Michikami Hiroo, Minaguchi Takeo, Ochi Hiroyuki, Onuki Mamiko, Okada Satoshi, Matsumoto Koji, Satoh Toyomi, Oki Akinori, Yoshikawa Hiroyuki
Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Obstet Gynaecol Res. 2013 Jan;39(1):330-5. doi: 10.1111/j.1447-0756.2012.01893.x. Epub 2012 May 28.
Repeated treatment with carboplatin increases the incidence of hypersensitivity reactions. Current managements for carboplatin hypersensitivity reactions involve premedication, desensitization, and replacing agents. However, preventive effects for recurrent reactions by the former two methods are still limited, and substituting non-platinum agent can attenuate efficacy against platinum-sensitive diseases. The aim of this study was to evaluate the safety and efficacy of substituting nedaplatin, another platinum compound, as a strategy to deal with carboplatin hypersensitivity reactions in gynecologic cancers.
Patients who experienced carboplatin hypersensitivity reactions and subsequently switched to nedaplatin between 2001 and 2009 were identified through our database. The incidence and severity of nedaplatin hypersensitivity were examined. Response to nedaplatin therapy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) and serum CA-125 levels.
Forty-six of 570 patients (8.1%) experienced carboplatin hypersensitivity reactions, and the increased cycle numbers of carboplatin-based regimens correlated with the high incidence of hypersensitivity (≤6, 0.9% vs ≥7, 19.2%). Of these 46 patients, 38 subsequently switched to nedaplatin-based regimens (ovarian, tubal or peritoneal carcinoma, 30; endometrial carcinoma, 6; cervical carcinoma, 2). Three of the 38 patients (7.9%) eventually developed hypersensitivity against nedaplatin, and all their reactions were grade 2. The response rate to nedaplatin therapy among 32 evaluable patients was 31.3%.
Replacing carboplatin with nedaplatin provided a safe and efficacious approach to manage carboplatin hypersensitivity. To the authors' knowledge, this study is the first to indicate the usefulness of nedaplatin after carboplatin hypersensitivity reactions. Further evaluations are warranted to confirm our finding.
重复使用卡铂治疗会增加过敏反应的发生率。目前针对卡铂过敏反应的处理方法包括预处理、脱敏和更换药物。然而，前两种方法对复发性反应的预防效果仍然有限，而替换为非铂类药物会削弱对铂敏感疾病的疗效。本研究的目的是评估用另一种铂类化合物奈达铂替代卡铂作为处理妇科癌症中卡铂过敏反应策略的安全性和有效性。
通过我们的数据库确定了2001年至2009年间经历卡铂过敏反应并随后改用奈达铂的患者。检查了奈达铂过敏的发生率和严重程度。根据实体瘤疗效评价标准（RECIST）和血清CA-125水平评估对奈达铂治疗的反应。
570例患者中有46例（8.1%）经历了卡铂过敏反应，基于卡铂的方案的周期数增加与过敏反应的高发生率相关（≤6个周期，0.9%对≥7个周期，19.2%）。在这46例患者中，38例随后改用基于奈达铂的方案（卵巢癌、输卵管癌或腹膜癌，30例；子宫内膜癌，6例；宫颈癌，2例）。38例患者中有3例（7.9%）最终对奈达铂产生过敏反应，且所有反应均为2级。32例可评估患者中对奈达铂治疗的反应率为31.3%。
用奈达铂替代卡铂为处理卡铂过敏反应提供了一种安全有效的方法。据作者所知，本研究首次表明卡铂过敏反应后奈达铂的有效性。需要进一步评估以证实我们的发现。
