Choi James, Harnett Paul, Fulcher David A
Immunology Unit, Westmead Hospital, Westmead, Sydney, Australia.
Ann Allergy Asthma Immunol. 2004 Aug;93(2):137-41. doi: 10.1016/S1081-1206(10)61465-2.
IgE-mediated carboplatin hypersensitivity reactions occur in up to 30% of patients receiving this agent for chemotherapy of solid tumors, thus limiting therapeutic options.
To describe our experience with intravenous carboplatin desensitization regimens, which culminated in a standardized, successful protocol for safe administration.
Eight consecutive patients with ovarian cancer who had experienced severe anaphylactic reactions to carboplatin were referred to our hospital. Intradermal skin testing was performed by raising a 3-mm bleb by injection of undiluted carboplatin at 10 mg/mL, and the wheal size was read at 20 minutes. The outcomes of the various desensitization regimens were documented prospectively, and the experience gained was used to develop a standardized protocol for administration.
All patients had positive intradermal skin test results. The first 3 patients were treated with short (90 minutes to 6 hours) desensitization protocols, and all protocols failed on the first or second infusions. These 3 and a subsequent 5 patients were given intravenous carboplatin according to a protocol of gradual dose escalation over a 4-log dose range given during a 4-day period, with subsequent 3-weekly infusions given more rapidly by omitting the most dilute log dose on each occasion. All patients tolerated the longer infusion protocol without event, and all but 1 patient experienced appropriate tumor marker response.
Short carboplatin desensitization protocols (less than 6 hours) have an unacceptable failure rate in patients with carboplatin allergy, but longer infusion times (days) are well tolerated without recurrence of the allergic reaction and with good tumor response. In cases where carboplatin is the optimal therapeutic agent, clinicians should not be deterred by an anaphylactic reaction to it or by failure of shorter desensitization regimens.
在接受顺铂进行实体瘤化疗的患者中，高达30%会发生IgE介导的顺铂超敏反应，从而限制了治疗选择。
描述我们在静脉注射顺铂脱敏方案方面的经验，最终形成了一个标准化的、成功的安全给药方案。
连续8例对顺铂发生严重过敏反应的卵巢癌患者被转诊至我院。通过注射10mg/mL未稀释的顺铂形成一个3mm的丘疹进行皮内皮肤试验，并在20分钟时读取风团大小。前瞻性记录各种脱敏方案的结果，并利用所获得的经验制定标准化的给药方案。
所有患者皮内皮肤试验结果均为阳性。前3例患者采用短时间（90分钟至6小时）脱敏方案治疗，所有方案在第一次或第二次输注时均失败。这3例患者以及随后的5例患者按照在4天内逐步增加剂量范围达4个对数剂量的方案静脉输注顺铂，随后每3周输注一次，每次输注时省略最稀释的对数剂量，输注速度更快。所有患者均耐受较长时间的输注方案且无不良事件发生，除1例患者外，所有患者的肿瘤标志物均有适当反应。
短时间的顺铂脱敏方案（少于6小时）在顺铂过敏患者中的失败率不可接受，但较长的输注时间（数天）耐受性良好，过敏反应无复发且肿瘤反应良好。在顺铂是最佳治疗药物的情况下，临床医生不应因对顺铂的过敏反应或较短脱敏方案的失败而退缩。
