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Risk protocol identifies patients with cancer not allergic to carboplatin, oxaliplatin
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Patients with cancer who had a history of presumed carboplatin- and oxaliplatin-induced hypersensitivity reaction did not appear allergic to the chemotherapy drugs after skin prick tests, according to retrospective study results.
The risk-stratification protocol appeared to safely identify patients without allergic reaction to the drugs, allowing them to return to an outpatient setting for further treatment without desensitization.
Alberta L. Wang
“Skin testing is the diagnostic standard for evaluating carboplatin and oxaliplatin hypersensitivity reactions, but one-time skin testing has a high false–negative rate,” Alberta L. Wang, MD, a clinical and research fellow in the division of rheumatology, immunology and allergy at Brigham and Women’s Hospital told Healio.com/Allergy. “Our group [developed] a risk stratification protocol utilizing repeat skin testing for patients with history of presumed hypersensitivity reaction to carboplatin or oxaliplatin, and this study showed that the protocol is able to safely identify false–negative skin tests and non-allergic patients.”
Wang and colleagues conducted a 5-year retrospective review of patients at Massachusetts General Hospital with carboplatin- and oxaliplatin-induced HSR to analyze the effectiveness of a risk-stratification protocol to determine if a patient with cancer had an allergic reaction to either chemotherapy drug.
The protocol included three repeat skin tests (STs) with intervening desensitizations. If a ST result remained negative each time, patients received further infusions without desensitizations.
The analysis included 142 patients — 92 treated with carboplatin and 50 treated with oxaliplatin.
The study included mostly women (84.5%) and 91.5% of the patients were white.
Patients treated with carboplatin predominantly had ovarian cancer (94.6%) and patients treated with oxaliplatin mostly had colorectal cancer (96%).
Thirty-two patients treated with carboplatin had a positive and 60 patients had a negative reaction at the first skin test. After repeat skin testing, 22 patients converted from negative to positive and 38 patients showed no signs of a reaction.
Seventeen of 22 patients who showed no signs of a reaction during the first three skin tests continued treatment regimens through 59 outpatient infusions without complication.
Among the patients treated with oxaliplatin, 22 had a positive reaction and 28 had a negative reaction at the initial skin test. Twenty-five patients still showed no signs of a reaction after the repeat skin tests.
Sixteen of 18 patients who continued oxaliplatin treatments did so through 95 outpatient infusions without complication.
The study results are beneficial because they provide patients without an allergic reaction to the drugs more freedom, according to the researchers.
“Patients who were diagnosed as non-allergic were able to return to outpatient infusions without desensitizations, leading to decreased unnecessary desensitizations and improved quality of life,” Wang told Healio.com/Allergy. – by Ryan McDonald
Disclosure: The researchers report no relevant financial disclosures.
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