Document Detail


Carboplatin desensitization.
MedLine Citation:
PMID:  15328672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: IgE-mediated carboplatin hypersensitivity reactions occur in up to 30% of patients receiving this agent for chemotherapy of solid tumors, thus limiting therapeutic options. OBJECTIVE: To describe our experience with intravenous carboplatin desensitization regimens, which culminated in a standardized, successful protocol for safe administration. METHODS: Eight consecutive patients with ovarian cancer who had experienced severe anaphylactic reactions to carboplatin were referred to our hospital. Intradermal skin testing was performed by raising a 3-mm bleb by injection of undiluted carboplatin at 10 mg/mL, and the wheal size was read at 20 minutes. The outcomes of the various desensitization regimens were documented prospectively, and the experience gained was used to develop a standardized protocol for administration. RESULTS: All patients had positive intradermal skin test results. The first 3 patients were treated with short (90 minutes to 6 hours) desensitization protocols, and all protocols failed on the first or second infusions. These 3 and a subsequent 5 patients were given intravenous carboplatin according to a protocol of gradual dose escalation over a 4-log dose range given during a 4-day period, with subsequent 3-weekly infusions given more rapidly by omitting the most dilute log dose on each occasion. All patients tolerated the longer infusion protocol without event, and all but 1 patient experienced appropriate tumor marker response. CONCLUSIONS: Short carboplatin desensitization protocols (less than 6 hours) have an unacceptable failure rate in patients with carboplatin allergy, but longer infusion times (days) are well tolerated without recurrence of the allergic reaction and with good tumor response. In cases where carboplatin is the optimal therapeutic agent, clinicians should not be deterred by an anaphylactic reaction to it or by failure of shorter desensitization regimens.
Authors:
James Choi; Paul Harnett; David A Fulcher
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology     Volume:  93     ISSN:  1081-1206     ISO Abbreviation:  Ann. Allergy Asthma Immunol.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-26     Completed Date:  2004-09-23     Revised Date:  2006-04-24    
Medline Journal Info:
Nlm Unique ID:  9503580     Medline TA:  Ann Allergy Asthma Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  137-41     Citation Subset:  IM    
Affiliation:
Immunology Unit, Westmead Hospital, Westmead, Sydney, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anaphylaxis / chemically induced,  diagnosis
Antineoplastic Agents / administration & dosage,  adverse effects*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Australia
Carboplatin / administration & dosage,  adverse effects*
Desensitization, Immunologic*
Dose-Response Relationship, Drug
Drug Hypersensitivity / diagnosis,  etiology
Female
Humans
Infusions, Intravenous
Middle Aged
Neoplasm Staging
Ovarian Neoplasms / drug therapy,  pathology
Paclitaxel / administration & dosage
Skin Tests
Women's Health
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 33069-62-4/Paclitaxel; 41575-94-4/Carboplatin
Comments/Corrections
Comment In:
Ann Allergy Asthma Immunol. 2004 Aug;93(2):111   [PMID:  15328668 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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