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Jimenez-Rodriguez TW, de Las Vecillas L, Labella M, Lynch DM, Besz KM, Marquis K, Burgos A, Soriano Gomis V, Lozano I, Antón RAM, de la Calle FM, González Delgado MP, Gutiérrez A, Montenegro E, Rodríguez F, Fernández Sánchez FJ, Castells M. Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization. Allergy 2024; 79:679-689. [PMID: 37916741 DOI: 10.1111/all.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Drug hypersensitivity reactions (DHRs) to platinum-based drugs are heterogenous and restrict their access, and drug desensitization (DD) has provided a ground-breaking procedure for their re-introduction, although the response is heterogeneous. We aimed to identify the phenotypes, endotypes, and biomarkers of reactions to carboplatin and oxaliplatin and their response to DD. METHODS Seventy-nine patients presenting with DHRs to oxaliplatin (N = 46) and carboplatin (N = 33) were evaluated at the Allergy Departments of two tertiary care hospitals in Spain. Patient symptoms, skin testing, biomarkers, and outcomes of 267 DDs were retrospectively analyzed. RESULTS Oxaliplatin-reactive patients presented with type I (74%), cytokine release reaction (CRR) (11%), and mixed (Mx) (15%) phenotypes. In contrast, carboplatin reactive patients presented with predominantly type I (85%) and Mx (15%) but no CRRs. Out of 267 DDs, breakthrough reactions (BTRs) to oxaliplatin occurred twice as frequently as carboplatin (32% vs. 15%; p < .05). Phenotype switching from type I to another phenotype was observed in 46% of oxaliplatin DDs compared to 21% of carboplatin DDs. Tryptase was elevated in type I and Mx reactions, and IL-6 in CRR and Mx, indicating different mechanisms and endotypes. CONCLUSION Carboplatin and oxaliplatin induced three different types of reactions with defined phenotypes and endotypes amendable to DD. Although most of the initial reactions for both were type I, oxaliplatin presented with unique CRR reactions. During DD, carboplatin reactive patients presented mostly type I BTR, while oxaliplatin-reactive patients frequently switched from type I to CRR, providing a critical difference and the need for personalized DD protocols.
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Affiliation(s)
- Teodorikez-Wilfox Jimenez-Rodriguez
- Allergy Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- ARADyAL Spanish Network (RD16/0006), Instituto de Salud Carlos III (ISCIII), Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
| | - Leticia de Las Vecillas
- Allergy Section, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Marina Labella
- ARADyAL Spanish Network (RD16/0006), Instituto de Salud Carlos III (ISCIII), Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Donna-Marie Lynch
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kylie Marie Besz
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Marquis
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amparo Burgos
- Pharmacy Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Victor Soriano Gomis
- Allergy Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- ARADyAL Spanish Network (RD16/0006), Instituto de Salud Carlos III (ISCIII), Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - Inmaculada Lozano
- Oncology Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rosa Ana Montoyo Antón
- Oncology Day Hospital Nursing Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Francisco Marco de la Calle
- Immunology Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Purificación González Delgado
- Allergy Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- ARADyAL Spanish Network (RD16/0006), Instituto de Salud Carlos III (ISCIII), Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - Aurora Gutiérrez
- Allergy Section, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Estefanía Montenegro
- Allergy Section, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Fernando Rodríguez
- Allergy Section, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Francisco Javier Fernández Sánchez
- Allergy Section, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- ARADyAL Spanish Network (RD16/0006), Instituto de Salud Carlos III (ISCIII), Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zwimpfer TA, Scherer K, Schötzau A, Heinzelmann‐Schwarz V, Hartmann K, Vetter M, Montavon C. Desensitization in patients with hypersensitivity to platinum and taxane in gynecological cancers. Cancer Med 2023; 13:e6840. [PMID: 38140783 PMCID: PMC10807606 DOI: 10.1002/cam4.6840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Exposure to paclitaxel and carboplatin has the risk of developing hypersensitivity reactions (HSRs), which could necessitate using less effective treatments to avoid anaphylaxis. Desensitization to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen; therefore, this study investigated rates and benefits of successful desensitization in patients with gynecologic cancers (GC). METHODS We collected data from 241 patients with GC who had at least one cycle of platinum or taxane chemotherapy. The rate of HSRs and successful desensitization were evaluated, and an outcome analysis was conducted. RESULTS The rate of HSRs to platinum and taxane was 6.39% and 13.07%, respectively. We observed a 100% success rate of desensitization in our cohort. Patients with HSR were significantly younger (57.1 vs. 64.9 years, p = 0.030) in the taxane cohort. Importantly, the overall survival (OS) of patients with platinum and taxane HSRs who underwent desensitization was comparable to that of patients with no HSRs (platinum vs. controls; median OS 60.36 vs. 60.39 months, p = 0.31; taxane vs. controls; OS 80.29 vs. 60.00 months, p = 0.59). CONCLUSION Thus, we show that desensitization for platinum and taxane HSRs is safe and effective, resulting in an outcome that is well comparable to patients without HSR. Based on these observations, desensitization procedures might be considered as standard of care before switching to less effective treatment for patients with GC.
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Affiliation(s)
- Tibor A. Zwimpfer
- Department of Gynecology and Gynecological Oncology, Hospital for WomenUniversity Hospital BaselBaselSwitzerland
- Gynecological Cancer CenterUniversity Hospital BaselBaselSwitzerland
- Peter MacCallum Cancer CenterEast MelbourneVictoriaAustralia
| | - Kathrin Scherer
- Division of Allergy Unit, Department of DermatologyCantonal Hospital AarauAarauSwitzerland
| | - Andreas Schötzau
- Department of Gynecology and Gynecological Oncology, Hospital for WomenUniversity Hospital BaselBaselSwitzerland
| | - Viola Heinzelmann‐Schwarz
- Department of Gynecology and Gynecological Oncology, Hospital for WomenUniversity Hospital BaselBaselSwitzerland
- Gynecological Cancer CenterUniversity Hospital BaselBaselSwitzerland
| | - Karin Hartmann
- Department of DermatologyUniversity Hospital BaselBaselSwitzerland
| | - Marcus Vetter
- Cancer Center, Cantonal Hospital BasellandMedical University ClinicLiestalSwitzerland
| | - Céline Montavon
- Department of Gynecology and Gynecological Oncology, Hospital for WomenUniversity Hospital BaselBaselSwitzerland
- Gynecological Cancer CenterUniversity Hospital BaselBaselSwitzerland
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3
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Joshi SR, Salinas W, Khan DA. Drug Hypersensitivity. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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4
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Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J, Khan DA, Golden DBK, Shaker M, Stukus DR, Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol 2022; 150:1333-1393. [PMID: 36122788 DOI: 10.1016/j.jaci.2022.08.028] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Aleena Banerji
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Roland Solensky
- Corvallis Clinic, Oregon State University/Oregon Health Science University College of Pharmacy, Corvallis, Ore
| | - Andrew A White
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Matthew J Greenhawt
- Food Challenge and Research Unit Section of Allergy and Immunology, Children's Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
| | - Caroline C Horner
- Department of Pediatrics, Division of Allergy Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla; James A. Haley Veterans Affairs Hospital, Tampa, Fla
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
| | - John Oppenheimer
- Division of Allergy, Rutgers New Jersey Medical School, Rutgers, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Dana Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Bergmann C, Poli A, Agache I, Bianchini R, Bax HJ, Castells M, Crescioli S, Dombrowicz D, Ferastraoaru D, Fiebiger E, Gould HJ, Hartmann K, Izquierdo E, Jordakieva G, Josephs DH, Jutel M, Levi‐Schaffer F, de las Vecillas L, Lotze MT, Osborn G, Pascal M, Redegeld F, Rosenstreich D, Roth‐Walter F, Schmidt‐Weber C, Shamji M, Steveling EH, Turner MC, Untersmayr E, Jensen‐Jarolim E, Karagiannis SN. AllergoOncology: Danger signals in allergology and oncology: A European Academy of Allergy and Clinical Immunology (EAACI) Position Paper. Allergy 2022; 77:2594-2617. [PMID: 35152450 PMCID: PMC9545837 DOI: 10.1111/all.15255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023]
Abstract
The immune system interacts with many nominal 'danger' signals, endogenous danger-associated (DAMP), exogenous pathogen (PAMP) and allergen (AAMP)-associated molecular patterns. The immune context under which these are received can promote or prevent immune activating or inflammatory mechanisms and may orchestrate diverse immune responses in allergy and cancer. Each can act either by favouring a respective pathology or by supporting the immune response to confer protective effects, depending on acuity or chronicity. In this Position Paper under the collective term danger signals or DAMPs, PAMPs and AAMPs, we consider their diverse roles in allergy and cancer and the connection between these in AllergoOncology. We focus on their interactions with different immune cells of the innate and adaptive immune system and how these promote immune responses with juxtaposing clinical outcomes in allergy and cancer. While danger signals present potential targets to overcome inflammatory responses in allergy, these may be reconsidered in relation to a history of allergy, chronic inflammation and autoimmunity linked to the risk of developing cancer, and with regard to clinical responses to anti-cancer immune and targeted therapies. Cross-disciplinary insights in AllergoOncology derived from dissecting clinical phenotypes of common danger signal pathways may improve allergy and cancer clinical outcomes.
