Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH 43220, USA.
Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43220, USA.
Gynecol Oncol. 2019 Feb;152(2):316-321. doi: 10.1016/j.ygyno.2018.10.037. Epub 2018 Nov 29.
Platinum hypersensitivity reactions (HSR) affect approximately 5% of the general oncologic population. Here we report the efficacy and safety of outpatient platinum desensitization protocol (PD) in gynecologic oncology patients with moderate (high-risk) to severe platinum HSR.
This is a retrospective report of patients with gynecologic malignancies undergoing an outpatient PD for moderate (high-risk) to severe platinum HSR from 2011 to 2017. Patient demographics, chemotherapy histories, and PD outcomes were collected. Descriptive statistics were performed given the exploratory nature of the study.
Forty-eight patients meeting inclusion criteria were identified. Most patients were being treated for ovarian cancer (56.3%) and were receiving carboplatin during their initial platinum HSR (75.0%). Patients received a mean of 10.3 platinum doses prior to their initial HSR. Transient hypertension was the most common sign of moderate (high-risk) HSR while persistent tachycardia was the most common sign of severe HSR. A total of 295 PD cycles were attempted with a successful completion rate of 96.6%. The mean number of PD cycles received by patients was 5.1. Almost 65% of patients experienced breakthrough reactions but over 58% of these breakthrough reactions were isolated to the first PD cycle. Only 8.3% of patients had severe breakthrough reactions, all of whom initially underwent shortened desensitization. Of these 4 patients, 2 successfully underwent desensitization with a prolonged protocol.
Outpatient PD is safe and effective in patients with gynecologic malignancies. This may present a feasible option for institutions with multi-disciplinary teams experienced with the management of platinum HSR.
铂类药物过敏反应（HSR）影响大约 5%的普通肿瘤患者。本研究报告了在中重度（高危）铂类药物 HSR 的妇科肿瘤患者中，门诊铂类脱敏方案（PD）的疗效和安全性。
这是一项回顾性报告，纳入了 2011 年至 2017 年间因中重度（高危）铂类药物 HSR 而接受门诊 PD 的妇科恶性肿瘤患者。收集了患者的人口统计学、化疗史和 PD 结果。鉴于该研究的探索性质，采用描述性统计方法。
确定了符合纳入标准的 48 例患者。大多数患者正在接受卵巢癌治疗（56.3%），在初次铂类药物 HSR 时接受卡铂治疗（75.0%）。患者在初次 HSR 前接受了平均 10.3 个铂类药物剂量。短暂性高血压是中重度（高危）HSR 的最常见表现，而持续性心动过速是重度 HSR 的最常见表现。共尝试了 295 个 PD 周期，完成率为 96.6%。患者平均接受 5.1 个 PD 周期。近 65%的患者发生突破性反应，但超过 58%的突破性反应仅发生在第一个 PD 周期。只有 8.3%的患者发生严重的突破性反应，所有这些患者最初都接受了缩短的脱敏治疗。其中 4 名患者中，有 2 名成功接受了延长脱敏方案的脱敏治疗。
门诊 PD 对妇科恶性肿瘤患者是安全有效的。对于具有多学科团队、经验丰富的铂类药物 HSR 管理机构来说，这可能是一种可行的选择。
