Carboplatin hypersensitivity induced by low-dose paclitaxel/carboplatin in multiple platinum-treated patients with recurrent ovarian cancer

Readministration of Platinum Agents in Recurrent Ovarian Cancer Patients Who Developed Hypersensitivity Reactions to Carboplatin

BACKGROUND/AIM

Hypersensitivity reactions (HSRs) to carboplatin, a key drug for ovarian cancer patients, are problematic. The aim of this study was to evaluate the efficacy and safety of readministration of platinum agents (PTs) in recurrent ovarian cancer patients who developed HSRs to carboplatin.

PATIENTS AND METHODS

Thirty-one patients with recurrent ovarian cancer who developed HSRs to carboplatin were divided into those who continued to receive PTs in the following cycle (continuation group, n=24) and those in whom either the drug was switched to non-platinum agents (non-PTs) or chemotherapy was ended (discontinuation group, n=7). Outcomes were evaluated based on patients' medical records.

RESULTS

The median survival time following HSRs was 28.1 and 15.4 months in the continuation and discontinuation groups, respectively (p=0.018). In the continuation group, a total of 155 cycles of PTs were re-administrated, and 50 cycles (32%) led to recurrent HSRs. There were no recurrent HSRs with a severity of grade 3 or greater.

CONCLUSION

Continuation of PTs in ovarian cancer patients may contribute to improvement in their overall survival without severe recurrent HSRs.

Successful resuscitation after cardiac arrest secondary to carboplatin infusion: A case report

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Sudden cardiac arrest can be a form of carboplatin hypersensitivity reaction.

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Platinum retreatment and cumulative cycles of ≥ 8 are risk factors.

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Awareness of the reaction related to carboplatin infusion is necessary.

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Successful resuscitation with high quality CPR is achievable with trained staffs.

Kounis syndrome is likely culprit of coronary vasospasm induced by capecitabine

Capecitabine administration has been associated with various allergic reactions including acneiform skin rash, linchenoid photosensitive eruption, exudative non healing scalp, skin reactions, pyogenic granuloma, subacute cutaneous systemic lupus erythematosus, exudative hyponychia dermatitis, and hand–foot syndrome. A patient who developed ventricular fibrillation following capecitabine-induced coronary vasospasm and necessitating cardioverter-defibrillator implantation was published recently in J Oncol Pharm Practice. The authors attributed this reaction to capecitabine cardiotoxicity, but capecitabine hypersensitivity is closely associated with Kounis syndrome. Tests and measures which will help to confirm, prevent and treat cardiac hypersensitivity to antineoplastic agents are recommended.

Usefulness of desensitization protocol for a carboplatin hypersensitivity reaction during docetaxel-carboplatin therapy for recurrent ovarian cancer: Case report

We report a case of recurrent ovarian cancer in which desensitization for a carboplatin hypersensitivity reaction proved useful. The patient was a 65-year-old woman who presented with a recurrence of stage IIIc ovarian cancer. The initial chemotherapy consisted of 6 courses of paclitaxel and carboplatin. Recurrence in the pelvis, splenic hilum and para-aortic lymph nodes was detected 19 months after the final day of treatment. The patient was treated with docetaxel-carboplatin therapy for the recurrence, but a Grade 3 hypersensitivity reaction to carboplatin was observed during the second course. Carboplatin desensitization was commenced with the third course and 6 courses were completed with no evidence of hypersensitivity reaction. The antitumor effect showed a complete response and the patient has had a disease-free survival thus far. Desensitization for patients diagnosed with a carboplatin hypersensitivity reaction appeared to be a key method of treatment for prolonging the survival time of patients with recurrent ovarian cancer.

Risk factors contributing to the development of carboplatin-related delayed hypersensitivity reactions in Japanese patients with gynecologic cancers

PURPOSE

The rate of hypersensitivity reactions in patients receiving carboplatin (CBDCA) has been reported to increase after multiple doses of the agent. However, risk factors for these onsets have not been well described. In this study, we investigated the contribution of the reported risk factors to the onset of CBDCA-related delayed hypersensitivity reactions.

