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Medline ® Abstract for Reference 50

of 'Infusion reactions to systemic chemotherapy'

50
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Cisplatin can be safely administered to ovarian cancer patients with hypersensitivity to carboplatin.
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Bergamini A, Pisano C, Di Napoli M, Arenare L, Della Pepa C, Tambaro R, Facchini G, Gargiulo P, Rossetti S, Mangili G, Pignata S, Cecere SC
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Gynecol Oncol. 2017;144(1):72.
 
OBJECTIVE: Hypersensitivity reactions (HSR) are frequently reported in patients rechallenged with carboplatin for recurrent ovarian cancer (ROC) and represent a critical issue, since discontinuation of the platinum-based therapy could affect prognosis. Several strategies to allow platinum rechallenge have been described, with controversial outcomes. The aim of this study is to illustrate a 10-year experience with cisplatin in patients with a previous HSR to carboplatin or at risk for allergy.
METHODS: A retrospective review of all patients with platinum sensitive ROC retreated with carboplatin was performed between January 2007 and May 2016 at the Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples.
RESULTS: Among 183 patients, 49 (26.8%) presented HSR to carboplatin, mainly during second line therapy. Mean number of cycles before HSR was 8 (range 3-17). G2, G3 and G4 reaction were detected in 83%, 15% and 2% of patients, respectively. In a multivariate analysis including age, hystotype, BRCA status, previous known HSR, and combination drug administered, only the type of carboplatin-based doublet used as 2nd line therapy was found to significantly affect HSR development, with a protective effect of PLD (pegylated liposomal doxorubicin) (p = 0.014, OR = 0.027). Thirty seven patients (77%) with a previous HSR to carboplatin were rechallenged with cisplatin. Treatment was generally well tolerated. 5 patients (13.1%) experienced mild HSR to cisplatin, successfully managed in all cases. 14 patients were treated with cisplatin even without a carboplatin-related HSR due to other allergies. Among these, only one developed HSR (7.1%).
CONCLUSIONS: Cisplatin rechallenge is a feasible approach in patients experiencing HSR to carboplatin to maintain the beneficial effect of platinum while reducing hypersensitivity-related risks.
AD
Department of Urology and Gynaecology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy; Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
PMID