Salvador Alonso Martinez1, Neil H Segal2, Andrea Cercek2, Rona Yaeger2, Zsofia Stadler2, Nancy E Kemeny2, Maliha Nusrat2, Armin Shahrokni2, Louise Connell2, Leonard B Saltz2. 1. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Address for correspondence: Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY 10065. Electronic address: alonsoms@mskcc.org. 2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Address for correspondence: Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY 10065.
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.
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.
Authors: Diana Pérez-Alzate; Natalia Blanca-López; María Luisa Somoza; Francisco Javier Ruano; Gloria Serrano Montero; María José Penalva; Carmen Gimeno; Miguel Blanca; Gabriela Canto Journal: Ann Allergy Asthma Immunol Date: 2018-04 Impact factor: 6.347
Authors: David Sloane; Usha Govindarajulu; Jacob Harrow-Mortelliti; William Barry; Florence Ida Hsu; David Hong; Tanya Laidlaw; Ross Palis; Henry Legere; Supinda Bunyavanich; Rebecca Breslow; Duane Wesemann; Nora Barrett; Patrick Brennan; Hey Jin Chong; Anne Liu; James Fernandez; Laura Fanning; Timothy Kyin; Katherine Cahill; Lora Bankova; Ashly Lynch; Suzanne Berlin; Susana Campos; Charles Fuchs; Robert Mayer; Ursula Matulonis; Mariana Castells Journal: J Allergy Clin Immunol Pract Date: 2016-02-16
Authors: J R Cernadas; K Brockow; A Romano; W Aberer; M J Torres; A Bircher; P Campi; M L Sanz; M Castells; P Demoly; W J Pichler Journal: Allergy Date: 2010-08-17 Impact factor: 13.146
Authors: Mariana C Castells; Nichole M Tennant; David E Sloane; F Ida Hsu; Nora A Barrett; David I Hong; Tanya M Laidlaw; Henry J Legere; Samridhi N Nallamshetty; Ross I Palis; Jayanti J Rao; Suzanne T Berlin; Susana M Campos; Ursula A Matulonis Journal: J Allergy Clin Immunol Date: 2008-05-27 Impact factor: 10.793