North Sichuan Medical College, Nanchong, Sichuan Province, China.
Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China.
Medicine (Baltimore). 2023 Dec 15;102(50):e36690. doi: 10.1097/MD.0000000000036690.
Although rare, systemic hypersensitivity reactions to nedaplatin chemotherapy arise rapidly and can be life-threatening. The causes are unclear, and multiple potential mechanisms exist. Here, we report a case of systemic hypersensitivity reaction to nedaplatin and review the literature to establish a recommended protocol.
A 62-year-old man was being treated for squamous lung cancer with multiple metastases. On the first day of chemotherapy, 5 minutes after nedaplatin infusion, he developed panic, shortness of breath, and dyspnea with rapid heart rate, reduced oxygen saturation, and elevated blood pressure.
The symptoms indicated that the patient had developed a severe hypersensitivity reaction to nedaplatin, which could be life-threatening without immediate intervention.
Nedaplatin was discontinued, and he was treated with oxygen, ECG monitoring, finger pulse oximeter monitoring, 10 mg dexamethasone sodium phosphate injected intravenously, 20 mg diphenhydramine hydrochloride injected intramuscularly, and 40 mg methylprednisolone sodium succinate injected intravenously.
His allergic symptoms resolved, and once his vital signs stabilized, he was given 5 mg oral desloratadine once daily and 10 mg oral ebastine once daily to alleviate the effects of the allergic reaction. Once his vital signs remained stable without any special supportive treatment, he was discharged from the hospital. His chemotherapy regimen was discontinued, with no plan for a follow-up treatment due to the possibility of cross-allergic reactions between platinum-based drugs.
Clinical use of nedaplatin should be monitored and managed intensively for prevention and treatment of hypersensitivity reactions. Care should be taken to control the titration rate during infusion while closely monitoring vital signs. Clinical staff should be prepared to treat allergic symptoms as soon as they appear. The acute phase should involve immediate discontinuation of the drug; intravenous saline infusion for volume expansion; rapid assessment of circulation, airway, respiration, state of consciousness, and skin condition; and administration of oxygen, antihistamines, and epinephrine as appropriate for anaphylaxis. More randomized clinical trials are needed to elucidate appropriate preventative and management strategies to improve patient safety and support their successful completion of clinical treatment programs.
尽管罕见，但奈达铂化疗引起的全身性过敏反应发展迅速，可能危及生命。其病因尚不清楚，存在多种潜在机制。在此，我们报告一例奈达铂引起的全身性过敏反应病例，并复习文献以建立推荐方案。
一名 62 岁男性患有鳞状肺癌伴多处转移，接受化疗。化疗第 1 天，奈达铂输注 5 分钟后，患者出现恐慌、呼吸急促和呼吸困难，伴有心率加快、血氧饱和度降低和血压升高。
这些症状表明患者发生严重的奈达铂过敏反应，如果不立即干预，可能危及生命。
停用奈达铂，给予吸氧、心电图监测、指脉搏血氧仪监测，静脉注射 10mg 磷酸地塞米松钠、肌肉注射 20mg 盐酸苯海拉明、静脉注射 40mg 甲泼尼龙琥珀酸钠。
过敏症状缓解，生命体征稳定后，给予患者 5mg 地氯雷他定口服 1 次/天和 10mg 依巴斯汀口服 1 次/天以缓解过敏反应。生命体征稳定后无需特殊支持治疗，患者出院。由于铂类药物之间可能发生交叉过敏反应，故停用其化疗方案，不考虑后续治疗。
奈达铂临床应用应密切监测和管理，预防和治疗过敏反应。输注时应注意控制滴注速度，同时密切监测生命体征。一旦出现过敏症状，临床人员应做好治疗准备。急性期应立即停药；静脉补液扩容；快速评估循环、气道、呼吸、意识状态和皮肤状况；根据过敏反应的严重程度，给予氧疗、抗组胺药和肾上腺素。需要更多的随机临床试验来阐明适当的预防和管理策略，以提高患者安全性并支持其成功完成临床治疗方案。
