Liao Juanyan, Jiang Ming
Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Pharmacol. 2025 Jan 15;15:1471038. doi: 10.3389/fphar.2024.1471038. eCollection 2024.
Oxaliplatin-induced hypersensitivity reactions (HSRs) are commonly encountered in first-line therapies for various malignancies. Recent research indicates that these reactions can include cytokine release reactions (CRRs), which are characterized by a marked increase in interleukin-6 (IL-6) levels, sometimes rising as much as 40-fold. Standard management strategies for HSRs typically involve desensitization protocols and routine treatments. However, these conventional approaches may be insufficient for managing CRRs. Preliminary studies suggest that tocilizumab, an IL-6 receptor (IL-6R) antagonist, may play a crucial role in mitigating CRRs. In our case, a 65-year-old male with stage IV extranodal NK/T-cell lymphoma developed a severe HSR on day 1 following the infusion of oxaliplatin during his fourth chemotherapy cycle. This reaction was marked by a substantial increase in IL-6 levels. Despite the administration of standard treatments, including epinephrine and corticosteroids, the patient required ventilatory support and vasopressors on day 1. On day 2, tocilizumab was administered, resulting in a rapid and significant reduction in IL-6 levels. Subsequently, the patient's symptoms, including fever, dyspnea, and hypotension, resolved, and he was discharged on day 5. This case demonstrates that tocilizumab can be an effective intervention in managing severe HSRs associated with CRRs. To our knowledge, this is the first reported instance of tocilizumab successfully salvaging a patient experiencing oxaliplatin-induced HSR. Nevertheless, further research is required to validate the efficacy of tocilizumab in treating oxaliplatin-induced HSRs.
奥沙利铂诱导的超敏反应（HSRs）在各种恶性肿瘤的一线治疗中很常见。最近的研究表明，这些反应可能包括细胞因子释放反应（CRRs），其特征是白细胞介素-6（IL-6）水平显著升高，有时可升高多达40倍。HSRs的标准管理策略通常包括脱敏方案和常规治疗。然而，这些传统方法可能不足以管理CRRs。初步研究表明，托珠单抗，一种IL-6受体（IL-6R）拮抗剂，可能在减轻CRRs中起关键作用。在我们的病例中，一名65岁的IV期结外NK/T细胞淋巴瘤男性患者在第四次化疗周期输注奥沙利铂后的第1天发生了严重的HSR。这种反应的特点是IL-6水平大幅升高。尽管给予了包括肾上腺素和皮质类固醇在内的标准治疗，但患者在第1天仍需要通气支持和血管升压药。在第2天，给予托珠单抗，导致IL-6水平迅速显著降低。随后，患者的症状，包括发热、呼吸困难和低血压，得到缓解，并于第5天出院。该病例表明，托珠单抗可以是管理与CRRs相关的严重HSRs的有效干预措施。据我们所知，这是托珠单抗成功挽救一名奥沙利铂诱导的HSR患者的首例报道。然而，需要进一步研究来验证托珠单抗治疗奥沙利铂诱导的HSRs的疗效。
