Villarreal-González Rosalaura V, González-Díaz Sandra N, Vidal-Gutiérrez Oscar, Zayas-Villanueva Omar A, Solís-Lara Hugo, Santos-Fernández Wendy J, Casas-Murillo Claudio A, López-Méndez Alfonso
Autonomous University of Nuevo León, 103564University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Regional Center of Allergy and Clinical Immunology, Monterrey, Mexico.
Autonomous University of Nuevo León, 103564University Hospital "Dr Jose Eleuterio Gonzalez", Oncology Department, Monterrey, Mexico.
J Oncol Pharm Pract. 2022 Sep;28(6):1441-1445. doi: 10.1177/10781552221074975. Epub 2022 Feb 4.
High-grade serous primary peritoneal cancer is highly sensitive to platinum-based chemotherapy with response rates above 80%. Incidence of immediate hypersensitivity reactions to carboplatin is estimated to be between 15% and 20%, usually seen after a mean of 6-8 infusions, with patients developing moderate to severe reactions.
A 62-year-old female patient with stage IIIC primary high-grade serous carcinoma of the peritoneum was diagnosed and chemotherapy with carboplatin and Paclitaxel was indicated by the oncology service and patient shows response. At 6 months the patient returns, a new PET/CT reports progression of the disease. Carboplatin/paclitaxel cycles are restarted and in the eight cycle of carboplatin within 40 min of administration, she presented severe anaphylaxis with skin, pulmonary, cardiac and atypical symptoms. Infusion is suspended and intramuscular epinephrine with hydrocortisone and chlorphenamine are administered resolving symptoms.
Intradermal skin test with carboplatin at the concentration of 10 mg / ml (dilution 1: 100) was positive. Due to the symptoms presented and to continue the safe reintroduction to carboplatin, a 4 bag 16-step drug desensitization protocol was carried out at a total dose of 620 mg with no hypersensitivity reactions.
Prolonged carboplatin use is associated with an increased incidence of carboplatin-related hypersensitivity reactions. And in patients that present hypersensitivity reactions, a safe and effective carboplatin desensitization protocol can be carried out to reach the administration of a full dose. Desensitization protocol induces tolerance to a drug temporarily and is dependent on continuous exposure.
高级别浆液性原发性腹膜癌对铂类化疗高度敏感，缓解率超过80%。据估计，对卡铂立即发生超敏反应的发生率在15%至20%之间，通常在平均6 - 8次输注后出现，患者会出现中度至重度反应。
一名62岁女性患者被诊断为IIIC期原发性腹膜高级别浆液性癌，肿瘤学服务部门建议使用卡铂和紫杉醇进行化疗，患者有反应。6个月后患者复诊，新的PET/CT报告显示疾病进展。重新开始卡铂/紫杉醇周期治疗，在卡铂第八周期给药后40分钟内，她出现了严重的过敏反应，伴有皮肤、肺部、心脏和非典型症状。输液暂停，给予肌肉注射肾上腺素、氢化可的松和氯苯那敏，症状得以缓解。
用浓度为10mg/ml（稀释1:100）的卡铂进行皮内皮肤试验呈阳性。由于出现了这些症状且要继续安全地重新使用卡铂，于是实施了一个4袋16步的药物脱敏方案，总剂量为620mg，未出现过敏反应。
长期使用卡铂与卡铂相关超敏反应的发生率增加有关。对于出现超敏反应的患者，可以实施一个安全有效的卡铂脱敏方案以达到全剂量给药。脱敏方案会暂时诱导对药物的耐受性，并且依赖于持续接触。
