对于对卡铂过敏的复发性妇科癌症患者，奥沙利铂是一种安全的替代选择。
Oxaliplatin is a safe alternative option for patients with recurrent gynecologic cancers after hypersensitivity reaction to Carboplatin.
作者信息
Kolomeyevskaya Nonna V, Lele Shashikant B, Miller Austin, Riebandt Grazyna C, Blum Bonnie L, Odunsi Kunle O, Frederick Peter J
机构信息
Departments of *Gynecologic Oncology, †Biostatistics, and ‡Pharmacy, Roswell Park Cancer Institute, Buffalo, NY.
出版信息
Int J Gynecol Cancer. 2015 Jan;25(1):42-8. doi: 10.1097/IGC.0000000000000307.
OBJECTIVE
The aim of this study was to determine the tolerability and efficacy of oxaliplatin in patients with recurrent gynecologic malignancies after carboplatin hypersensitivity reactions in comparison with conventionally used cisplatin.
METHODS
Forty-six patients were treated with platinum-based chemotherapy from 2006 to 2011 and developed hypersensitivity reactions to carboplatin. Oxaliplatin was administered to 27 patients; 19 patients received cisplatin. Clinicopathologic variables, toxicity, and time-to-failure were analyzed retrospectively using descriptive statistics, Fisher exact, and independent sample permutation t tests.
RESULTS
The median number of carboplatin cycles and cumulative dose before reaction were similar in the oxaliplatin and cisplatin groups, respectively (6 vs 7.5 cycles, P = 0.93; 980 [662] mg vs 686 [579.6] mg, P = 0.49). Non-life-threatening hypersensitivity reaction to oxaliplatin developed in 2 of 27 patients. No reactions to cisplatin occurred. The median number of oxaliplatin/cisplatin cycles was 6 in both groups. Complete response to therapy was 34.6% (oxaliplatin) and 31.6% (cisplatin); stable disease was seen in 50.0% and 36.8% of oxaliplatin- and cisplatin-treated patients, respectively (P = 0.46). Exposure to oxaliplatin resulted in less neurotoxicity than cisplatin (25.9% vs 68.4%, P = 0.01). The median number of prior chemotherapy lines in both groups was 2. The median time-to-failure was 10.8 months in oxaliplatin group and 9.8 months in cisplatin group (P = 0.86).
CONCLUSIONS
Salvage therapy with oxaliplatin after hypersensitivity reaction to carboplatin is associated with excellent tolerability and time-to-failure comparable to cisplatin. When further administration of carboplatin is precluded, oxaliplatin represents a safe and effective treatment strategy in the platinum-sensitive relapse setting. The significantly lower neurotoxicity profile makes it an attractive alternative to cisplatin.
目的
本研究旨在确定奥沙利铂在卡铂过敏反应后的复发性妇科恶性肿瘤患者中的耐受性和疗效，并与传统使用的顺铂进行比较。
方法
2006年至2011年期间，46例接受铂类化疗的患者出现了对卡铂的过敏反应。27例患者接受奥沙利铂治疗；19例患者接受顺铂治疗。使用描述性统计、Fisher精确检验和独立样本置换t检验对临床病理变量、毒性和失败时间进行回顾性分析。
结果
奥沙利铂组和顺铂组在反应前的卡铂化疗周期中位数和累积剂量分别相似（6个周期对7.5个周期，P = 0.93；980 [662] mg对686 [579.6] mg，P = 0.49）。27例患者中有2例出现了对奥沙利铂的非危及生命的过敏反应。未发生对顺铂的反应。两组中奥沙利铂/顺铂的化疗周期中位数均为6个。治疗的完全缓解率分别为34.6%（奥沙利铂）和31.6%（顺铂）；奥沙利铂治疗组和顺铂治疗组分别有50.0%和36.8%的患者病情稳定（P = 0.46）。与顺铂相比，使用奥沙利铂导致的神经毒性更低（25.9%对68.4%，P = 0.01）。两组之前的化疗线数中位数均为2。奥沙利铂组的失败时间中位数为10.8个月，顺铂组为9.8个月（P = 0.86）。
结论
卡铂过敏反应后用奥沙利铂进行挽救治疗具有良好的耐受性，失败时间与顺铂相当。当无法进一步使用卡铂时，奥沙利铂是铂敏感复发情况下一种安全有效的治疗策略。其显著较低的神经毒性使其成为顺铂的一个有吸引力的替代方案。
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