Oxaliplatin hypersensitivity: evaluation, implications of skin testing, and desensitization

Abstract

Background: Oxaliplatin hypersensitivity (OXS) presents a challenge in the treatment of oxaliplatin-sensitive malignancies.

Objective: To analyze patient characteristics of patients with OXS, skin test results, and desensitization outcomes to optimize management.

Methods: Over 5 years, 48 patients with OXS were referred to the allergy/immunology unit at Massachusetts General Hospital. Their clinical reaction patterns were analyzed. Immediate hypersensitivity skin testing was used for risk stratification, and drug desensitizations were performed by using 3 related continuous intravenous protocols that were chosen based on clinical history, skin test reactivity, and the patients' previous desensitization outcomes.

Results: OXS occurred in both sexes, with mostly gastrointestinal-related tumors. Hypersensitivity reaction (HSR) onset had occurred during any course of therapy (course nos. 1-28), with a median onset at course no. 8. HSR to oxaliplatin was similar to those observed with cisplatin and carboplatin, including cutaneous, cardiovascular, pulmonary, and gastrointestinal symptoms. However, neurologic symptoms, including tingling, and systemic symptoms, including fever and chills, occurred more often in patients with OXS. Unique to OXS, 2 patients developed drug-induced thrombocytopenia; 1 patients also developed drug-induced hemolytic anemia. Skin testing was positive for the majority of patients with OXS (27/46 [59%]) and correlated with a greater likelihood of developing an HSR during subsequent desensitizations. We safely performed 200 desensitizations in 48 patients with OXS.

Conclusion: OXS is common with much similarity to other platin agents but also have distinct differences in the onset of hypersensitivity, sex, tumor type, drug-induced hemolytic anemia, and drug-induced thrombocytopenia. Skin testing was helpful for risk stratification. All of the desensitizations were completed successfully.

Keywords: CAS; CIS; Carboplatin; Carboplatin hypersensitivity; Cisplatin; Cisplatin hypersensitivity; Continuous; DIHA; DITP; Desensitization; Drug-induced hemolytic anemia; Drug-induced thrombocytopenia; GI; Gastrointestinal; HRP; HSR; High-risk protocol; Hypersensitivity; Hypersensitivity reaction; IP; Ig; Immunoglobulin; Intermediate protocol; Intravenous; OXS; Onset; Oxaliplatin; Oxaliplatin hypersensitivity; RP; Rapid protocol; Skin test.