E18 - A post-reaction regimen for CRC patients manifesting hypersensitivity to oxaliplatin : an effective alternative not to rule out an important option of treatment

Abstract

Background: Oxaliplatin based regimens are highly effective treatments for colorectal cancer (CRC) in both metastatic and adjuvant settings. Hypersensitivity reactions (HSRs) to Oxaliplatin are reported in about 12% of patients (pts), although life-threatening HSRs occur in only 1% of pts. Clinical manifestations include anaphylactic-like reactions : rush, urticaria, erythema, pruritus and rarely bronchospasm and hypotension.Different desensitization protocols involve serial diluitions of the total oxaliplatin dose or prolonged administration of oxaliplatin after premedication with steroids and antihistaminics.Patients and methods: We retrospectively evaluated hypersensitivity reactions in CRC pts treated with Oxaliplatin regimens at our Unit from Jan 2012 to Dec 2014. We adopted a post reaction regimen containing prolonged steroid premedication and slower oxaliplatin infusion as follows:Tabled 1drugdosedurationtimeprednisone50 mgdays -2,-1dexamethasone20 mg i.v.45 min before oxaliplatinchlorphenamine10 mg30 min before oxaliplatinranitidine50 mg i.v.30 min before oxaliplatinOxaliplatin85 mg/mq -q14 ore 135 mg/mq -q21360 min0 Open table in a new tab Results: Thirteen of 241 (5.4%) CRC pts treated with Oxaliplatin showed symptoms of HSRs and 8 of them had history of allergy. The HSRs occurred after a median course number of 2 (range 1–10). Three of 13 pts showed mild HSRs including a case of dry cough and 2 cases of itchy throat. 9/13 experienced severe HSRs according to CTAE v 2.0, including 8 cases of broncho-laringospasm (2 cases with dysphonia) and a case of diffuse skin rash. Each patient subsequently received oxaliplatin p-rR cycles and completed the treatment both in adjuvant and metastatic setting without further reactions. Median p-rR course number was 5.5 (2-8). A pt presented anaphylactic shock and definitively discontinued Oxaliplatin.Conclusion: We conclude that a post-reaction regimen including extended premedication and prolonged infusion of oxaliplatin might be safely adopted in the majority of patients after a severe HRSs. Background: Oxaliplatin based regimens are highly effective treatments for colorectal cancer (CRC) in both metastatic and adjuvant settings. Hypersensitivity reactions (HSRs) to Oxaliplatin are reported in about 12% of patients (pts), although life-threatening HSRs occur in only 1% of pts. Clinical manifestations include anaphylactic-like reactions : rush, urticaria, erythema, pruritus and rarely bronchospasm and hypotension.Different desensitization protocols involve serial diluitions of the total oxaliplatin dose or prolonged administration of oxaliplatin after premedication with steroids and antihistaminics. Patients and methods: We retrospectively evaluated hypersensitivity reactions in CRC pts treated with Oxaliplatin regimens at our Unit from Jan 2012 to Dec 2014. We adopted a post reaction regimen containing prolonged steroid premedication and slower oxaliplatin infusion as follows: Results: Thirteen of 241 (5.4%) CRC pts treated with Oxaliplatin showed symptoms of HSRs and 8 of them had history of allergy. The HSRs occurred after a median course number of 2 (range 1–10). Three of 13 pts showed mild HSRs including a case of dry cough and 2 cases of itchy throat. 9/13 experienced severe HSRs according to CTAE v 2.0, including 8 cases of broncho-laringospasm (2 cases with dysphonia) and a case of diffuse skin rash. Each patient subsequently received oxaliplatin p-rR cycles and completed the treatment both in adjuvant and metastatic setting without further reactions. Median p-rR course number was 5.5 (2-8). A pt presented anaphylactic shock and definitively discontinued Oxaliplatin. Conclusion: We conclude that a post-reaction regimen including extended premedication and prolonged infusion of oxaliplatin might be safely adopted in the majority of patients after a severe HRSs.