4-step, 2-h carboplatin desensitization in Japanese patients with ovarian cancer: a prospective study

Meiko Nishimura,Hideki Sakai,Koji Matsumoto,Satoshi Morita,Noriyuki Katsumata,Genmu Kadokura,Takuma Onoe,Takaaki Yokoyama,Shogen Boku

doi:10.1007/s10147-021-01935-7

Abstract

BackgroundCarboplatin is a key drug for ovarian cancer. However, it sometimes induces hypersensitivity reactions (HSRs) that result in the discontinuation of the treatment. Although various desensitization protocols have been reported in previous retrospective studies, a limited number of prospective studies have analyzed these protocols.MethodsPatients with platinum-sensitive relapsed ovarian cancer who experienced carboplatin-induced HSRs were treated with diluted solutions of 1/1000, 1/100, 1/10 and an undiluted solution of carboplatin over a 1-h period. If no HSRs occurred within the first two cycles, a short protocol regimen over a 30-min period per solution was followed. The primary endpoint was treatment completion rate.ResultsBetween May 2015 and September 2018, 21 patients were enrolled from two institutions. One patient experienced platinum-sensitive recurrence after the desensitization protocol; thus, 22 sessions were analyzed. Epinephrine use, treatment-related death, and intensive care unit (ICU) admissions did not occur. The median number of desensitization cycles was 6 (range 1–6). Two sessions were discontinued early because of grade 2 dysgeusia and grade 2 malaise. Treatment in two (9.1%) patients was discontinued because of HSR development. The treatment completion rate was 90.9%. Six (27.3%) sessions met the criteria for transition to the short protocol regimen. In 14 (63.6%) sessions, HSRs were observed during infusion of the undiluted solution. The median progression-free survival and overall survival were 14.8 and 23.8 months, respectively.ConclusionThis 4-step, 2-h carboplatin desensitization protocol is safe and feasible. Patients require careful monitoring with a rapid response to HSRs, especially during the administration of undiluted solutions.

Highlights

Despite initial treatment with surgical induction and chemotherapy by carboplatin plus paclitaxel, the majority of patients with ovarian cancer relapse
Regimen was not changed in cases where the initial hypersensitivity reactions (HSRs) occurred during cycles, and we permitted patients with platinum-sensitive recurrence to change regimen in cases where the initial HSRs had occurred in the previous last cycles
The median cumulative number of carboplatin cycles at initial HSR was 10, and 90.9% of the patients received more than seven cycles of carboplatin

Summary

Introduction

Despite initial treatment with surgical induction and chemotherapy by carboplatin plus paclitaxel, the majority of patients with ovarian cancer relapse. The median survival time of carboplatin rechallenge in patients with platinum-sensitive recurrent ovarian cancer is approximately 30 months. Carboplatin is a key drug, especially for platinum-sensitive recurrent ovarian cancer. It sometimes induces hypersensitivity reactions (HSRs) that result. Carboplatin is a key drug for ovarian cancer It sometimes induces hypersensitivity reactions (HSRs) that result in the discontinuation of the treatment. Methods Patients with platinum-sensitive relapsed ovarian cancer who experienced carboplatin-induced HSRs were treated with diluted solutions of 1/1000, 1/100, 1/10 and an undiluted solution of carboplatin over a 1-h period. If no HSRs occurred within the first two cycles, a short protocol regimen over a 30-min period per solution was followed. One patient experienced platinum-sensitive recurrence after the desensitization protocol; 22 sessions were analyzed. Patients require careful monitoring with a rapid response to HSRs, especially during the administration of undiluted solutions

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Results

Conclusion