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Affiliation(s)
- Christoph Bergmann
- Department of OtorhinolaryngologyRKM740 Interdisciplinary ClinicsDüsseldorfGermany
| | - Aurélie Poli
- Neuro‐Immunology GroupDepartment of OncologyLuxembourg Institute of HealthLuxembourgLuxembourg
| | - Ioana Agache
- Faculty of MedicineTransylania University BrasovBrasovRomania
| | - Rodolfo Bianchini
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria
| | - Heather J. Bax
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,School of Cancer and Pharmaceutical SciencesGuy's Hospital, King's College LondonLondonUnited Kingdom
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Silvia Crescioli
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom
| | - David Dombrowicz
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐EGIDLilleFrance
| | - Denisa Ferastraoaru
- Department of Internal Medicine/Allergy and Immunology, Montefiore Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Edda Fiebiger
- Division of Gastroenterology, Hepatology and Nutrition Research, Department of Medicine ResearchChildren's University Hospital BostonBostonMassachusettsUSA
| | - Hannah J. Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic & Medical BiosciencesKing's College London, New Hunt's HouseLondonUnited Kingdom,Medical Research Council & Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUnited Kingdom
| | - Karin Hartmann
- Department of DermatologyUniversity of BaselBaselSwitzerland
| | - Elena Izquierdo
- IMMA, School of Medicine, Institute of Applied Molecular MedicineCEU San Pablo UniversityMadridSpain
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational MedicineMedical University of ViennaViennaAustria
| | - Debra H. Josephs
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,School of Cancer and Pharmaceutical SciencesGuy's Hospital, King's College LondonLondonUnited Kingdom
| | - Marek Jutel
- Department of Clinical ImmunologyWroclaw Medical UniversityWroclawPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | - Francesca Levi‐Schaffer
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Faculty of MedicineThe Institute for Drug Research, The Hebrew University of JerusalemJerusalemIsrael
| | | | - Michael T. Lotze
- G.27A Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Gabriel Osborn
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom
| | - Mariona Pascal
- Department of Immunology, CDB, Hospital Clinic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de BarcelonaBarcelonaSpain
| | - Frank Redegeld
- Division of Pharmacology, Faculty of ScienceUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands
| | - David Rosenstreich
- Department of Internal Medicine/Allergy and Immunology, Montefiore Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Franziska Roth‐Walter
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria,Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Carsten Schmidt‐Weber
- Center of Allergy & Environment (ZAUM)Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental HealthMunichGermany,German Center for Lung Research (DZL)MunichGermany
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical ImmunologyImperial College LondonLondonUnited Kingdom
| | | | | | - Eva Untersmayr
- Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Erika Jensen‐Jarolim
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria,Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Sophia N. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,Breast Cancer Now Research UnitSchool of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital,LondonSE1 9RTUnited Kindgom
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Pagani M, Bavbek S, Alvarez‐Cuesta E, Berna Dursun A, Bonadonna P, Castells M, Cernadas J, Chiriac A, Sahar H, Madrigal‐Burgaleta R, Sanchez Sanchez S. Hypersensitivity reactions to chemotherapy: an EAACI Position Paper. Allergy 2022; 77:388-403. [PMID: 34587281 DOI: 10.1111/all.15113] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/30/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022]
Abstract
Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.
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Affiliation(s)
- Mauro Pagani
- Department of Medicine Medicine Ward C. Poma Mantova HospitalASST Mantova Mantova Italy
| | - Sevim Bavbek
- Division of Immunology and Allergy Department of Chest Diseases Ankara University School of Medicine Ankara Turkey
| | | | - Adile Berna Dursun
- Department of Immunology and Allergic Diseases Recep Tayyip Erdoğan University Rize Turkey
| | | | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy Department of Medicine Brigham and Women's HospitalHarvard Medical School Boston Massachusetts USA
| | - Josefina Cernadas
- Department of Allergy and Clinical Immunology Medical University, H. S. Joao Porto Portugal
| | - Anca Chiriac
- Division of Allergy Department of Pulmonology Hôpital Arnaud de VilleneuveUniversity Hospital of Montpellier Montpellier France
| | - Hamadi Sahar
- The Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
| | - Ricardo Madrigal‐Burgaleta
- Allergy & Severe Asthma Service St Bartholomew's Hospital'sBarts Health NHS Trust London UK
- Drug Desensitisation Centre Catalan Institute of Oncology (ICO) Bellvitge University Hospital Barcelona Spain
| | - Soledad Sanchez Sanchez
- Division of Allergy & Clinical Immunology Department of Medicine University Hospital Complex of A Coruna A Coruna Spain
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7
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Hwang WY, Lee M, Suh DH, Kim K, No JH, Kim YB, Kim JH. Risk factors for and prognosis of carboplatin-related hypersensitivity in patients with epithelial ovarian cancer. Arch Gynecol Obstet 2022; 306:443-449. [PMID: 35044514 DOI: 10.1007/s00404-022-06403-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to identify the predictive risk factors for carboplatin-related hypersensitive reactions (HRs) and investigate their impact on survival outcomes in patients with epithelial ovarian cancer (EOC). METHODS This retrospective study included 222 patients with EOC who received carboplatin infusion between July 2016 and November 2019. We compared the clinicopathologic characteristics and survival outcomes between carboplatin-related hypersensitivity and non-hypersensitivity groups. Hypersensitivity data were classified using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, categorizing grades from 1 to 5 as mild/moderate/severe/life-threatening/death. Multiple logistic regression analysis was used to analyze risk factors of HRs. The Cox proportional hazard regression model was used to determine the factors of being significantly associated with overall survival. RESULTS Of the 222 patients, eight exhibited HRs (incidence rate, 3.6%). All HRs were of grade 3 or 4 (life-threatening). In all cases, a desensitization protocol was followed. Advanced stage (III or IV) (P = 0.022), previous history of carboplatin use (P < 0.001), and recurrent ovarian cancer (P = 0.001) were significantly associated with HR to carboplatin. Multivariate logistic analysis showed that a previous history of carboplatin was the only independent risk factor for carboplatin-related hypersensitivity (OR, 20.19; 95% CI 1.22 - 3034.10; P = 0.034). However, HR to carboplatin did not influence the overall survival (P = 0.526). CONCLUSION In EOC patients, prior use of carboplatin was an independent risk factor for carboplatin-related HRs; HRs to carboplatin did not influence the overall survival. Clinicians should not underestimate the possibility risk of carboplatin HSRs when re-administrating carboplatin in EOC patients.
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Affiliation(s)
- Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Minjung Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ju-Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea.
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The Role of Skin Tests in the Prevention and Diagnosis of Hypersensitivity Reactions to Platinum Agents in Gynecological Cancer: A Single-Center Italian Retrospective Study. Cancers (Basel) 2021; 13:cancers13215468. [PMID: 34771629 PMCID: PMC8582380 DOI: 10.3390/cancers13215468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The development of hypersensitivity reactions to platinum agents in patients with gynecological cancers limits the use of platinum re-treatment for recurrent disease. In those patients who developed a hypersensitivity reactions during treatment with platinum agents it could be safer to undergo allergy diagnosis. This approach includes the in-vivo skin tests before re-exposure to the platinum agent, especially in those patients who have to undergo a 2nd or 3rd line therapy. In our experience, skin test for platinum agents resulted in a simple and sensitive tool for the diagnosis and prevention of hypersensitivity reactions to platinum agents. In addition, this approach identified a sub-group of patients that became sensitized to the platinum agent during the previous platinum-based therapy. Abstract Background: Hypersensitivity reactions (HSR)s to platinum agents are increasing in frequency, due to their extensive use and repeated exposures in patients with increased life expectancy. The aims of our study are to analyze the frequency of both type I and type IV HSRs in patients with gynecological cancer treated with (CBDCA) carboplatin and/or (CDDP) cisplatin, to evaluate the role of skin tests in the diagnosis and prevention of HSRs. Methods: From 2011 to 2018, we evaluated 124 consecutive female patients previously treated with CBDCA and/or CDDP for gynecological cancer. All patients, including those with and without HSR to previous platinum-based therapy, underwent in-vivo skin tests for platinum agents before starting the second or more therapeutic lines. To reduce the risk of false negative results, patients with a negative skin test at the first evaluation were re-tested after 3 weeks from the platinum re-exposure. Results: Among the 124 patients evaluated, 58 (47%) experienced HSRs to at least one platinum agent: 35% were to CBDCA, 5% to CDDP, 7% to both. Fifty-six of the 58 HSRs were classified as immediate and two delayed. Skin tests confirmed an IgE-dependent mechanism in 67% of patients with immediate-HSRs to CBDCA and identified a cross-reactivity between platinum agents in 18% of patients. Moreover, among those who had never developed an HSRs during platinum-based therapy, in-vivo skin tests identified 12% of sensitized patients. Conclusions: On the basis of our findings, skin test for platinum agents is a simple and sensitive tool for the diagnosis and prevention of HSRs to CBDCA and/or CDDP and can be useful for detecting possible cross-reactivity among platinum agents.
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Abstract
Hypersensitivity reactions (HSRs) to chemotherapy agents can present a serious challenge to treating patients with preferred or first-line therapies. Allergic reactions through an immunologic mechanism have been established for platinum and taxane agents, which are used to treat a wide variety of cancers including gynecologic cancers. Platin HSRs typically occur after multiple cycles of chemotherapy, reflecting the development of drug IgE sensitization, while taxane HSRs often occur on first or second exposure. Despite observed differences between platin and taxane HSRs, drug desensitization has been an effective method to reintroduce both chemotherapeutic agents safely. Skin testing is the primary diagnostic tool used to risk-stratify patients after initial HSRs, with more widespread use for platinum agents than taxanes. Different practices exist around the use of skin testing, drug challenge, and choice of desensitization protocol. Here, we review the epidemiology, mechanism, and clinical presentation of HSRs to platinum and taxane agents, as well as key controversies in their evaluation and management.
