Anaphylactic Shock to Oxaliplatin in the Adjuvant Context

Abstract

Objective: To report a case of anaphylactic shock in a patient receiving oxaliplatin treatment. Case Summary: A 60-year-old Chinese woman received adjuvant oxaliplatin in combination with fluorouracil and folinic acid for treatment of stage 3 colon cancer. Shortly after initiation of her 12th infusion, she developed anaphylactic shock. She has since fully recovered from the adverse drug event. She was not rechallenged with oxaliplatin. Discussion: Severe hypersensitivity reactions to oxaliplatin are rare. An objective causality assessment using the Naranjo probability scale revealed that an adverse drug reaction to oxaliplatin was highly probable. Based on the Common Terminology Criteria for Adverse Events version 3 for defining reaction severity, our patient had experienced a grade 4 reaction, or anaphylaxis. Conclusions: With more widespread use of oxaliplatin in the treatment of early stage as well as advanced disease, the potential for more instances of severe hypersensitivity reactions exists, although the percentage of grade 4 reactions will likely remain rare. The role of intradermal skin testing to predict oxaliplatin sensitivity and the implementation of oxaliplatin desensitization protocols in cases of severe hypersensitivity reactions to this drug in the adjuvant setting may be useful.