Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Saturday, October 29, 2016

Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study



abstract

Highlights

Highlights an effective, safe and short desensitization protocol
Allows hypersensitive patients to continue with carboplatin therapy
Employs a straightforward home and inpatient premedication regimen
Identifies factors that help to risk stratify patients undergoing desensitization
Decreases the burden on health care by reducing admissions to the hospital and ICU

Objectives

The carboplatin desensitization (CD) protocol presented here allows patients with either a positive skin test or a prior hypersensitivity reaction (HSR) to safely, rapidly and effectively continue with carboplatin infusions. Newly described factors can identify patients at risk for developing adverse events during CD.

Methods

A retrospective review was performed on patients with gynecologic cancer who underwent CD between 2005 and 2014. The CD protocol uses a four-step dilution process over 3.5 h.

Results

129 patients underwent CD and completed a total of 788 cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1 cycles (SD ± 4.55, range 0–23) with CD. The CD protocol allowed 73% (94 of 129) of the patients to undergo carboplatin infusion without reaction. Patients with moderate to life-threatening HSRs (grade 2 through 4) were 10.5 years younger at initial CD than patients with grades 0 or 1 HSRs (52.3 vs. 63, P = 0.0307). One patient death occurred during her thirteenth desensitization cycle. The HSR in this case was complicated by pre-exisiting pulmonary hypertension.

Conclusions

This is the largest study of its kind showing a safe, effective and rapid (3.5 h) CD protocol. The majority of patients with a history of either carboplatin hypersensitivity reaction or a positive skin test completed the CD protocol without HSRs. Age was identified as a risk factor for HSR severity during CD. Age can be employed along with pre-load dependent cardiac conditions as a way to help risk stratify patients undergoing CD.

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