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Nishimura M, Sakai H, Onoe T, Boku S, Yokoyama T, Kadokura G, Morita S, Katsumata N, Matsumoto K. 4-step, 2-h carboplatin desensitization in Japanese patients with ovarian cancer: a prospective study. Int J Clin Oncol 2021; 26:1553-1560. [PMID: 34037884 PMCID: PMC8286943 DOI: 10.1007/s10147-021-01935-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/08/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Carboplatin 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. 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. The primary endpoint was treatment completion rate. RESULTS Between 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. CONCLUSION This 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.
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Affiliation(s)
- Meiko Nishimura
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Hideki Sakai
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Takuma Onoe
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Shogen Boku
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
- Cancer Treatment Center, Kansai Medical University Hospital, Osaka, Japan
| | - Takaaki Yokoyama
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Genmu Kadokura
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
- Department of Medical Oncology, Suwa Central Hospital, Nagano, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriyuki Katsumata
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Koji Matsumoto
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan.
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Drug Desensitizations for Chemotherapy: Safety and Efficacy in Preventing Anaphylaxis. Curr Allergy Asthma Rep 2021; 21:37. [PMID: 34232411 DOI: 10.1007/s11882-021-01014-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/17/2022]
Abstract
Hypersensitivity reactions (HSRs) to antineoplastic drugs are increasing due to the expanding use of classical and new drugs in a wide variety of malignancies. PURPOSE OF REVIEW: The goal of this review is to provide current best practices in the diagnosis and management of HSRs based on data and evidence. RECENT FINDINGS: A plethora of studies have provided evidence of the safety and efficacy of rapid drug desensitizations (RDD) to allow for the reintroduction of antineoplastic drugs following an HSR, based on risk stratification. Recently described biomarkers such as basophil activation test, total IgE, BRCA genotyping, and serum IL-6 can aid in guiding improved precision desensitization protocols. Personalized premedication regimens and protocols have improved RDD safety and outcomes. RDD allows for the continued use of chemotherapeutic drugs without impaired drug efficacy. RDD represents the best approach to maintain cancer patients on their most effective treatments.
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Giannone G, Scotto G, Katsaros D, De Giorgi U, Farolfi A, Borella F, Cosma S, Ferrero A, Mangiacotti S, Villa M, Tuninetti V, Ghisoni E, Turinetto M, Mittica G, Gemmiti S, Zavallone L, Aglietta M, Pasini B, Di Maio M, Valabrega G. Hypersensitivity to platinum salts according to BRCA status in ovarian cancer: A retrospective analysis of clinical outcomes and systematic review of literature. Gynecol Oncol 2021; 162:80-87. [PMID: 33896588 DOI: 10.1016/j.ygyno.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypersensitivity reactions (HSRs) to platinum are an important issue in the treatment of patients (pts) with ovarian cancer (OC). Germline BRCA mutations have been proposed as a risk factor. We aimed at evaluating the incidence and severity of HSRs to platinum in OC pts. with known BRCA status. PATIENTS AND METHODS We retrospectively analyzed 432 pts. from 5 Italian Centers. In addition, we performed a systematic review and meta-analysis of published series. RESULTS Four hundred nine pts. received at least one prior platinum-based treatment line: 314 were BRCA wild type (77%) and 95 were BRCA mutated (23%). There was no statistical difference in exposure to platinum. Incidence of any grade HSRs was higher among BRCA mutated pts. [9% vs 18%, p = 0.019] and the time-to-HSRs curves show that the risk increases with the duration of platinum exposure, in BRCA mutated pts. more than in BRCA wild type. A multivariable analysis showed that harboring a germline BRCA mutation was related to a higher incidence of HSRs (HR: 1.84, 95% CI 1.00-3.99, p = 0.05) while having received pegylated liposomal doxorubicin (PLD) was related to a lower incidence of HSRs (HR: 0.03 95% CI 0.004-0.22, p = 0.001). The systematic review confirmed the higher incidence of HSRs in BRCA mutated pts., though heterogeneity among series was significant. CONCLUSIONS In OC pts. with BRCA mutations, there is a significantly higher incidence of HSRs to carboplatin, not justified by longer drug exposure. On the other hand, PLD exerted a protective role in our series.
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Affiliation(s)
- G Giannone
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy.
| | - G Scotto
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - D Katsaros
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - U De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - F Borella
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - S Cosma
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - A Ferrero
- Academic Department Gynaecology and Obstetrics, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | | | - M Villa
- Academic Department Gynaecology and Obstetrics, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - V Tuninetti
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - E Ghisoni
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - M Turinetto
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - G Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Omegna (VB), Italy
| | - S Gemmiti
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - L Zavallone
- Department of Medical Oncology, Infermi Hospital, Biella, Italy
| | - M Aglietta
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - B Pasini
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - G Valabrega
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
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Lorusso D, González-Martín A, Ray-Coquard I. Managing recurrent ovarian cancer in daily clinical practice: case studies and evidence review with a focus on the use of trabectedin. Future Oncol 2021; 17:9-19. [DOI: 10.2217/fon-2020-1123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Following the failure of first-line platinum-based chemotherapy in ovarian cancer, options for further therapy in potentially platinum-responsive patients are: carboplatin doublets with pegylated liposomal doxorubicin, gemcitabine or paclitaxel in association with bevacizumab, followed by maintenance with bevacizumab (for nonpretreated patients); or maintenance monotherapy with a poly(ADP-ribose) polymerase inhibitor after a response. The choice of biological therapy depends on a patient’s previous treatments and priority for a symptomatic response. In cases of a rapidly growing tumor or need for symptomatic relief, the addition of bevacizumab should be considered. Patients with limited potential sensitivity to platinum, such as those with a platinum treatment-free interval of 6–12 months, may benefit from intercalation with trabectedin and pegylated liposomal doxorubicin to possibly restore platinum sensitivity.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Isabelle Ray-Coquard
- Centre Leon Bérard, Laboratoire HESPER Université Claude Bernard Lyon 1, Lyon, France
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Tüzer C, Sari M, Aktaş Çetin E, Ak N, Büyüköztürk S, Çolakoğlu B, Mualla Saip P, Deniz G, Gelincik A. Rapid drug desensitization for platinum-based chemotherapy drugs significantly increases peripheral blood IL-10 levels. Allergy 2020; 75:2942-2945. [PMID: 32277714 DOI: 10.1111/all.14311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Can Tüzer
- Division of Allergy and Immunology Istanbul Faculty of Medicine Department of Internal Medicine Istanbul University Istanbul Turkey
| | - Murat Sari
- Institute of Oncology Medical Oncology Istanbul University Istanbul Turkey
| | - Esin Aktaş Çetin
- Institute of Experimental Medicine (DETAE) Immunology Istanbul University Istanbul Turkey
| | - Naziye Ak
- Institute of Oncology Medical Oncology Istanbul University Istanbul Turkey
| | - Suna Büyüköztürk
- Division of Allergy and Immunology Istanbul Faculty of Medicine Department of Internal Medicine Istanbul University Istanbul Turkey
| | - Bahattin Çolakoğlu
- Division of Allergy and Immunology Istanbul Faculty of Medicine Department of Internal Medicine Istanbul University Istanbul Turkey
| | - Pınar Mualla Saip
- Institute of Oncology Medical Oncology Istanbul University Istanbul Turkey
| | - Günnur Deniz
- Institute of Experimental Medicine (DETAE) Immunology Istanbul University Istanbul Turkey
| | - Aslı Gelincik
- Division of Allergy and Immunology Istanbul Faculty of Medicine Department of Internal Medicine Istanbul University Istanbul Turkey
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15
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Rolfe M, Gegeckas C, Turner S, Orr JW. Predictive factors for carboplatin hypersensitivity reactions in gynecologic cancers: Effect of BRCA status. J Oncol Pharm Pract 2020; 27:1704-1709. [DOI: 10.1177/1078155220967988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Carboplatin hypersensitivity reactions have been reported to occur in up to 16% of patients with gynecologic cancers. Several predisposing factors have been suggested including presence of BRCA1/2 mutation, however, contribution of these mutations to reaction development has not been extensively studied. The purpose of this study was to determine if there is an association between BRCA1/2 mutation status and the development of carboplatin hypersensitivity reactions. Methodology: Eligible patients were women aged 18 years or older with a diagnosis of ovarian, fallopian tube, uterine, endometrial, or primary peritoneal cancer who attempted to receive at least one dose of carboplatin. The primary outcome was the effect of BRCA1/2 status on the development of carboplatin hypersensitivity reactions with regard to: reaction frequency, timing, and severity. Secondary outcomes included identification of additional risk factors that may help identify predisposition to carboplatin hypersensitivity reaction. Results A total of 44 patients were included in this study. Five patients (38%) in the reaction group and 4 patients (31%) in the no reaction group had a documented mutation in one or both BRCA genes (p = 1.00). No significant differences were found in terms of reaction severity or symptoms, and timing of reaction after dose administration. Incidence of thyroid disorder was significantly higher among patients who experienced a hypersensitivity reaction (1 (4%) vs 10 (45%); p = 0.004). Conclusion BRCA mutation status was not associated with an increased risk of carboplatin hypersensitivity in our patient population. Further investigation into thyroid dysfunction as a risk factor for reaction development is warranted.
