Successful intravenous desensitization of paclitaxel and cisplatin in adult ovarian cancer patients with prior anaphylactic reactions

Abstract

Rationale Paclitaxel and Cisplatin are chemotherapeutic agents commonly used in the treatment of gynecologic malignancies. Methods We present a case series of two adult patients with advanced stage ovarian cancer. Patient A had anaphylactic symptoms to Paclitaxel; she had one treatment of Paclitaxel prior. Patient B had a similar reaction to Cisplatin; she had six courses of Carboplatin and one course of Cisplatin before. Both patients developed shortness of breath, stridor, tachycardia and severe hypotension within the first 15 minutes of infusion of their chemotherapeutic regimen. Intravenous desensitization was performed in both patients in a monitored setting, under constant medical supervision, one day after anaphylaxis. Results Both patients successfully completed their intravenous desensitization protocol. Patient A had no significant adverse reactions except intermittent, brief episodes of asymptomatic tachycardia (defined as heart rate greater than 100) during desensitization. She was otherwise hemodynamically stable. Patient B had transient hives that lasted 15 minutes two hours post desensitization. She subsequently underwent her third cycle of treatment with Cisplatin under our repeat desensitization protocol without adverse sequelae. Conclusions Intravenous desensitization to the chemotherapeutic agents Paclitaxel and Cisplatin is possible, even immediately after anaphylaxis. Hypersensitivity reactions to Paclitaxel and Cisplatin do not necessarily preclude their future use in patients who need them as first line therapy.