Hypersensitivity and idiosyncratic reactions to oxaliplatin.
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 pruritus 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.
Thomas
Rebecca R
RR
Cancer Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, NCI-Navy Medical Oncology, National Naval Medical Center, Bethesda, Maryland 20889-5105, USA.
Quinn
Mary G
MG
Schuler
Barbara
B
Grem
Jean L
JL
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002927:Cimetidine / Q000008:administration & dosage / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000209:etiology*; D004417:Dyspnea / Q000139:chemically induced* / Q000188:drug therapy; D004890:Erythema / Q000139:chemically induced* / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000188:drug therapy; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin
D000893:Anti-Inflammatory Agents; D000932:Antiemetics; D000970:Antineoplastic Agents; D006635:Histamine H2 Antagonists; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D008776:Methylprednisolone Hemisuccinate; D003907:Dexamethasone; D002927:Cimetidine; D004155:Diphenhydramine