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Affiliation(s)
| | | | | | - James W Orr
- Fl Gynecologic Oncology & Regional Cancer Care, Fort Myers, FL, USA
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16
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Tomao F, Boccia SM, Sassu CM, Chirra M, Palaia I, Petrella MC, Di Donato V, Colombo N, Benedetti Panici P. First-Line Treatment with Olaparib for Early Stage BRCA-Positive Ovarian Cancer: May It Be Possible? Hypothesis Potentially Generating a Line of Research. Cancer Manag Res 2020; 12:5479-5489. [PMID: 32765062 PMCID: PMC7369298 DOI: 10.2147/cmar.s194874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/09/2020] [Indexed: 01/01/2023] Open
Abstract
Olaparib is currently approved in maintenance treatment of advanced ovarian cancer after response to first-line chemotherapy for breast related cancer antigens (BRCA) mutated patients. The use of this agent is based on data from SOLO1 study that observed a decreased risk of disease progression or death and a median progression-free survival about 36 months longer in case of therapy with olaparib. However, this trial recruited only patients with advanced stage ovarian cancer. The aim of this review is to retrace the available data in order to clarify the potential efficacy and feasibility of olaparib administration in newly diagnosed epithelial ovarian cancer also in early stages.
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Affiliation(s)
- Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Serena Maria Boccia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome,Polyclinic Umberto I, Rome, Italy
| | - Carolina Maria Sassu
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome,Polyclinic Umberto I, Rome, Italy
| | - Martina Chirra
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome,Polyclinic Umberto I, Rome, Italy
| | | | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome,Polyclinic Umberto I, Rome, Italy
| | - Nicoletta Colombo
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome,Polyclinic Umberto I, Rome, Italy
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Allergy Evaluation of Hypersensitivity to Platinum Salts and Taxanes: A Six-Year Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1658-1664. [DOI: 10.1016/j.jaip.2019.12.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 01/27/2023]
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18
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Jakubovic BD, Vecillas LDL, Jimenez-Rodriguez TW, Sanchez-Sanchez S, Castells M. Drug hypersensitivity in the fast lane: What clinicians should know about phenotypes, endotypes, and biomarkers. Ann Allergy Asthma Immunol 2020; 124:566-572. [PMID: 32302769 DOI: 10.1016/j.anai.2020.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review novel concepts in drug hypersensitivity and the management of immediate hypersensitivity reactions. DATA SOURCES English language literature on MEDLINE and Embase surrounding drug hypersensitivity and desensitization. STUDY SELECTIONS References were selected based on relevance, date of publication, and originality. RESULTS There are numerous citations looking at categorizing drug reactions, pathogenesis, biomarkers, and desensitization. Current understanding supports the use of a phenotype-endotype-biomarker model for categorizing immediate hypersensitivity reactions. Drug desensitization is a powerful therapeutic strategy that enables temporary induction of tolerance to medications that triggered immediate reactions. CONCLUSION Immediate hypersensitivity reactions are diverse in presentation and pathogenesis. Drug desensitization is an effective intervention with sufficient evidence to support its more widespread availability.
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Affiliation(s)
- Baruch D Jakubovic
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Leticia de Las Vecillas
- Divison of Allergy, Marqués de Valdecilla University Hospital-Instituto de Investigacion Marques de Valdecilla (IDIVAL), Santander, Spain
| | | | - Soledad Sanchez-Sanchez
- Division of Allergy & Clinical Immunology, Department of Medicine, University Hospital Complex of A Coruna, A Coruna, Spain
| | - Mariana Castells
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts
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Kristeleit RS, Oaknin A, Ray-Coquard I, Leary A, Balmaña J, Drew Y, Oza AM, Shapira-Frommer R, Domchek SM, Cameron T, Maloney L, Goble S, Lorusso D, Ledermann JA, McNeish IA. Antitumor activity of the poly(ADP-ribose) polymerase inhibitor rucaparib as monotherapy in patients with platinum-sensitive, relapsed, BRCA-mutated, high-grade ovarian cancer, and an update on safety. Int J Gynecol Cancer 2020; 29:1396-1404. [PMID: 31685558 DOI: 10.1136/ijgc-2019-000623] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To report results from an integrated efficacy and safety analysis supporting the European Commission's approval of the poly(ADP-ribose) polymerase inhibitor rucaparib as monotherapy treatment for relapsed, platinum-sensitive, BRCA-mutated ovarian cancer. METHODS Efficacy was analyzed in platinum-sensitive patients from Study 10 (NCT01482715) and ARIEL2 (NCT01891344) who had high-grade serous or endometrioid epithelial ovarian, fallopian tube, or primary peritoneal cancer and a deleterious BRCA1 or BRCA2 mutation and received two or more prior chemotherapies (including two or more platinum-based therapies). The primary end point was investigator-assessed, confirmed objective response rate (visit cut-off: April 10, 2017). Safety was analyzed in patients with ovarian cancer, regardless of BRCA mutation status or lines of prior chemotherapies, who received at least one dose of rucaparib 600 mg in either study (visit cut-off: December 31, 2017). RESULTS In the integrated platinum-sensitive efficacy population (n=79), objective response rate was 64.6% (95% CI, 53.0 to 75.0); 10.1% (8/79) of patients had a complete response and 54.4% (43/79) had a partial response. Median duration of response was 294 days (95% CI, 224 to 393). In the integrated safety population (n=565), the most common any-grade treatment-emergent adverse events were nausea (77.7%, 439/565), asthenia/fatigue (74.7%, 422/565), vomiting (45.8%, 259/565), and hemoglobin decreased (44.2%, 250/565). Treatment-emergent adverse events led to treatment interruption, dose reduction, or discontinuation in 60.2% (340/565), 46.0% (260/565), and 16.8% (95/565) of patients. CONCLUSIONS In patients with platinum-sensitive, BRCA-mutated ovarian cancer, rucaparib demonstrated antitumor activity and is the first and currently the only poly(ADP-ribose) polymerase inhibitor approved by the European Commission as treatment for this population. The safety analysis used a more recent visit cut-off date and larger population than previously published, was consistent with prior reports, and was the basis for the treatment-indication safety population in rucaparib's recently updated European Union label.
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Affiliation(s)
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Isabelle Ray-Coquard
- Centre Léon Bérard and University Claude Bernard and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon, France
| | - Alexandra Leary
- Gustave Roussy Cancer Center, INSERM U981, and GINECO, Villejuif, France
| | - Judith Balmaña
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Yvette Drew
- Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust and Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Susan M Domchek
- Abramson Cancer Center, Basser Center for BRCA, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Zhong R, Li H, Liu Y, Zhang S, Liu J, Huang Z, Cheng Y. Chemotherapy combined with bevacizumab for the treatment of advanced lung adenocarcinoma cancer harboring EGFR-ANXA2, EGFR-RAD51, ATR and BRCA2 mutations: A case report. Thorac Cancer 2019; 11:456-460. [PMID: 31865638 PMCID: PMC6997000 DOI: 10.1111/1759-7714.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 12/27/2022] Open
Abstract
Here, we report a case of a 36‐year‐old female patient with metastatic non‐small cell lung cancer (NSCLC) harboring EGFR‐ANXA2 and EGFR‐RAD51 double fusion mutations with BRCA2 (nonsense mutation of exon 11) and ATR mutations (Exon 44 variable shear mutation) identified by next generation sequencing (NGS). The efficacy was significantly improved after lobaplatin combined with pemetrexed, temozolomide and bevacizumab. This is the first report of a novel mutation type EGFR‐ANXA2, as well as double EGFR fusion mutations in advanced lung adenocarcinoma. Furthermore, platinum‐based chemotherapy plus bevacizumab rather than targeted therapy showed favorable effects in this patient, providing a novel therapeutic conception for patients, even with multidriver mutations.
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Affiliation(s)
- Rui Zhong
- Translational Cancer Research Lab, Jilin Cancer Hospital, Changchun, China
| | - Hui Li
- Translational Cancer Research Lab, Jilin Cancer Hospital, Changchun, China
| | - Yanling Liu
- Department of Medical Breast Oncology, Jilin Cancer Hospital, Changchun, China
| | - Shuang Zhang
- Department of Medical Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Jingjing Liu
- Department of Medical Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Zhicheng Huang
- Department of Radiation, Jilin Cancer Hospital, Changchun, China
| | - Ying Cheng
- Translational Cancer Research Lab, Jilin Cancer Hospital, Changchun, China.,Department of Medical Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
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21
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Bergamini A, Bocciolone L, Fodor A, Candiani M, Mangili G. Management of recurrent ovarian cancer: when platinum-based regimens are not a therapeutic option. Int J Gynecol Cancer 2019; 29:1431-1436. [PMID: 31537620 DOI: 10.1136/ijgc-2019-000624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022] Open
Abstract
Ovarian cancer relapses have been traditionally classified according to the platinum-free interval, leading to an arbitrary categorization of possible scenarios and treatment options. Its relevance in assessing treatment strategies has been revised in the last several years, as the panorama is constantly changing in the era of personalized medicine and targeted therapies. Factors to be considered while defining the best management of recurrent disease, and, consequently, the available treatment alternatives are increasing. Platinum remains one of the milestones of ovarian cancer treatment, but for some patients it might not be an ideal choice for several reasons other than limited platinum sensitivity. This review aims to analyze the scenarios in which platinum is not considered suitable in the management of patients with recurrent ovarian cancer, and the currently available alternatives.
