title: Successful rechallenge for oxaliplatin hypersensitivity reactions in patients with metastatic colorectal cancer.
abstract: BACKGROUND
  Discontinuation of oxaliplatin-containing regimens is sometimes necessary due to hypersensitivity reactions for which effective countermeasures have not yet been identified.
  
  
  METHODS
  We retrospectively reviewed cases in which hypersensitivity reactions developed in 623 patients treated with oxaliplatin for colorectal cancer. Clinical outcomes of patients who underwent oxaliplatin rechallenge with rechallenge protocol (STEP 1: hydrocortisone, chlorpheniramine, and/or ranitidine; STEP 2: hydrocortisone with an escalating dose to 500 mg, and/or prolonged administration time of oxaliplatin; and STEP 3: STEP 2 plus a subcutaneous injection of epinephrine) were examined.
  
  
  RESULTS
  Out of 623 patients, 126 (20.2%) patients developed hypersensitivity reactions. Out of these 126 patients, 99 (78.6%) underwent oxaliplatin rechallenge. As the initial oxaliplatin rechallenge, 19 patients received subsequent treatment without the rechallenge protocol and 80 patients received oxaliplatin with the rechallenge protocol of STEP 1 (n=64), STEP 2 (n=15), and STEP 3 (n=1). The median number of oxaliplatin rechallenges was 3 (range=1 to 29). The reason for treatment discontinuation was disease progression in 55 patients (56%) and hypersensitivity reactions in 21 patients (21%). Overall hypersensitivity reactions after rechallenge were observed in 59%, with grade 3/4 in 6%.
  
  
  CONCLUSIONS
  The rechallenge protocol is an effective treatment option for patients with oxaliplatin hypersensitivity reactions.
authors.affiliation: Division of Pharmacy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. tyanai@ncc.go.jp
authors.forename: Takako
authors.initials: T
authors.lastname: Yanai
authors.forename: Satoru
authors.initials: S
authors.lastname: Iwasa
authors.forename: Hirhonobu
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hamaguchi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Yamada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002744:Chlorpheniramine / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D004342:Drug Hypersensitivity / Q000188:drug therapy* / Q000209:etiology*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects*; D000077150:Oxaliplatin; D011899:Ranitidine / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002744:Chlorpheniramine; D011899:Ranitidine; D006854:Hydrocortisone; D004837:Epinephrine