Villarreal-González Rosalaura V, Vidal-Gutiérrez Oscar, Martínez-Moyano Javier A, Madrazo-Morales Marianela, Sáenz-Cantú Kathia S, Cadenas-García Diana E, Oyervides-Juárez Victor M, Noriega-Iriondo María Fernanda, Rodríguez-Niño Patricia
Oncology Service, Centro Universitario Contra el Cáncer (CUCC), Hospital Universitario "Dr José Eleuterio González", Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
J Oncol Pharm Pract. 2024 Aug 28:10781552241269766. doi: 10.1177/10781552241269766.
Taxanes and platinum are first-line treatments in gynecological tumors with high rates of hypersensitivity reactions (HSRs), leading to discontinuation of treatment. Desensitization involves induction of temporary tolerance to previously sensitized medications. The aims of this study are to describe HSRs to paclitaxel and carboplatin and evaluate the safety and effectiveness of desensitization protocols in gynecological cancer patients.
Original, retrospective, descriptive, analytical study, approved by Bioethics and Research Committee, included >18-year-old patients with gynecological tumors experiencing HSRs to first-line chemotherapy. Patients underwent 3-bag-12-step desensitization.
174 desensitization (95 paclitaxel, 79 carboplatin) in 33 female patients, mean age 45.5 years (18-71y). Cancer diagnosis: breast 8 (24.2%), ovarian 14 (42.2%), endometrial 2 (6.1%) and cervix 9 (27.2%). HSR occurred in paclitaxel during cycles 1-2 and in carboplatin after 6 cycles. The most frequently seen HSR symptom was cardiovascular with paclitaxel (94.7%), and cutaneous (93.3%) with carboplatin. Three-bags 12-steps desensitization protocol (initial dilution 1:100) in 5.67hrs. All patients reached total dose desensitization: 82% with no reaction, 12% mild, 6% moderate and 0% severe reaction. Mean disease-free interval and progression-free interval in months (m): breast cancer 29 m and 14 m, ovarian 22 m and 9 m, endometrial 40 m and cervical cancer: 67.5 m and 27 m. Twenty-five patients (73.5%) are still alive.
HSRs to paclitaxel manifest in the first 1-2 cycles and to carboplatin after 6 cycles. Symptoms include cardiovascular, atypical neuromuscular and urticaria. Changing treatment lines impacts prognosis. Our study revealed that ovarian cancer patients undergoing desensitization protocols achieved longer progression-free intervals. All patients successfully reached total dose desensitization. This study provides evidence of the effectiveness and safety of desensitization and promising perspective for continuing first-line treatment with HSRs.
紫杉烷类和铂类是妇科肿瘤的一线治疗药物，但过敏反应（HSR）发生率较高，常导致治疗中断。脱敏治疗是指诱导对先前致敏药物产生暂时耐受性。本研究旨在描述对紫杉醇和卡铂的过敏反应，并评估脱敏方案在妇科癌症患者中的安全性和有效性。
本研究为原始的、回顾性的、描述性的分析研究，经生物伦理与研究委员会批准，纳入年龄大于18岁、对一线化疗出现过敏反应的妇科肿瘤患者。患者接受3袋12步脱敏治疗。
33例女性患者共进行了174次脱敏治疗（95次针对紫杉醇，79次针对卡铂），平均年龄45.5岁（18 - 71岁）。癌症诊断情况：乳腺癌8例（24.2%），卵巢癌14例（42.2%），子宫内膜癌2例（6.1%），宫颈癌9例（27.2%）。紫杉醇过敏反应发生在第1 - 2周期，卡铂过敏反应发生在第6周期后。最常见的过敏反应症状，紫杉醇为心血管症状（94.7%），卡铂为皮肤症状（93.3%）。3袋12步脱敏方案（初始稀释比例1:100），历时5.67小时。所有患者均达到总剂量脱敏：82%无反应，12%为轻度反应，6%为中度反应，0%为重度反应。各癌症的平均无病间期和无进展间期（月）：乳腺癌为29个月和14个月，卵巢癌为22个月和9个月，子宫内膜癌为40个月，宫颈癌为67.5个月和27个月。25例患者（73.5%）仍存活。
紫杉醇过敏反应出现在第1 - 2周期，卡铂过敏反应出现在第6周期后。症状包括心血管症状、非典型神经肌肉症状和荨麻疹。改变治疗方案会影响预后。我们的研究表明，接受脱敏方案的卵巢癌患者无进展间期更长。所有患者均成功达到总剂量脱敏。本研究为脱敏治疗的有效性和安全性提供了证据，并为对过敏反应患者继续进行一线治疗提供了有前景的方向。
