title: Initial experience with a novel desensitization strategy for carboplatin-associated hypersensitivity reactions: carboplatin-hypersensitivity reactions.
abstract: OBJECTIVE
  Carboplatin hypersensitivity is an increasingly recognized toxicity in individuals receiving >6 cumulative courses of this important antineoplastic agent. We wished to determine if a novel multi-pronged approach to re-treating patients with a high risk for this potentially serious side effect could permit the safe delivery of this class of cytotoxic drugs.
  
  
  METHODS
  Five patients with gynecologic malignancies who had either experienced a documented carboplatin hypersensitivity reaction ( n =4) or had a "positive" carboplatin skin test ( n =1), received a multi-drug oral regimen administered over several days which was designed to block known mediators of anaphylaxis. Four of these individuals subsequently underwent treatment with either cisplatin or carboplatin employing a "dose escalation" desensitization schema.
  
  
  RESULTS
  Four patients underwent successful treatment with either cisplatin or carboplatin (3, 4, 5, 6+ total additional courses) without any further evidence of hypersensitivity.
  
  
  CONCLUSIONS
  In this preliminary report of a limited patient population, we have demonstrated the ability to safely deliver a platinum agent to individuals with either documented carboplatin hypersensitivity, or a high risk for this potentially serious toxicity of carboplatin. Further exploration of this novel management strategy in a larger group of patients is indicated.
authors.affiliation: Department of Hematology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. markmam@ccf.org
authors.forename: Maurie
authors.initials: M
authors.lastname: Markman
authors.forename: Fred
authors.initials: F
authors.lastname: Hsieh
authors.forename: Kristine
authors.initials: K
authors.lastname: Zanotti
authors.forename: Kenneth
authors.initials: K
authors.lastname: Webster
authors.forename: Gertrude
authors.initials: G
authors.lastname: Peterson
authors.forename: Barbara
authors.initials: B
authors.lastname: Kulp
authors.forename: Ann
authors.initials: A
authors.lastname: Spicel
authors.forename: Jerome
authors.initials: J
authors.lastname: Belinson
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin