title: Cisplatin can be safely administered to ovarian cancer patients with hypersensitivity to carboplatin.
abstract: OBJECTIVE
  Hypersensitivity reactions (HSR) are frequently reported in patients rechallenged with carboplatin for recurrent ovarian cancer (ROC) and represent a critical issue, since discontinuation of the platinum-based therapy could affect prognosis. Several strategies to allow platinum rechallenge have been described, with controversial outcomes. The aim of this study is to illustrate a 10-year experience with cisplatin in patients with a previous HSR to carboplatin or at risk for allergy.
  
  
  METHODS
  A retrospective review of all patients with platinum sensitive ROC retreated with carboplatin was performed between January 2007 and May 2016 at the Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples.
  
  
  RESULTS
  Among 183 patients, 49 (26.8%) presented HSR to carboplatin, mainly during second line therapy. Mean number of cycles before HSR was 8 (range 3-17). G2, G3 and G4 reaction were detected in 83%, 15% and 2% of patients, respectively. In a multivariate analysis including age, hystotype, BRCA status, previous known HSR, and combination drug administered, only the type of carboplatin-based doublet used as 2nd line therapy was found to significantly affect HSR development, with a protective effect of PLD (pegylated liposomal doxorubicin) (p = 0.014, OR = 0.027). Thirty seven patients (77%) with a previous HSR to carboplatin were rechallenged with cisplatin. Treatment was generally well tolerated. 5 patients (13.1%) experienced mild HSR to cisplatin, successfully managed in all cases. 14 patients were treated with cisplatin even without a carboplatin-related HSR due to other allergies. Among these, only one developed HSR (7.1%).
  
  
  CONCLUSIONS
  Cisplatin rechallenge is a feasible approach in patients experiencing HSR to carboplatin to maintain the beneficial effect of platinum while reducing hypersensitivity-related risks.
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy; Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bergamini
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pisano
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Napoli
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Arenare
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Della Pepa
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tambaro
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Facchini
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gargiulo
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rossetti
authors.affiliation: Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mangili
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy. Electronic address: s.pignata@istitutotumori.na.it.
authors.forename: S
authors.initials: S
authors.lastname: Pignata
authors.affiliation: Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy.
authors.forename: S C
authors.initials: SC
authors.lastname: Cecere
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012189:Retrospective Studies; D000093542:Gemcitabine
chemical_list: C506643:liposomal doxorubicin; D003841:Deoxycytidine; D011092:Polyethylene Glycols; D004317:Doxorubicin; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine
keywords: Adverse drug reaction; Carboplatin; Chemotherapy; Cisplatin; Hypersensitivity reaction; Ovarian cancer