Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea,
Cancer Chemother Pharmacol. 2014 May;73(5):1021-9. doi: 10.1007/s00280-014-2437-5. Epub 2014 Apr 3.
This study investigated the characteristics of oxaliplatin-related hypersensitivity reactions (HSR) and evaluated the efficacy of premedication and desensitization administration for controlling HSR in patients with gastrointestinal malignancy.
This retrospective study includes oxaliplatin hypersensitivity cases reported to our in-hospital, adverse drug reaction monitoring system between May 2008 and April 2012. We analyzed administration histories of oxaliplatin and premedication treatments, chemotherapy cycle and severity of the initial HSR, and prophylactic measures and their outcomes in subsequent chemotherapy cycles.
One hundred and seventy-three patients showed hypersensitivity to oxaliplatin-based chemotherapy. Oxaliplatin HSR developed after mean chemotherapy cycle 6.3 ± 0.3. Specifically, while HSR occurred at cycle 7.6 ± 0.3 in the case of patients previously unexposed to oxaliplatin-containing chemotherapy, it occurred at cycle 2.6 ± 0.3 in previously exposed patients. Of the 173 patients who exhibited HSR, premedication was administered in 134 patients and 71.6 % of them succeeded in preventing HSR. Desensitization was attempted in 38 patients, including 20 patients in whom premedication administration was unsuccessful, and 89 % of desensitized patients successfully underwent oxaliplatin chemotherapy without HSR. As severity of HSR increased, the success rate by premedication decreased and the percentage of patients that underwent desensitization increased.
Attention should be paid to patients with any prior exposure to oxaliplatin, especially during early chemotherapy cycles. Given the high success rate of preventing HSR by desensitization administration and its apparent safety profile, we suggest that desensitization be considered as the first option for the treatment of grades 3 and 4 HSR cases.
本研究旨在探讨奥沙利铂相关过敏反应（HSR）的特点，并评估预处理和脱敏给药在控制胃肠道恶性肿瘤患者 HSR 中的疗效。
本回顾性研究纳入了 2008 年 5 月至 2012 年 4 月向我院药物不良反应监测系统报告的奥沙利铂过敏病例。我们分析了奥沙利铂的给药史和预处理治疗、化疗周期以及初始 HSR 的严重程度，以及后续化疗周期中的预防措施及其结果。
173 例患者对奥沙利铂为基础的化疗表现出过敏反应。奥沙利铂 HSR 发生在平均化疗周期 6.3 ± 0.3 后。具体来说，在未接触过奥沙利铂含化疗药物的患者中，HSR 发生在第 7.6 ± 0.3 周期，而在既往暴露于奥沙利铂的患者中，HSR 发生在第 2.6 ± 0.3 周期。在 173 例出现 HSR 的患者中，134 例患者给予了预处理，其中 71.6%的患者成功预防了 HSR。对 38 例患者进行了脱敏治疗，其中 20 例预处理治疗失败的患者进行了脱敏治疗，89%的脱敏患者成功地进行了奥沙利铂化疗，没有出现 HSR。随着 HSR 严重程度的增加，预处理的成功率降低，脱敏治疗的患者比例增加。
应注意任何既往接触过奥沙利铂的患者，特别是在早期化疗周期。鉴于脱敏给药预防 HSR 的成功率高，且安全性良好，我们建议将脱敏治疗作为治疗 3 级和 4 级 HSR 病例的首选方法。
