Robinson J B, Singh D, Bodurka-Bevers D C, Wharton J T, Gershenson D M, Wolf J K
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Gynecol Oncol. 2001 Sep;82(3):550-8. doi: 10.1006/gyno.2001.6331.
The aims of this study were to characterize hypersensitivity reactions to chemotherapy in patients with gynecologic malignancies and to determine the utility of oral and intravenous desensitization.
We retrospectively reviewed patients with hypersensitivity reactions identified by direct physician query and by review of charts with ICD9 code E933.1 (Adverse Effect Anti-Neoplastic).
Thirty-two patients were identified: 27 with ovarian cancer, 4 with primary peritoneal cancer, and 1 with cervical cancer. Nine patients experienced hypersensitivity reactions during the primary regimen and 23 during chemotherapy for recurrent disease. Hypersensitivity occurred following an average of nine courses. Hypersensitivity occurred secondary to paclitaxel (10) carboplatin (16), cisplatin (4), bleomycin (1), and paclitaxel/carboplatin combination therapy (1). Patients had previously received the agent in 93.8% of carboplatin reactions, in 54.5% of paclitaxel reactions, and in all other agent reactions. Hypersensitivity reactions most commonly included flushing, dyspnea/bronchospasm, back pain, chest discomfort, pruritus, erythema, and nausea and occasionally included alterations in blood pressure or pulse rate. Reactions were successfully treated in 96.9% of patients by interrupting the infusion and administering steroids, antihistamines, benzodiazepines, nebulized beta-agonists, and/or pressors. Seventeen patients underwent desensitization, one to two agents, with 94% success. Nine of ten patients had successful iv desensitization, and 8/10 patients had successful oral desensitization. One failure on the oral regimen had previous successful iv desensitization.
Hypersensitivity reactions to chemotherapeutic agents do not necessarily require exclusion of a compound from the treatment regimen. Intravenous and oral desensitization protocols are useful for successful and safe administration of paclitaxel and platinum compounds in patients with prior hypersensitivity reactions.
本研究旨在描述妇科恶性肿瘤患者化疗过敏反应的特征，并确定口服和静脉脱敏的效用。
我们回顾性分析了通过医生直接询问和查阅国际疾病分类第九版（ICD9）编码为E933.1（抗肿瘤药物不良反应）的病历而确定的过敏反应患者。
共确定32例患者：27例卵巢癌，4例原发性腹膜癌，1例宫颈癌。9例患者在初始治疗方案期间出现过敏反应，23例在复发性疾病化疗期间出现过敏反应。过敏反应平均发生在九个疗程之后。过敏反应继发于紫杉醇（10例）、卡铂（16例）、顺铂（4例）、博来霉素（1例）和紫杉醇/卡铂联合治疗（1例）。在卡铂过敏反应中，93.8%的患者之前曾接受过该药物治疗；在紫杉醇过敏反应中，54.5%的患者之前曾接受过该药物治疗；在所有其他药物过敏反应中，患者之前均接受过该药物治疗。过敏反应最常见的包括潮红、呼吸困难/支气管痉挛、背痛、胸部不适、瘙痒、红斑和恶心，偶尔包括血压或脉搏率改变。96.9%的患者通过中断输注并给予类固醇、抗组胺药、苯二氮䓬类药物、雾化β受体激动剂和/或升压药成功治疗了反应。17例患者接受了一至两种药物的脱敏治疗，成功率为94%。10例患者中有9例静脉脱敏成功，10例患者中有8例口服脱敏成功。口服治疗方案中有1例失败，该患者之前静脉脱敏成功。
化疗药物过敏反应不一定需要将某种化合物排除在治疗方案之外。静脉和口服脱敏方案有助于对既往有过敏反应的患者成功、安全地使用紫杉醇和铂类化合物。
