Koshiba H, Hosokawa K, Kubo A, Miyagi Y, Oda T, Miyagi Y, Watanabe A, Honjo H
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Kajiicho, Kamigyoku, Japan.
Int J Gynecol Cancer. 2009 Apr;19(3):460-5. doi: 10.1111/IGC.0b013e3181a1bf2e.
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.
卡铂是治疗妇科恶性肿瘤最常用且耐受性良好的药物之一。据报道，在接受卡铂治疗的患者总体人群中，多次给药后过敏反应（HSRs）的发生率会增加。我们回顾性分析了113例日本妇科恶性肿瘤患者中卡铂相关HSRs的发生率、临床特征、处理方法或结局，以及再次使用该药物的可能性。我们在紫杉醇或多西他赛后静脉给予卡铂。轻度HSRs可通过暂时中断卡铂输注、额外使用抗组胺药和/或皮质类固醇来缓解。如果出现HSRs，卡铂在后续周期中稀释至不超过1mg/mL，并在2小时内缓慢输注。10例患者发生卡铂HSRs，总发生率为8.85%。所有病例的首次HSR发作均为轻度。再次使用卡铂时，4例出现严重HSRs。超过9个周期和/或超过5000mg卡铂给药显著增加了HSRs的发生率。特别是，超过15个周期和/或8000mg的卡铂治疗增加了严重HSRs的风险（P<0.0001）。卵巢癌组HSRs的发生率显著高于子宫癌组（P=0.0046）。在超过9个周期和/或5000mg的卡铂治疗期间，应密切关注HSRs。超过15个周期和/或8000mg时，严重HSRs的发生率会大幅增加。需要进一步研究以确定可能导致卡铂HSRs发生的潜在风险因素，并降低反应风险。