METHODS

We reviewed the records of gynecologic cancer patients receiving CBDCA of more than 7 cycles in Mie University Hospital from March 2006 to July 2009. The patients were divided into two groups on the basis of whether hypersensitivity reactions developed (13 patients) or not (43 patients). Thereafter, the potential influences of the patients' characteristics on the development of CBDCA-related delayed hypersensitivity reactions were explored using logistic regression analyses.

RESULTS

The median CBDCA-free interval (10 months) in patients with hypersensitivity reactions was significantly higher than that (3 months) in patients without hypersensitivity reactions. Logistic regression analyses revealed a CBDCA-free interval >13 months (odds ratio 22.2, 95% confidence interval 2.57-192, p < 0.01) and a maximum dose of CBDCA > 650 mg (odds ratio 9.52, 95% confidence interval 1.04-93.9; p < 0.05) were significantly correlated with the incidence of CBDCA-related delayed hypersensitivity reactions.

CONCLUSIONS

Careful attention should be paid to the onset of delayed hypersensitivity reactions for recurrent gynecologic cancer patients receiving CBDCA > 650 mg after an interval of more than 13 months from the previous CBDCA administration.

Incidence of Carboplatin-related hypersensitivity reactions in Japanese patients with gynecologic malignancies

Carboplatin is one of the most commonly used and well-tolerated agents for gynecologic malignancies. The rate of hypersensitivity reactions (HSRs) in the overall population of patients receiving carboplatin has been reported to increase after multiple doses of the agent. We retrospectively analyzed the incidence, clinical features, management, or outcome of carboplatin-related HSRs in 113 Japanese patients with gynecologic malignancies and the possibility of rechallenge with the drug. We intravenously administered carboplatin after paclitaxel or docetaxel. Mild HSRs are resolved by temporary interruption of carboplatin infusion, an additional antihistamine, and/or a corticosteroid. If HSRs arose, carboplatin was diluted, not exceeding 1 mg/mL, and slowly infused over 2 hours in subsequent cycles. Ten patients experienced carboplatin HSRs, with an overall incidence of 8.85%. The first HSR episode was mild in all cases. When retreated with carboplatin, 4 exhibited severe HSRs. More than 9 cycles and/or more than 5000 mg of carboplatin administration significantly increased the incidence of HSRs. In particular, carboplatin treatment beyond 15 cycles and/or 8000 mg increased the risk of severe HSRs (P < 0.0001). The incidence of HSRs in the ovarian carcinoma group was significantly greater than that in the uterine carcinoma group (P = 0.0046). Careful attention should be paid to HSRs during carboplatin treatment beyond 9 cycles and/or 5000 mg. The rate of severe HSRs greatly increases beyond 15 cycles and/or 8000 mg. Further studies are needed to identify potential risk factors that may contribute to the development of carboplatin HSRs and to decrease the risk of reactions.

Coronary Stents, Hypersensitivity Reactions, and the Kounis Syndrome

The use of drug-eluting stents (DES) for the treatment of coronary stenosis has increased sharply and now accounts for more than 75% of all coronary stents utilized. However, concern has been increasing that DES could be associated with stent thrombosis, paradoxical coronary vasoconstriction, and hypersensitivity reactions. Components of currently used DES have been reported to induce, either separately or synergistically, hypersensitivity reactions and possibly lead to cardiac events. DES-activated intracoronary mast cells could release histamine, arachidonic acid metabolites, proteolytic enzymes, as well as a variety of cytokines, chemokines, and platelet-activating factor (PAF) leading to local inflammation and thrombosis. These events may be more common than suspected because it is hard to document them, unless they become systemic, in which case they manifest themselves as the "Kounis syndrome," characterized by the concurrence of acute coronary events with hypersensitivity reactions. Recognition of this problem may lead to better vigilance, as well as new DES with mast cell blocking molecules that may also be disease modifying.