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Medline ® Abstract for Reference 56

of 'Infusion reactions to systemic chemotherapy'

Expanded experience with an intradermal skin test to predict for the presence or absence of carboplatin hypersensitivity.
Markman M, Zanotti K, Peterson G, Kulp B, Webster K, Belinson J
J Clin Oncol. 2003;21(24):4611.
PURPOSE: Carboplatin-associated hypersensitivity is increasingly recognized as a potentially serious toxicity when this agent is administered for more than six total cycles.
PATIENTS AND METHODS: Our group has used a predictive skin test in women with gynecologic cancers who have previously received more than six cumulative cycles of platinum-based chemotherapy. Thirty minutes before all subsequent carboplatin courses, a 0.02-mL aliquot from the solution prepared for treatment is injected intradermally. A positive test is considered to be a>or = 5-mm wheal, with a surrounding flare.
RESULTS: From October 1998 through March 2003, 126 patients received a total of 717 carboplatin skin tests (median per patient, four tests; range, one to 54 tests). Of the 668 negative tests (93% of the total performed), 10 were associated with evidence of carboplatin hypersensitivity (1.5% false-negative rate; 95% CI, 0.6% to 2.4%), none of which were severe (eg, dyspnea, hypotension, cardiac/respiratory compromise). Of the 41 positive tests, the decision wasmade to not deliver the drug to 32 patients, although seven women ultimately underwent a future attempt at re-treatment with a platinum agent using a desensitization program. In seven episodes where patients received the carboplatin despite the finding of a positive test, six were associated with the development of symptoms of anaphylaxis (none severe).
CONCLUSION: A negative carboplatin skin test seems to predict with reasonable reliability for the absence of a severe hypersensitivity reaction with the subsequent drug infusion. The implications of a positive test remain less certain, but limited experience with continued treatment suggests this approach must be undertaken with considerable caution.
Department of Hematology/Medical Oncology (R-35), the Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. markmam@ccf.org