From the aDivision of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School and bDepartment of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
J Natl Compr Canc Netw. 2014 Mar 1;12(3):389-402. doi: 10.6004/jnccn.2014.0040.
Ovarian cancer is the fifth leading cause of cancer death among women in the United States. Chemotherapy using a taxane and platinum combination is key in improving survival in patients with newly diagnosed advanced ovarian cancer and is also used to treat recurrent platinum-sensitive disease. However, hypersensitivity reactions (HSRs) to chemotherapeutic agents are increasingly common and can greatly limit their use. Moreover, because of the frequent lack of equally effective alternative agents, chances of survival can be compromised. Therefore, physicians caring for these patients must be familiar with the management of HSRs to chemotherapy, and major advancements have recently been made in this field. Most HSRs implicate mast cell and basophil activation either through an IgE-mediated (ie, platinum agents) or nonspecific (ie, taxanes) mechanism. Therefore, these reactions have the potential to lead to anaphylaxis, at which time they should be treated with intramuscular epinephrine. Serum tryptase, which is released alongside histamine after mast cell activation, may be measured after an acute HSR to document mast cell involvement. After an HSR, the decision to re-treat with the same agent or a closely related one will vary depending on the causative drug, the type of HSR, and its severity. Drug desensitization has emerged as a safe and effective way of reintroducing a chemotherapeutic agent or monoclonal antibody responsible for an HSR in a patient who is expected to benefit from its continued use and for whom alternatives are considered less effective and/or more toxic. Currently, candidates for desensitization are preferably evaluated in academic settings with expertise in those procedures, because their use is still limited. Efforts are now needed to increase awareness about desensitization procedures so that more patients may benefit. This challenge will require the close collaboration of patients, nurses, oncologists, and allergists.
卵巢癌是美国女性癌症死亡的第五大主要原因。在新诊断的晚期卵巢癌患者中，使用紫杉烷和铂类药物联合化疗是提高生存率的关键，也用于治疗复发性铂类敏感疾病。然而，化疗药物的过敏反应（HSR）越来越常见，极大地限制了它们的使用。此外，由于缺乏同样有效的替代药物，生存机会可能受到影响。因此，治疗这些患者的医生必须熟悉 HSR 对化疗的管理，而该领域最近取得了重大进展。大多数 HSR 通过 IgE 介导（即铂类药物）或非特异性（即紫杉烷）机制涉及肥大细胞和嗜碱性粒细胞的激活。因此，这些反应有可能导致过敏反应，此时应使用肌内肾上腺素治疗。血清类胰蛋白酶，在肥大细胞活化后与组胺一起释放，在急性 HSR 后可以测量，以记录肥大细胞的参与。在 HSR 后，是否重新使用相同药物或密切相关药物进行治疗的决定将取决于致病药物、HSR 类型及其严重程度。药物脱敏已成为一种安全有效的方法，可在预计继续使用化疗药物或单克隆抗体受益且替代药物被认为效果较差和/或毒性较大的 HSR 患者中重新引入。目前，脱敏的候选者最好在具有这些程序专业知识的学术环境中进行评估，因为它们的使用仍然有限。现在需要努力提高对脱敏程序的认识，以便更多的患者受益。这一挑战将需要患者、护士、肿瘤学家和过敏症专家的密切合作。