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Affiliation(s)
- Alice Bergamini
- Obstetrics and Gynecology, Ospedale San Raffaele, Milano, Italy .,Università Vita Salute San Raffaele, Milano, Italy
| | - Luca Bocciolone
- Obstetrics and Gynecology, Ospedale San Raffaele, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, Ospedale San Raffaele, Milano, Italy
| | | | - Giorgia Mangili
- Obstetrics and Gynecology, Ospedale San Raffaele, Milano, Italy
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22
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Garcia A, Frahm C, Jeter JM, Abraham I, Chambers SK, Cragun JM, McBride A. Incidence of Hypersensitivity Reactions to Carboplatin or Paclitaxel in Patients With Ovarian, Fallopian Tube, or Primary Peritoneal Cancer With or Without BRCA1 or BRCA2 Mutations. J Adv Pract Oncol 2019; 10:428-439. [PMID: 33457057 PMCID: PMC7779569 DOI: 10.6004/jadpro.2019.10.5.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The association of BRCA mutation status with hypersensitivity reactions (HSRs) to carboplatin has gained interest in recent years, particularly in patients with ovarian, fallopian tube, and primary peritoneal cancer. The primary objective of this study is to determine whether the presence of BRCA mutations increased the likelihood of HSRs to carboplatin. The incidence of HSRs to paclitaxel and symptom grade based on the Common Terminology Criteria for Adverse Events, version 4.0, were explored as secondary endpoints. A retrospective chart review of patients with ovarian, fallopian tube, or primary peritoneal cancer at the University of Arizona Cancer Center who underwent treatment with carboplatin-containing regimens and received genetic testing was performed. Institutional review board approval was obtained for this study. Fisher's exact test was used to analyze the primary outcome. Out of 167 initial patients, 62 with germline test results constituted the evaluable sample. 15 of 62 (24.2%) BRCA-tested patients were treated with carboplatin monotherapy, while 44 of 62 (71.0%) patients were treated with paclitaxel-containing regimens. Hypersensitivity reactions occurred in 4 of 13 (30.8%) BRCA-mutated patients and 22 of 49 (44.9%) BRCA wild-type patients (p = .5291). Hypersensitivity reactions to paclitaxel occurred in 1 of 13 (7.7%) BRCA-mutated patients and 26 of 49 (53.1%) BRCA wild-type patients (p = .0039). Overall, there were 11 grade 1 reactions, 14 grade 2 reactions, and 16 grade 3 reactions to carboplatin. All reactions to carboplatin in BRCA-mutated patients were grade 1. All paclitaxel reactions manifested as grade 2. The sample size was the main study limitation. The presence of BRCA mutations was not statistically significantly associated with a higher incidence of HSRs to carboplatin, but was statistically significant with regards to paclitaxel.
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Affiliation(s)
- Andrew Garcia
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | - Corey Frahm
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | - Joanne M. Jeter
- Divisions of Human Genetics and Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ivo Abraham
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | | | | | - Ali McBride
- From University of Arizona College of Pharmacy, Tucson, Arizona
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23
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Ma J, Deng H, Li J, Hu S, Yang Y, Liu S, Han X. Efficacy and safety of olaparib maintenance therapy in platinum-sensitive ovarian cancer patients with BRCA mutations: a meta-analysis on randomized controlled trials. Cancer Manag Res 2019; 11:3061-3078. [PMID: 31114351 PMCID: PMC6489675 DOI: 10.2147/cmar.s191107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Olaparib, a potent oral poly (ADP-ribose) polymerase inhibitor, exhibits antitumor activity and prevents the recurrence in advanced ovarian cancer. In this article, we assessed the efficacy and safety of olaparib maintenance therapy on platinum-sensitive ovarian cancer patients with BRCA mutations through a meta-analysis of available randomized controlled trials (RCTs) to provide more evidence for its clinical applications. Methods: We searched PubMed, Embase, Wanfang, CNKI, Web of Science, Cochrane Library, and VIP databases from 1 August 2018 to identify RCTs and finally included four RCTs (seven articles) with 567 eligible participants beyond the participants, interventions, comparisons, outcomes, and study design regulation. The outcomes of olaparib efficacy including progression-free survival (PFS) and overall survival (OS) were measured by HR and 95% CI, while the quality of life was evaluated by calculating the combination of P-value. Seven common adverse events were tested by risk ratio and 95% CI as the outcomes of olaparib safety. These data were analyzed, and the forest figures were produced using Review Manager 5.3. Results: Compared with other interventions (ie, placebo or chemotherapy drugs), olaparib significantly prolonged PFS (HR=0.31, 95% CI=0.15–0.62) and slightly improved OS (HR=0.75, 95% CI=0.56–0.99), but did not influence the quality of life (P=0.058) in the patients with platinum-sensitive BRCA-mutated ovarian cancer. Additionally, the toxicity profile of olaparib involved anemia, fatigue, vomiting, diarrhea, and nausea with grade 1–2. Conclusion: This meta-analysis suggests that olaparib maintenance therapy is effective and well-tolerated for the patients with platinum-sensitive BRCA-mutated ovarian cancer. More updated RCTs and long-term follow-up should be conducted to compare and analyze the efficacy and toxicity of olaparib at different doses in ovarian cancer patients.
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Affiliation(s)
- Jiao Ma
- Institute of Chinese Traditional Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, People's Republic of China
| | - Hongyong Deng
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai 200032, People's Republic of China
| | - Jiajia Li
- Institute of Chinese Traditional Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, People's Republic of China
| | - Shaopu Hu
- Science and Information Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, People's Republic of China
| | - Yanping Yang
- Science and Information Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, People's Republic of China
| | - Sheng Liu
- Institute of Chinese Traditional Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, People's Republic of China
| | - Xianghui Han
- Institute of Chinese Traditional Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, People's Republic of China
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24
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Outpatient desensitization of patients with moderate (high-risk) to severe platinum hypersensitivity reactions. Gynecol Oncol 2019; 152:316-321. [DOI: 10.1016/j.ygyno.2018.10.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022]
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25
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26
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LaVigne K, Hyman DM, Zhou QC, Iasonos A, Tew WP, Aghajanian C, Makker V, Hensley ML, Konner J, Grisham RN, Cangemi N, Soldan K, Spriggs DR, Sabbatini PJ, OʼCearbhaill RE. A Randomized Trial of Prophylactic Extended Carboplatin Infusion to Reduce Hypersensitivity Reactions in Recurrent Ovarian Cancer. Int J Gynecol Cancer 2018; 28:1176-1182. [PMID: 29757876 PMCID: PMC6033627 DOI: 10.1097/igc.0000000000001280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Hypersensitivity with repeated exposure to platinum agents is common and can preclude continued treatment, even in patients with disease that remains platinum sensitive. We sought to compare the effects of prophylactic, extended carboplatin infusion versus standard infusion on the rate of carboplatin hypersensitivity reactions (HSRs) in women with recurrent ovarian cancer. METHODS This was a single-institution, randomized, nonblinded trial comparing a graded, 3-hour extended infusion of carboplatin with a standard 30-minute infusion in patients with recurrent ovarian cancer who were enrolled from January 2011 to April 2015. The study was designed to detect a decrease in the HSR rate from 20% (standard infusion) to 5% (extended infusion) assuming a type 1 error of 10% and power of 80% using a 1-sided test. RESULTS Of 146 enrolled patients, 114 were evaluable. Fifteen (13%) had an HSR-11% (6/56) in the extended-infusion and 16% (9/58) in the standard-infusion groups (P = 0.582). Planned treatment completion was achieved in 50 (89%) of 56 patients and 49 (84%) of 58 patients, respectively. Of 25 patients who received single-agent carboplatin, 8 (32%) had an HSR (53% of all patients who had an HSR [8/15]). Of 23 patients who received carboplatin with gemcitabine, 4 (17%) had an HSR (27% of all patients who had an HSR [4/15]). Of 8 patients who received carboplatin with paclitaxel, 3 (38%) had an HSR (20% of all patients who had an HSR [3/15]). There were no HSRs with pegylated liposomal doxorubicin, the most commonly given concurrent chemotherapy (46% of all patients). CONCLUSIONS A prophylactic, extended carboplatin infusion was not associated with a decreased HSR rate. The overall low HSR rate suggests that premedication may help reduce HSRs.
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Affiliation(s)
| | | | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Nicholas Cangemi
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Krysten Soldan
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center
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27
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Options in Hypersensitivity Reactions to Chemotherapeutics. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Koul A, Forsland EL, Bjurberg M. Prophylactic 3-hour graduated infusion schedule minimizes risk of carboplatin hypersensitivity reactions - A prospective study. Gynecol Oncol 2017; 148:363-367. [PMID: 29208369 DOI: 10.1016/j.ygyno.2017.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/14/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aim of this study was observation of hypersensitivity reaction (HSR) frequency by using a 3-hour graduated infusion protocol with appropriate premedication as a prophylactic measure in patients with gynecological cancer receiving carboplatin retreatment in second line or above. None of the patients had experienced HSRs to platinum previously. METHOD All the patients in this study received premedication with corticosteroids and anti-histamines followed by carboplatin as 3-hour graduated infusion. Carboplatin was administered either as monotherapy or in combination with other chemotherapeutic agents. RESULTS Ninety-nine patients with ovarian (n=71), fallopian tube (n=9), peritoneal (n=9) and other gynecological cancers (5 uterine cancer, 5 abdominal cancer of gynecological origin) were retreated by a total of 611cycles of carboplatin administered as monotherapy (210cycles) or combination regime (401cycles). HSRs were recorded in only 11cycles (1.8%) in a total of 11 patients. While 8 of these patients had grade 1or 2 reactions (8.1%), only 3 patients had grade 3 reactions (3%). After pause in the infusion and complete resolution of HSR symptoms, an attempt of retreatment using this infusion protocol with extra premedication was successful in 6 of these patients without any reoccurrence of HSRs. CONCLUSION In this prospective study, we report that prophylactic 3-hour graduated infusion rate with appropriate premedication is associated with low frequency of HSRs in gynecological cancer patients requiring carboplatin retreatment in second line or above.
