Saif M Wasif
Yale University School of Medicine, Section of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520, USA.
Expert Opin Drug Saf. 2006 Sep;5(5):687-94. doi: 10.1517/14740338.5.5.687.
The reported incidence of hypersensitivity reactions (HSRs) associated with oxaliplatin in patients with colorectal cancer (CRC) is approximately 12%, with 1 - 2% of patients developing grade 3 or 4 in severity. However, the recent rising incidence of HSR to oxaliplatin observed is the result of increasing clinical use. HSR to oxaliplatin may manifest as facial flushing, rash/hives, tachycardia, dyspnoea, erythema, pruritus, fever, tongue swelling, headache, chills, weakness, vomiting, burning sensations, dizziness and oedema. Anaphylactic shock is rare but serious, and must be considered in the event of hypotension. No definitive approaches to prevent and treat HSR associated with oxaliplatin are available; however, few successful strategies have been reported. Such strategies include: slowing the infusion rate, use of steroids and antagonists of type 1 and 2 histamine receptors, and desensitisation. Successful implementation of oxaliplatin desensitisation protocols based on other platinum-containing compounds have been reported, which could enable a small number of patients who experience severe HSR to further receive an effective therapy for CRC. However, reintroductions have only been reported as single case studies or small cohorts. Large-scale validation on desensitisation strategies are still missing. Recently, subcutaneous adrenaline has also been utilised as an alternative approach to manage HSR to oxaliplatin. Knowledge of this rare but real toxicity of oxaliplatin is paramount because the use of this drug continues to increase not only for the treatment of patients with stage II-IV CRC, but also other solid malignancies. In this article, the author discusses the incidence, clinical presentation, pathogenesis, risk factors and current strategies of management of HSR associated with oxaliplatin.
据报道，结直肠癌（CRC）患者中与奥沙利铂相关的过敏反应（HSR）发生率约为12%，其中1%-2%的患者过敏反应严重程度达3级或4级。然而，最近观察到的奥沙利铂过敏反应发生率上升是临床使用增加的结果。奥沙利铂过敏反应可能表现为面部潮红、皮疹/荨麻疹、心动过速、呼吸困难、红斑、瘙痒、发热、舌肿胀、头痛、寒战、虚弱、呕吐、烧灼感、头晕和水肿。过敏性休克虽罕见但严重，出现低血压时必须考虑。目前尚无预防和治疗奥沙利铂相关过敏反应的确切方法；不过，已有少数成功策略的报道。这些策略包括：减慢输注速度、使用类固醇以及1型和2型组胺受体拮抗剂，以及脱敏。已有基于其他含铂化合物的奥沙利铂脱敏方案成功实施的报道，这能使少数经历严重过敏反应的患者进一步接受有效的结直肠癌治疗。然而，再次使用仅作为单例研究或小队列报道。脱敏策略的大规模验证仍缺失。最近，皮下注射肾上腺素也被用作处理奥沙利铂过敏反应的替代方法。了解奥沙利铂这种罕见但实际存在的毒性至关重要，因为不仅在治疗II-IV期结直肠癌患者中，而且在其他实体恶性肿瘤治疗中，这种药物的使用都在持续增加。在本文中，作者讨论了与奥沙利铂相关的过敏反应的发生率、临床表现、发病机制、危险因素及当前管理策略。
