在卵巢癌患者卡铂再治疗期间，预防性转换为延长输注方案并使用预处理药物以预防过敏反应。
The prophylactic conversion to an extended infusion schedule and use of premedication to prevent hypersensitivity reactions in ovarian cancer patients during carboplatin retreatment.
作者信息
O'Cearbhaill Roisin, Zhou Qin, Iasonos Alexia, Hensley Martee L, Tew William P, Aghajanian Carol, Spriggs David R, Lichtman Stuart M, Sabbatini Paul J
机构信息
Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
出版信息
Gynecol Oncol. 2010 Mar;116(3):326-31. doi: 10.1016/j.ygyno.2009.10.070. Epub 2009 Nov 27.
OBJECTIVE
Repeated exposure to carboplatin can lead to hypersensitivity reactions during retreatment with carboplatin. This may prevent its further use in platinum-sensitive ovarian cancer patients. At our institution, an increasing proportion of patients are prophylactically converted to an extended schedule of infusion after 8 cycles of carboplatin. We sought to determine whether an incrementally increasing, extended 3-hour infusion of carboplatin with appropriate premedication was associated with a lower rate of hypersensitivity reactions compared to the standard 30-minute schedule in sequentially treated patients.
METHODS
We performed a retrospective electronic medical record review of patients with recurrent ovarian cancer retreated with carboplatin at our institution from January 1998 to December 2008.
RESULTS
Seven hundred and seventy-seven patients with relapsed ovarian, fallopian tube, or primary peritoneal cancer were retreated with carboplatin and met study inclusion criteria. Of these, 117 (17%) developed hypersensitivity reactions during second-line or greater carboplatin-based treatment for recurrent disease. Only 6 (3.4%) of the 174 patients who received the extended schedule developed hypersensitivity reactions (0% grade 4; 50% grade 3) compared to 111 (21%) of 533 patients in the standard schedule group (13% grade 4; 77% grade 3). The first hypersensitivity episode occurred after a median of 16 platinum (carboplatin and cisplatin) treatments in the extended group compared to 9 in the standard group. Using the Fisher exact test, there was an association with a reduced incidence of hypersensitivity reactions with the extended infusion schedule (P<0.001).
CONCLUSION
Our data suggest appropriate premedication and prophylactic conversion to an extended infusion during carboplatin retreatment may reduce hypersensitivity reactions.
目的
反复接触卡铂可导致再次使用卡铂治疗期间发生过敏反应。这可能会阻止其在铂敏感型卵巢癌患者中的进一步应用。在我们机构，越来越多的患者在接受8个周期的卡铂治疗后预防性地改为延长输注方案。我们试图确定，与标准的30分钟输注方案相比，在序贯治疗的患者中，逐步增加至3小时的卡铂延长输注并给予适当的预处理是否与较低的过敏反应发生率相关。
方法
我们对1998年1月至2008年12月在我们机构接受卡铂复治的复发性卵巢癌患者进行了回顾性电子病历审查。
结果
777例复发的卵巢、输卵管或原发性腹膜癌患者接受了卡铂复治并符合研究纳入标准。其中，117例（17%）在基于卡铂的二线或更高级别的复发性疾病治疗期间发生了过敏反应。在接受延长输注方案的174例患者中，只有6例（3.4%）发生了过敏反应（0%为4级；50%为3级），而标准输注方案组的533例患者中有111例（21%）发生了过敏反应（13%为4级；77%为3级）。延长输注组首次过敏反应发作发生在中位16次铂（卡铂和顺铂）治疗后，而标准输注组为9次。使用Fisher精确检验，延长输注方案与过敏反应发生率降低相关（P<0.001）。
结论
我们的数据表明，在卡铂复治期间进行适当的预处理并预防性地改为延长输注可能会减少过敏反应。
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