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Affiliation(s)
- Anjila Koul
- Department of Hematology, Oncology, and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden.
| | - Eva L Forsland
- Department of Hematology, Oncology, and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
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29
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Castells M. Drug Hypersensitivity and Anaphylaxis in Cancer and Chronic Inflammatory Diseases: The Role of Desensitizations. Front Immunol 2017; 8:1472. [PMID: 29163536 PMCID: PMC5676049 DOI: 10.3389/fimmu.2017.01472] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/20/2017] [Indexed: 12/13/2022] Open
Abstract
Drug allergy is a rising problem in the twenty-first century which affects all populations and races, children, and adults, and for which the recognition, diagnosis, management, and treatment is still not well standardized. Classical and new chemotherapy drugs, monoclonal antibodies (MoAbs), and small molecules to treat cancer and chronic inflammatory diseases are aimed at improving quality of life and life expectancy of patients, but an increasing number of reactions including anaphylaxis precludes their use in targeted populations. Women are more affected by drug allergy and up to 27% of women with ovarian and breast cancer develop carboplatin allergy after multiple cycles of treatment. Carriers of BRCA genes develop drug allergy after fewer exposures and can present with severe reactions, including anaphylaxis. Atopic patients are at increased risk for chemotherapy and MoAbs drug allergy and the current patterns of treatment with recurrent and intermittent drug exposures may favor the development of drug allergies. To overcome drug allergy, desensitization has been developed, a novel approach which provides a unique opportunity to protect against anaphylaxis and to improve clinical outcomes. There is evidence that inhibitory mechanisms blocking IgE/antigen mast cell activation are active during desensitization, enhancing safety. Whether desensitization modulates drug allergic and anaphylactic responses facilitating tolerance is currently being investigated. This review provides insight into the current knowledge of drug allergy and anaphylaxis to cancer and chronic inflammatory diseases drugs, the mechanisms of drug desensitization and its applications to personalized medicine.
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Affiliation(s)
- Mariana Castells
- Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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30
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Tai YH, Tai YJ, Hsu HC, Lee SP, Chen YY, Chiang YC, Chen YL, Chen CA, Cheng WF. Risk Factors of Hypersensitivity to Carboplatin in Patients with Gynecologic Malignancies. Front Pharmacol 2017; 8:800. [PMID: 29163180 PMCID: PMC5681487 DOI: 10.3389/fphar.2017.00800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022] Open
Abstract
We evaluated the prevalence of and risk factors for hypersensitivity reactions related to carboplatin, which is commonly used to treat gynecological malignancies. All women with pathologically documented ovarian, fallopian tube, or primary peritoneal cancer treated with carboplatin alone or a carboplatin-based combination chemotherapy regimen at a single hospital between January 2006 and December 2013 were retrospectively recruited. We analyzed the incidence, characteristics, risk factors, management, and outcomes of carboplatin-related hypersensitivity reactions among these patients. Among 735 eligible women, 75 (10.2%) experienced a total of 215 carboplatin-related hypersensitivity reaction events. The annual incidence of carboplatin-related hypersensitivity reactions gradually increased from 0.88% in 2006 to 5.42% in 2013. The incidence of carboplatin-related hypersensitivity was higher in patients with advanced stage disease (P < 0.001, Kruskal-Wallis test), serous and mixed histological types (P = 0.003, Kruskal-Wallis test), malignant ascites (P = 0.009, chi-square test), and history of other drug allergy (P < 0.001, chi-square test). Compared to women without hypersensitivity reactions, women who experienced hypersensitivity reactions had a significantly greater median cycle number (12 vs. 6, P < 0.001, independent sample t-test) and dose (6,816 vs. 3,844 mg, P < 0.001, independent sample t-test). The cumulative incidence of carboplatin-related hypersensitivity reactions dramatically increased with >8 cycles or dose >3,500 mg. Therefore, disease severity, histological type, malignant ascites, past drug allergies, and cumulative carboplatin dose are risk factors for carboplatin-related hypersensitivity reactions. Such reactions could potentially be reduced or prevented by slowing the infusion rate and using a desensitization protocol involving anti-allergy medications.
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Affiliation(s)
- Yu-Hsiao Tai
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shu-Ping Lee
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Yuan Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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31
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Anomalies de la réparation de l’ADN et cancers gynécologiques. Bull Cancer 2017; 104:971-980. [DOI: 10.1016/j.bulcan.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022]
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32
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Otani IM, Wong J, Banerji A. Platinum Chemotherapy Hypersensitivity. Immunol Allergy Clin North Am 2017; 37:663-677. [DOI: 10.1016/j.iac.2017.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Colombo N. When nonplatinum is the answer: the role of trabectedin plus pegylated liposomal doxorubicin in recurrent ovarian cancer. Future Oncol 2017; 13:23-29. [DOI: 10.2217/fon-2017-0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Trabectedin + pegylated liposomal doxorubicin (PLD) offers a well tolerated and effective nonplatinum, nontaxane alternative for treatment of ovarian cancer patients with a treatment-free interval after platinum beyond 6 months, especially for those relapsing between 6 and 12 months and those who are not candidates to receive platinum-based therapy. Using the nonplatinum trabectedin + PLD combination gives patients time to recover from platinum-related toxicities and may restore platinum sensitivity in tumor cells. The sequence effect, by which intercalation of trabectedin + PLD between platinum regimens may enhance the activity of next platinum and improve survival, is currently under investigation in the Phase III prospective INternational OVArian cancer patients Trial with YONdelis.
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Affiliation(s)
- Nicoletta Colombo
- European Institute of Oncology, University of Milan-Bicocca, via Ripamonti 435, Milan, Italy
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34
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Castells M. Diagnosis and management of anaphylaxis in precision medicine. J Allergy Clin Immunol 2017; 140:321-333. [PMID: 28780940 DOI: 10.1016/j.jaci.2017.06.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/18/2022]
Abstract
Anaphylaxis is the most severe and frightening of the allergic reactions, placing patients at high risk and demanding prompt recognition and immediate management by health care providers. Yet because its symptoms imitate those of other diseases, such as asthma and urticaria, current data suggest that its diagnosis is often missed, with underuse of tryptase measurement; its treatment is delayed, with little use of epinephrine; and its underlying cause or causes are poorly investigated. Deaths from anaphylaxis are difficult to investigate because of miscoding. Surprisingly, patients treated with new and powerful chemotherapy agents and humanized mAbs present with nonclassical symptoms of anaphylaxis, and patients may present with unrecognized clonal mast cell disorders with KIT mutations may present as Hymenoptera-induced or idiopathic anaphylaxis. The goal of this review is to recognize the presentations of anaphylaxis with the description of its current phenotypes, to provide new insight and understanding of its mechanisms and causes through its endotypes, and to address its biomarkers for broad clinical use. Ultimately, the aim is to empower allergists and heath care providers with new tools that can help alleviate patients' symptoms, preventing and protecting them against anaphylaxis.
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Affiliation(s)
- Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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35
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de Las Vecillas Sánchez L, Alenazy LA, Garcia-Neuer M, Castells MC. Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches. Int J Mol Sci 2017; 18:E1316. [PMID: 28632196 PMCID: PMC5486137 DOI: 10.3390/ijms18061316] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022] Open
Abstract
Drug hypersensitivity reactions (HSRs) are increasing in the 21st Century with the ever expanding availability of new therapeutic agents. Patients with cancer, chronic inflammatory diseases, cystic fibrosis, or diabetes can become allergic to their first line therapy after repeated exposures or through cross reactivity with environmental allergens. Avoidance of the offending allergenic drug may impact disease management, quality of life, and life expectancy. Precision medicine provides new tools for the understanding and management of hypersensitivity reactions (HSRs), as well as a personalized treatment approach for IgE (Immunoglobuline E) and non-IgE mediated HSRs with drug desensitization (DS). DS induces a temporary hyporesponsive state by incremental escalation of sub-optimal doses of the offending drug. In vitro models have shown evidence that IgE desensitization is an antigen-specific process which blocks calcium flux, impacts antigen/IgE/FcεRI complex internalization and prevents the acute and late phase reactions as well as mast cell mediator release. Through a "bench to bedside" approach, in vitro desensitization models help elucidate the molecular pathways involved in DS, providing new insights to improved desensitization protocols for all patients. The aim of this review is to summarize up to date information on the drug HSRs, the IgE mediated mechanisms of desensitization, and their clinical applications.
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Affiliation(s)
- Leticia de Las Vecillas Sánchez
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Department of Allergy, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain.
| | - Leila A Alenazy
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia.
