Simplified graded infusion strategy for mitigation of oxaliplatin hypersensitivity Journal Article
| Authors: | Alonso Martinez, S.; Segal, N. H.; Cercek, A.; Yaeger, R.; Stadler, Z.; Kemeny, N. E.; Nusrat, M.; Shahrokni, A.; Connell, L.; Saltz, L. B. |
| Article Title: | Simplified graded infusion strategy for mitigation of oxaliplatin hypersensitivity |
| Abstract: | Background: Hypersensitivity reactions (HSRs) to oxaliplatin present a therapeutic challenge. The standard desensitization protocol consists of 12 infusion steps with 3 drug dilutions, often in an inpatient setting. Several years ago we implemented a simplified outpatient graded infusion protocol for oxaliplatin with 2 drug dilutions and 3 infusion steps. Materials and Methods: We performed a retrospective analysis of our experience to define the safety and outcomes associated with this simplified, ambulatory, graded infusion strategy. Results: Between January 1, 2011 and December 1, 2020, 374 patients who had experienced an oxaliplatin-related HSR were treated via a 3-step graded infusion in the outpatient setting. Of these 374 patients, 283 (76%) did not experience a subsequent HSR, while 91 (24%) did experience a breakthrough HSR. Of the 374 patients, 19 (5%) experienced a grade 3 or 4 HSR. Three patients (0.8%) were hospitalized. There was no grade 5 (fatal) HSRs. Overall, the 374 patients received a median additional 3 cycles of oxaliplatin (range 1-41). The most common reasons for treatment discontinuation were disease progression (35%), breakthrough HSRs (24%), completion of treatment (21%), and toxicity other than HSR (20%). Fifteen patients who experienced breakthrough HSRs during a graded infusion were subsequently treated with the standard 12-step desensitization. Five of these 15 patients had an HSR during their initial desensitization and 5 developed an HSR on subsequent 12-step desensitizations. Thus, treatment was discontinued in 67% of these 15 patients due to persistent HSRs. Conclusion: Our data indicate that the simplified 3-step graded infusion protocol is a safe outpatient strategy for patients with a history of HSR to oxaliplatin. © 2022 Elsevier Inc. |
| Keywords: | adult; treatment outcome; middle aged; retrospective studies; major clinical study; drug withdrawal; hypertension; side effect; antineoplastic agents; pancreas cancer; antineoplastic agent; protein blood level; multiple cycle treatment; anemia; hemolysis; gastrointestinal symptom; cohort analysis; dexamethasone; clinical protocol; retrospective study; hematuria; backache; coughing; drug hypersensitivity; dyspnea; fever; pruritus; hypoxia; hypotension; hospitalization; rigor; thorax pain; drug infusion; erythema; outpatient; stomach cancer; lactate dehydrogenase; bile duct carcinoma; hot flush; oxaliplatin; esophagus cancer; anaphylaxis; bilirubin blood level; haptoglobin; urticaria; bronchospasm; angioneurotic edema; hypertensive factor; diphenhydramine; appendix cancer; dysesthesia; colorectal adenocarcinoma; hypersensitivity; procedures; desensitization; autoimmune thrombocytopenia; famotidine; humans; human; male; female; article; graded infusion; bilirubin glucuronide; desensitization, immunologic |
| Journal Title: | Clinical Colorectal Cancer |
| Volume: | 21 |
| Issue: | 2 |
| ISSN: | 1533-0028 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-06-01 |
| Start Page: | 149 |
| End Page: | 153 |
| Language: | English |
| DOI: | 10.1016/j.clcc.2022.01.006 |
| PUBMED: | 35125319 |
| PROVIDER: | scopus |
| PMCID: | PMC9149089 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 July 2022 -- Source: Scopus |
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