Hypersensitivity reactions to oxaliplatin: a case report and the success of a continuous infusional desensitization schedule.
Oxaliplatin is a third-generation platinum analog that is used mainly to treat advanced colorectal cancer. The reported incidence of hypersensitivity reactions to oxaliplatin, especially after multiple cycles of therapy, is less than 1%. We report a patient with metastatic colon cancer who developed a hypersensitivity reaction to oxaliplatin during the sixth cycle of combination chemotherapy with oxaliplatin, high-dose 5-fluorouracil and leucovorin. The same reaction occurred again after re-exposure to oxaliplatin 2 weeks later even with prophylactic administration of steroids and H1 antihistamines. After failing third-line treatment with oral tegafur-uracil, we desensitized the patient by using a fixed-rate 24-h continuous infusion of dilute oxaliplatin (0.15 mg/ml), in addition to steroids and H1 antihistamines. He had no hypersensitivity reaction during or after that infusion or when the same concentration was infused in the same way 2 weeks later. Because his condition subsequently deteriorated and the cancer progressed, no further oxaliplatin was given. Our experience does demonstrate, however, that a fixed-rate 24-h continuous infusion of oxaliplatin in a low concentration may prevent a hypersensitivity reaction in a previously sensitized patient.
Lim
Ken-Hong
KH
Division of Hematology-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Huang
Ming-Jer
MJ
Lin
Huan-Chau
HC
Su
Ying-Wen
YW
Chang
Yi-Fang
YF
Lin
Johnson
J
Chang
Ming-Chih
MC
Hsieh
Ruey-Kuen
RK
D000284:Administration, Oral; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003888:Desensitization, Immunologic / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology*; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000188:drug therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D013624:Taiwan; D013997:Time Factors
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003907:Dexamethasone; D004155:Diphenhydramine; D002955:Leucovorin; D005472:Fluorouracil