- Master of Medical Sciences in Immunology Program, Harvard Medical School, Boston, MA 02115, USA.
| | - Marlene Garcia-Neuer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Mariana C Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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36
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Giavina-Bianchi P, Patil SU, Banerji A. Immediate Hypersensitivity Reaction to Chemotherapeutic Agents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:593-599. [DOI: 10.1016/j.jaip.2017.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/20/2017] [Accepted: 03/21/2017] [Indexed: 01/01/2023]
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37
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O'Malley DM, Vetter MH, Cohn DE, Khan A, Hays JL. Outpatient desensitization in selected patients with platinum hypersensitivity reactions. Gynecol Oncol 2017; 145:603-610. [PMID: 28410757 DOI: 10.1016/j.ygyno.2017.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 01/27/2023]
Abstract
Platinum-based chemotherapies are a standard treatment for both initial and recurrent gynecologic cancers. Given this widespread use, it is important to be aware of the features of platinum hypersensitivity reactions and the subsequent treatment of these reactions. There is also increasing interest in the development of desensitization protocols to allow patients with a history of platinum hypersensitivity to receive further platinum based therapy. In this review, we describe the management of platinum hypersensitivity reactions and the desensitization protocols utilized at our institution. We also describe the clinical categorizations utilized to triage patients to appropriate desensitization protocols.
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Affiliation(s)
- David M O'Malley
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA. david.o'
| | - Monica Hagan Vetter
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA
| | - David E Cohn
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA
| | - Ambar Khan
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43220, USA
| | - John L Hays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Cisplatin can be safely administered to ovarian cancer patients with hypersensitivity to carboplatin. Gynecol Oncol 2017; 144:72-76. [DOI: 10.1016/j.ygyno.2016.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 01/25/2023]
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Giavina-Bianchi P, Galvão VR, Picard M, Caiado J, Castells MC. Basophil Activation Test is a Relevant Biomarker of the Outcome of Rapid Desensitization in Platinum Compounds-Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:728-736. [PMID: 28034549 DOI: 10.1016/j.jaip.2016.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/30/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rapid drug desensitization (RDD) has become a cornerstone in the management of immediate drug hypersensitivity reactions (DHRs) to chemotherapeutic agents. Because of the inherent risk of anaphylaxis during RDD, biomarkers to predict patients at risk of developing such severe reactions are needed. The basophil activation test (BAT) has been used in DHRs as a diagnostic tool. OBJECTIVE We evaluated basophil CD63 and CD203c expression (BAT) as a biomarker to assess the safety and effectiveness of RDD in platinum compounds-allergic patients. METHODS Patients allergic to platinum compounds (n = 15) undergoing RDD were assessed through clinical history, skin testing, serum tryptase levels, and BAT. BAT was performed immediately before RDD, assessing CD203c and CD63 expression on basophils. BAT was also performed in 6 patients tolerant to platinum compounds and in 6 healthy volunteers. RESULTS BAT was positive to CD203c or CD63 in 11 out of 15 patients allergic to platinum compounds (73%), with increased expression of CD203c and CD63 in 11 (73%) and 6 (40%) patients, respectively. Increased CD63 expression tended to be associated with more severe initial reactions. All controls had negative test results. Reactions during RDD were associated with BAT positivity and increased tryptase levels. Only 1 of 4 patients with negative BAT had a mild reaction during RDD. BAT remained positive in multiple sequential RDD. CONCLUSIONS BAT identified patients allergic to platinum compounds with an increased risk of reactions during desensitization and higher CD63 expression was observed in severe reactions. Multiple RDDs to platinum compounds did not induce persistent hyporesponsiveness on basophils. BAT is a potential biomarker for RDD.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
| | - Violeta Régnier Galvão
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Matthieu Picard
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Canada
| | - Joana Caiado
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Immunoallergology Department, Hospital de Santa Maria/Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mariana C Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Jerzak KJ, Deghan Manshadi S, Ng P, Maganti M, McCuaig JM, Bulter M, Oza A, Mackay HJ. Prevention of carboplatin-induced hypersensitivity reactions in women with ovarian cancer. J Oncol Pharm Pract 2016; 24:83-90. [DOI: 10.1177/1078155216679028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Carboplatin-based chemotherapy offers high response rates and improved overall survival for women with epithelial ovarian cancer, but its use is limited by the occurrence of hypersensitivity reactions. To evaluate the efficacy of prophylactic diphenhydramine for hypersensitivity reaction prevention, we reviewed the incidence of hypersensitivity reactions and identified patients at high risk of hypersensitivity reactions. Methods Women receiving ≥6 cycles of carboplatin-based chemotherapy for epithelial ovarian cancer were identified from our institutional database at the Princess Margaret Cancer Centre. Institutional policy was changed in 2009 to introduce diphenhydramine prophylaxis for patients receiving ≥6 cycles of carboplatin. Additional clinical data were abstracted from the patient record. Results Between 2006 and 2012, 450 women received ≥6 cycles of carboplatin-based chemotherapy for epithelial ovarian cancer. Two hundred and ninety-one women received prophylaxis with diphenhydramine. Carboplatin-induced hypersensitivity reactions occurred in 41 of 449 patients (9%). Univariable predictors of carboplatin-induced hypersensitivity reactions included administration of 8 to 10 cycles of carboplatin, history of other drug allergies and a platinum-free interval >12 months. BRCA mutational status was not predictive. In a multivariable analysis, the number of cycles of carboplatin and a platinum-free interval >12 months were independent predictors of hypersensitivity reactions. There was a trend towards diphenhydramine prophylaxis reducing the incidence of hypersensitivity reactions in women with a platinum-free interval compared to continuous delivery; this was most marked when the platinum-free interval was >12 months (n = 64) (OR: 0.2 (95% CI: 0.046–0.83), p = 0.03). Conclusions The administration of diphenhydramine to women who have a platinum-free interval may reduce the risk of hypersensitivity reaction, but prospective evaluation is required.
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Affiliation(s)
- Katarzyna J Jerzak
- Division of Medical Oncology and Hematology, Faculty of Medicine, University of Toronto, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | | | - Pamela Ng
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Manjula Maganti
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeanna M McCuaig
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marcus Bulter
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit Oza
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Helen J Mackay
- Division of Medical Oncology and Hematology, Faculty of Medicine, University of Toronto, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
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Colombo N, Hardy-Bessard AC, Ferrandina G, Marth C, Romero I. Experience with trabectedin + pegylated liposomal doxorubicin for recurrent platinum-sensitive ovarian cancer unsuited to platinum rechallenge. Expert Rev Anticancer Ther 2016; 16:11-19. [DOI: 10.1080/14737140.2016.1243475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Galvão VR, Phillips E, Giavina-Bianchi P, Castells MC. Carboplatin-allergic patients undergoing desensitization: prevalence and impact of the BRCA 1/2 mutation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:816-818. [PMID: 27765459 DOI: 10.1016/j.jaip.2016.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/25/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Violeta Régnier Galvão
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of Clinical Immunology and Allergy, University of São Paulo Medical School, São Paulo, Brazil
| | - Elizabeth Phillips
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Tenn; Institute for Immunology and Infectious diseases, Murdoch University, Perth, Australia
| | - Pedro Giavina-Bianchi
- Division of Clinical Immunology and Allergy, University of São Paulo Medical School, São Paulo, Brazil
| | - Mariana C Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
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Iyevleva AG, Imyanitov EN. Cytotoxic and targeted therapy for hereditary cancers. Hered Cancer Clin Pract 2016; 14:17. [PMID: 27555886 PMCID: PMC4994296 DOI: 10.1186/s13053-016-0057-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022] Open
Abstract
There is a number of drugs demonstrating specific activity towards hereditary cancers. For example, tumors in BRCA1/2 mutation carriers usually arise via somatic inactivation of the remaining BRCA allele, which makes them particularly sensitive to platinum-based drugs, PARP inhibitors (PARPi), mitomycin C, liposomal doxorubicin, etc. There are several molecular assays for BRCA-ness, which permit to reveal BRCA-like phenocopies among sporadic tumors and thus extend clinical indications for the use of BRCA-specific therapies. Retrospective data on high-dose chemotherapy deserve consideration given some unexpected instances of cure from metastatic disease among BRCA1/2-mutated patients. Hereditary non-polyposis colorectal cancer (HNPCC) is characterized by high-level microsatellite instability (MSI-H), increased antigenicity and elevated expression of immunosuppressive molecules. Recent clinical trial demonstrated tumor responses in HNPCC patients treated by the immune checkpoint inhibitor pembrolizumab. There are successful clinical trials on the use of novel targeted agents for the treatment or rare cancer syndromes, e.g. RET inhibitors for hereditary medullary thyroid cancer, mTOR inhibitors for tumors arising in patients with tuberous sclerosis (TSC), and SMO inhibitors for basal-cell nevus syndrome. Germ-line mutation tests will be increasingly used in the future for the choice of the optimal therapy, therefore turnaround time for these laboratory procedures needs to be significantly reduced to ensure proper treatment planning.
