Carboplatin hypersensitivity: does introduction of skin test and desensitization reliably predict and avoid the problem? A prospective single-center study.

BACKGROUND: Carboplatinum-based retreatment can be regarded as a standard option in the so-called platinum-sensitive ovarian cancer, but its use can be limited by the occurrence of sometimes severe hypersensitivity reactions (HSRs). This study analyzes the value of carboplatin skin testing and desensitization. PATIENTS AND METHODS: Between 2004 and 2006, all patients with carboplatin reinduction chemotherapy received an intradermal injection of 0.2 microL of carboplatin and saline as negative control before chemotherapy. Carboplatin was administered in the standard way if the test was negative. If positive, carboplatin was administered after an already published desensitization protocol.
RESULTS: Fifty-four patients received retreatment with carboplatinum and were submitted to skin test. Seven patients (13%) had positive skin test, whereas 4 patients developed HSRs although they had negative skin test (8.5% false-negative rate). Skin test predicted HSRs in only 64% of the afflicted patients. Desensitization was performed in all patients with positive skin test, and 5 (71%) of 7 could receive 3 to 11 further carboplatinum courses. Repeated HSRs occurred in 2 of 7 patients despite desensitization; however, none of the HSRs after desensitization were severe.
CONCLUSIONS: Skin test did not reliably predict carboplatinum-induced HSR, but desensitization was demonstrated to be a rather successful strategy. Taking the low predictive value into account, we started another prospective series of administering antiallergic medication to all patients with carboplatinum retreatment and offer desensitization if any HSR occurs.