Abstract
BackgroundOxaliplatin-based regimens induce a potential risk of hypersensitivity reaction (HSR), with incidence varying from 10% to 25% and lack of clearly identified risk factors. The present study aimed to assess incidence and risk factors in HSR.MethodsAll patients treated with oxaliplatin in the Medical Oncology Department of the Lyon Sud University Hospital (Hospices Civils de Lyon, France) from October 2004 to January 2011 were enrolled. Incidence and severity of HSR were analyzed retrospectively and the potential clinicopathological covariates were tested on univariate and multivariate analysis.ResultsA total of 1,221 doses of oxaliplatin were administered for 191 patients, 8.9% of whom experienced an HSR. Seventeen HSRs were observed, with 1.6% grade 3 and no grade 4 events. The first reaction appeared after a median of 3 oxaliplatin infusions. Using univariate analysis, HSR was associated with younger age (mean age, 56.2 years; p = 0.04), female gender (p = 0.01) and prior exposure to platinum salts (p = 0.02). No increased risk was associated with mean dose or with presence of atopic background. Multivariate analysis confirmed that women were at higher risk of oxaliplatin HSR than men (p < 0.05). Reintroduction of oxaliplatin was effective in 64.7% of hypersensitive patients using an appropriate premedication strategy. Patients who experienced a grade 3 HSR were not rechallenged.ConclusionThe risk of developing oxaliplatin HSR should not be underestimated (8.9% of patients). The medical team’s vigilance should be increased with women, younger patients and patients with prior exposure to platinum salts.
Highlights
Oxaliplatin-based regimens induce a potential risk of hypersensitivity reaction (HSR), with incidence varying from 10% to 25% and lack of clearly identified risk factors
We investigated the influence of prior exposure to platinum salts
Uniform approach to prevent oxaliplatin HSR has not been established and reintroduction remains associated with recurrence of HSR, which requires permanent withdrawal of oxaliplatin infusion with obvious harmful
Summary
Oxaliplatin-based regimens induce a potential risk of hypersensitivity reaction (HSR), with incidence varying from 10% to 25% and lack of clearly identified risk factors. Oxaliplatin, a third-generation platinum agent, has been approved for the treatment of metastatic colorectal cancer and for adjuvant treatment in stage-III colon cancer [4]. It is used worldwide in other malignancies, such as ovarian cancer [5]. Identifying patients with high risk of oxaliplatin-HSR is a major clinical issue and several studies assessed risk factors, with heterogeneous results [3,7,9,10,14]. Asian populations were mostly investigated [3,7,8,10,12,13,14,15], but only some studies evaluated the risk factors using multivariate analysis [3,7,9,12]
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