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Affiliation(s)
- Aglaya G Iyevleva
- N.N. Petrov Institute of Oncology, Pesochny-2, St. Petersburg, 197758 Russia ; St. Petersburg Pediatric Medical University, St. Petersburg, 194100 Russia
| | - Evgeny N Imyanitov
- N.N. Petrov Institute of Oncology, Pesochny-2, St. Petersburg, 197758 Russia ; St. Petersburg Pediatric Medical University, St. Petersburg, 194100 Russia ; I.I. Mechnikov North-Western Medical University, St. Petersburg, 191015 Russia ; St. Petersburg State University, St. Petersburg, 199034 Russia
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Rodler ET, Kurland BF, Griffin M, Gralow JR, Porter P, Yeh RF, Gadi VK, Guenthoer J, Beumer JH, Korde L, Strychor S, Kiesel BF, Linden HM, Thompson JA, Swisher E, Chai X, Shepherd S, Giranda V, Specht JM. Phase I Study of Veliparib (ABT-888) Combined with Cisplatin and Vinorelbine in Advanced Triple-Negative Breast Cancer and/or BRCA Mutation-Associated Breast Cancer. Clin Cancer Res 2016; 22:2855-64. [PMID: 26801247 DOI: 10.1158/1078-0432.ccr-15-2137] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/22/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Cisplatin is synergistic with vinorelbine and the PARP inhibitor veliparib, and has antineoplastic activity in triple-negative breast cancer (TNBC) and BRCA mutation-associated breast cancer. This phase I study assessed veliparib with cisplatin and vinorelbine. EXPERIMENTAL DESIGN A 3+3 dose-escalation design evaluated veliparib administered twice daily for 14 days with cisplatin (75 mg/m(2) day 1) and vinorelbine (25 mg/m(2) days 1, 8) every 21 days, for 6 to 10 cycles, followed by veliparib monotherapy. Pharmacokinetics, measurement of poly(ADP-ribose) in peripheral blood mononuclear cells, and preliminary efficacy were assessed. IHC and gene-expression profiling were evaluated as potential predictors of response. RESULTS Forty-five patients enrolled in nine dose cohorts plus five in an expansion cohort at the highest dose level and recommended phase II dose, 300 mg twice daily. The MTD of veliparib was not reached. Neutropenia (36%), anemia (30%), and thrombocytopenia (12%) were the most common grade 3/4 adverse events. Best overall response for 48 patients was radiologic response with 9-week confirmation for 17 (35%; 2 complete, 15 partial), and stable disease for 21 (44%). Germline BRCA mutation presence versus absence was associated with 6-month progression-free survival [PFS; 10 of 14 (71%) vs. 8 of 27 (30%), mid-P = 0.01]. Median PFS for all 50 patients was 5.5 months (95% confidence interval, 4.1-6.7). CONCLUSIONS Veliparib at 300 mg twice daily combined with cisplatin and vinorelbine is well tolerated with encouraging response rates. A phase II randomized trial is planned to assess veliparib's contribution to cisplatin chemotherapy in metastatic TNBC and BRCA mutation-associated breast cancer. Clin Cancer Res; 22(12); 2855-64. ©2016 AACR.
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Affiliation(s)
| | | | - Melissa Griffin
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie R Gralow
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peggy Porter
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rosa F Yeh
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Vijayakrishna K Gadi
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jamie Guenthoer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jan H Beumer
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Larissa Korde
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Hannah M Linden
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John A Thompson
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth Swisher
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xiaoyu Chai
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Jennifer M Specht
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, Washington
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Abstract
Hypersensitivity reactions are increasingly prevalent, although underrecognized and underreported. Platins induce immunoglobulin E-mediated sensitization; taxenes and some monoclonal antibodies can induce reactions at first exposure. Severe hypersensitivity can preclude first-line therapy. Tryptase level at the time of a reaction is a useful diagnostic tool. Skin testing provides a specific diagnosis. Newer tests are promising diagnostic tools to help identify patients at risk before first exposure. Safe management includes rapid drug desensitization. This review provides information regarding the scope of hypersensitivity and anaphylactic reactions induced by chemotherapy and biological drugs, as well as diagnosis, management, and treatment options.
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Affiliation(s)
- Mariana C Castells
- Allergy Immunology Training Program, Drug Hypersensitivity and Desensitization Center, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Boston, MA 02115, USA.
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Miyamoto S, Okada R, Ando K. Platinum hypersensitivity and desensitization. Jpn J Clin Oncol 2015; 45:795-804. [DOI: 10.1093/jjco/hyv081] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 01/28/2023] Open
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Liu JF, Barry WT, Birrer M, Lee JM, Buckanovich RJ, Fleming GF, Rimel B, Buss MK, Nattam S, Hurteau J, Luo W, Quy P, Whalen C, Obermayer L, Lee H, Winer EP, Kohn EC, Ivy SP, Matulonis UA. Combination cediranib and olaparib versus olaparib alone for women with recurrent platinum-sensitive ovarian cancer: a randomised phase 2 study. Lancet Oncol 2014; 15:1207-14. [PMID: 25218906 PMCID: PMC4294183 DOI: 10.1016/s1470-2045(14)70391-2] [Citation(s) in RCA: 447] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Olaparib is a poly(ADP-ribose) polymerase inhibitor and cediranib is an anti-angiogenic agent with activity against VEGF receptor (VEGFR) 1, VEGFR2, and VEGFR3. Both oral agents have antitumour activity in women with recurrent ovarian cancer, and their combination was active and had manageable toxicities in a phase 1 trial. We investigated whether this combination could improve progression-free survival (PFS) compared with olaparib monotherapy in women with recurrent platinum-sensitive ovarian cancer. METHODS In our randomised, open-label, phase 2 study, we recruited women (aged ≥18 years) who had measurable platinum-sensitive, relapsed, high-grade serous or endometrioid ovarian, fallopian tube, or primary peritoneal cancer, or those with deleterious germline BRCA1/2 mutations from nine participating US academic medical centres. We randomly allocated participants (1:1) according to permuted blocks, stratified by germline BRCA status and previous anti-angiogenic therapy, to receive olaparib capsules 400 mg twice daily or the combination at the recommended phase 2 dose of cediranib 30 mg daily and olaparib capsules 200 mg twice daily. The primary endpoint was progression-free survival analysed in the intention-to-treat population. The phase 2 trial is no longer accruing patients. An interim analysis was conducted in November, 2013, after 50% of expected events had occurred and efficacy results were unmasked. The primary analysis was performed on March 31, 2014, after 47 events (66% of those expected). The trial is registered with ClinicalTrials.gov, number NCT01116648. FINDINGS Between Oct 26, 2011, and June 3, 2013, we randomly allocated 46 women to receive olaparib alone and 44 to receive the combination of olaparib and cediranib. Median PFS was 17·7 months (95% CI 14·7-not reached) for the women treated with cediranib plus olaparib compared with 9·0 months (95% CI 5·7-16·5) for those treated with olaparib monotherapy (hazard ratio 0·42, 95% CI 0·23-0·76; p=0·005). Grade 3 and 4 adverse events were more common with combination therapy than with monotherapy, including fatigue (12 patients in the cediranib plus olaparib group vs five patients in the olaparib monotherapy group), diarrhoea (ten vs none), and hypertension (18 vs none). INTERPRETATION Cediranib plus olaparib seems to improve PFS in women with recurrent platinum-sensitive high-grade serous or endometrioid ovarian cancer, and warrants study in a phase 3 trial. The side-effect profile suggests such investigations should include assessments of quality of life and patient-reported outcomes to understand the effects of a continuing oral regimen with that of intermittent chemotherapy. FUNDING American Recovery and Reinvestment Act grant from the National Institutes of Health (NIH) (3 U01 CA062490-16S2); Intramural Program of the Center for Cancer Research; and the Division of Cancer Treatment and Diagnosis, National Cancer Institute, NIH.
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Affiliation(s)
- Joyce F Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - William T Barry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Birrer
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Gini F Fleming
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Bj Rimel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary K Buss
- Division of Hematology/Oncology, Beth-Israel Deaconess Medical Center, Boston, MA, USA
| | - Sreenivasa Nattam
- Department of Oncology, Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN, USA
| | - Jean Hurteau
- Division of Gynecologic Oncology, North Shore University Health System, Evanston Hospital, Evanston, IL, USA
| | - Weixiu Luo
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philippa Quy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christin Whalen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lisa Obermayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hang Lee
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - S Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Hsu Blatman KS, Castells MC. Desensitizations for chemotherapy and monoclonal antibodies: indications and outcomes. Curr Allergy Asthma Rep 2014; 14:453. [PMID: 24994467 DOI: 10.1007/s11882-014-0453-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute infusion reactions to both chemotherapeutic agents and humanized monoclonal antibodies can occur, which may limit therapeutic options for treatment of malignancies and chronic inflammatory diseases. Many of these acute infusion reactions are consistent with a type I hypersensitivity reaction, including anaphylaxis. If a patient experiences a significant acute infusion reaction, often the recommendation is to discontinue the medication and find an alternative agent. However, the "second-line" agent may be more toxic or inferior. If the reaction is likely a type I or type IV hypersensitivity reaction, one option is to undergo desensitization to the offending drug. Drug desensitization is the process of readministering a needed drug in incremental doses over hours or days until a full therapeutic dose is tolerated. This article will review the current literature on indications and outcomes for drug desensitization in the management of allergy to either chemotherapeutic agents or monoclonal antibodies.
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Affiliation(s)
- Karen S Hsu Blatman
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 850 Boylston Street Suite 540, Chestnut Hill, MA, 02467, USA,
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Caiado J, Picard M. Diagnostic Tools for Hypersensitivity to Platinum Drugs and Taxanes: Skin Testing, Specific IgE, and Mast Cell/Basophil Mediators. Curr Allergy Asthma Rep 2014; 14:451. [DOI: 10.1007/s11882-014-0451-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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