96% success rate), which is consistent with results from other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no consensus on indications for desensitization protocols and their discontinuation, it is appropriate to discontinue desensitization protocols for severe HSR, grades 3 to 4, in general. 15,21 Various carboplatin desensitization protocols have been reported. In each of these, steps and duration vary.…”

Section: Discussionmentioning

confidence: 99%

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Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Toyohara

Sone

Nishida

et al. 2020

J of Obstet and Gynaecol

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Aim: Carboplatin is a key drug for gynecologic cancers. However, hypersensitivity reactions (HSR) are major adverse effects that might necessitate carboplatin discontinuation. Desensitization is an effective method in patients who developed initial HSR and further required carboplatin treatment. Here, we aimed to evaluate our experience with the use of the carboplatin desensitization protocol in five patients at the University of Tokyo Hospital. Methods: We established a four-step, 5-h desensitization protocol for our hospital. Observational and retrospective analyses were performed. Additionally, we have shared the patients' clinical information with the emergency department to ensure the safety of this protocol. Results: Five patients with recurrent gynecological cancer were treated using this protocol. Four of the five patients were treated effectively and 28 of 29 desensitization protocols were completed successfully. In one patient, we switched to olaparib successfully after two courses of our protocol. One patient who developed grade 4 HSR during initial carboplatin administration developed grade 2 HSR and we discontinued the protocol. Conclusion: The carboplatin desensitization protocol is very efficient. The outcome of our protocol was on a par with other protocols. To the best of our knowledge, this is the first study to indicate that switching to olaparib can be considered a suitable option in patients who develop HSR to carboplatin.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Toyohara

Sone

Nishida

et al. 2020

J of Obstet and Gynaecol

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“…Chemotherapy with platinum salts continues to be one of the mainstays for treating several types of cancer. However, hypersensitivity reactions (HSR) have emerged as a frequent adverse event to these agents and may pose a limitation for their use, because HSR clinical symptoms are variable and unpredictable, and can even lead to life-threatening events [1,2].…”

Section: Introductionmentioning

confidence: 99%

Value of Skin Tests for Managing Hypersensitivity Reactions to Platinum Salts

Pedraza-Nieto¹,

Beunza-Sola²,

Moreno³

et al. 2021

Preprint

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Background: Platinum-based therapy continues to be one of the pillars of the treatment of different types of cancer. However, many times the responsible clinician renounces its use after the appearance of a hypersensitivity reaction.Objective: To assess the value of skin tests (ST) in clinical practice to address the treatment of patients with suspicion of immediate hypersensitivity reactions (HSRs) to platinum salts.Methods: Single-center retrospective study performed for 3 years. Adult patients treated with any platinum salt who experienced HSR symptoms and for whom an oncologist requested ST, were included. ST with cisplatin, carboplatin and oxaliplatin were performed. Results: Twenty-two patients were included. ST were positive in 12 patients (54.5%), of which 4 (33%) presented cross-reactivity to another platinum salt. Fifteen patients continued platinum-based chemotherapy: 9 patients with positive ST (4 continued by desensitization and 5 with another platinum) and 6 patients with negative ST, of which 1 repeated an HSR. A NPV of 0.91 was calculated. Conclusion: ST allowed accurate identification of platinum allergy patients and the resumption of platinum-based therapy in many patients for whom no suitable therapeutic alternative was clinically acceptable.

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“…Various desensitisation protocols have been implemented with a success rate of 80–100% 5. They enable the same platinum agent to be readministered by gradual reintroduction of small amounts of drug up to full therapeutic doses; patients receive their target dose of medication in incremental steps 3 4 6.…”

Section: Introductionmentioning

confidence: 99%

Current situation of carboplatin desensitisation protocols in the hospitals of Spain

et al. 2019

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Desensitisation protocols allow the continuation of treatment in patients who have presented hypersensitivity reactions. Carboplatin desensitisation solutions are usually prepared in the chemotherapy centralised units of hospital pharmacies and they are diluted under the established concentration limit to guarantee the stability of the preparation. An online survey was sent to hospital pharmacies, inquiring about local desensitisation protocols: reasons for use of desensitisation protocols, the protocols used and the stability given to carboplatin solutions. An important variability among the hospitals in carboplatin desensitisation practice was detected. Six different carboplatin desensitisation protocols were described and discordance with the storage period of the carboplatin solutions was observed. The lack of consensus on which protocol must be followed and data supporting the stability of the diluted product, contribute to distrust of carboplatin desensitisation protocols. Although the efficacy and safety of carboplatin desensitisation protocols has been widely demonstrated, many professionals still have concerns.

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Platinum hypersensitivity and desensitization

Cited by 25 publications

References 105 publications

Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Desensitization strategy for hypersensitivity reactions to carboplatin in five patients with gynecological cancer

Value of Skin Tests for Managing Hypersensitivity Reactions to Platinum Salts

Current situation of carboplatin desensitisation protocols in the hospitals of Spain

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