Xue Jing, Lian Zhihao, Li Xiaoyan
Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Front Pharmacol. 2025 Jul 8;16:1624322. doi: 10.3389/fphar.2025.1624322. eCollection 2025.
Oxaliplatin (OXA) serves as a first-line treatment for digestive system tumors such as colorectal cancer (CRC) and gastric cancer. OXA-induced hypersensitivity reactions (HSRs) may pose life-threatening risks to patients. This study aimed to explore the risk factors and protective factors of OXA-induced HSRs in Chinese CRC patients.
A retrospective analysis was conducted on 233 CRC patients who received OXA treatment between June 2022 and December 2022. Demographic data and medical histories were extracted from the hospital's medical record system.
Among the 233 patients, 51 patients (21.9%) developed OXA-induced HSRs, with the median treatment cycle at onset being the 4th cycle. Univariate and multivariate analyses revealed that an OXA treatment interruption lasting ≥30 days (P < 0.05, odds ratio [OR] = 10.76, 95% confidence interval [CI] = 4.57-25.3), a history of platinum-based drug allergy (P < 0.05, OR = 19.03, 95% CI = 1.66-217.99), and abnormal absolute neutrophil count (P < 0.05, OR = 8.96, 95% CI = 3.11-25.86) were independent risk factors. Pretreatment with dual-drug or triple-drug prophylactic regimens before OXA administration was identified as an independent protective factor (P < 0.05, OR = 0.37, 95% CI = 0.17-0.82). The area under the receiver operating characteristic (ROC) curve was 0.82 (P < 0.001, 95% CI = 0.75-0.89). Although previous platinum-based drug dosage and abnormal absolute lymphocyte count showed significant differences in univariate analysis, they did not emerge as independent influencing factors in multivariate logistic regression.
Prolonged OXA treatment interruption, a history of platinum-based drug allergy, and abnormal neutrophil count are independent risk factors for OXA-induced HSRs, while dual/triple-drug pretreatment acts as an independent protective factor. Clinicians should evaluate these risks before medication and consider intensified pretreatment regimens to reduce HSR incidence.
奥沙利铂（OXA）是结直肠癌（CRC）和胃癌等消化系统肿瘤的一线治疗药物。奥沙利铂引起的超敏反应（HSR）可能给患者带来危及生命的风险。本研究旨在探讨中国CRC患者中奥沙利铂诱导的HSR的危险因素和保护因素。
对2022年6月至2022年12月期间接受奥沙利铂治疗的233例CRC患者进行回顾性分析。从医院病历系统中提取人口统计学数据和病史。
在233例患者中，51例（21.9%）发生了奥沙利铂诱导的HSR，发病时的中位治疗周期为第4周期。单因素和多因素分析显示，奥沙利铂治疗中断持续≥30天（P<0.05，比值比[OR]=10.76，95%置信区间[CI]=4.57-25.3）、铂类药物过敏史（P<0.05，OR=19.03，95%CI=1.66-217.99）和绝对中性粒细胞计数异常（P<0.05，OR=8.96，95%CI=3.11-25.86）是独立危险因素。在奥沙利铂给药前采用双药或三药预防性方案进行预处理被确定为独立保护因素（P<0.05，OR=0.37，95%CI=0.17-0.82）。受试者工作特征（ROC）曲线下面积为0.82（P<0.001，95%CI=0.75-0.89）。虽然既往铂类药物剂量和绝对淋巴细胞计数异常在单因素分析中显示出显著差异，但在多因素逻辑回归中它们并未成为独立影响因素。
奥沙利铂治疗中断时间延长、铂类药物过敏史和中性粒细胞计数异常是奥沙利铂诱导的HSR的独立危险因素，而双药/三药预处理是独立保护因素。临床医生在用药前应评估这些风险，并考虑强化预处理方案以降低HSR发生率。
