Abstract
Oxaliplatin immune-induced syndrome (OIIS) is an uncommon, potentially life-threatening,
side effect associated with oxaliplatin-based chemotherapy. The present study reports
5 original cases of OIIS and systematically reviewed the available published cases.
We retrospectively analyzed the clinical archives of the Niguarda Cancer Center from
2009 to 2015 and conducted a search for OIIS using the PubMed database, followed by
deeper investigation of the references of the recorded studies. We pooled our series
with other reported cases for systematic review in accordance with the recommendations
of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement
using only English language as the selection criterion. A total of 61 OIIS cases were
analyzed, the largest series reported to date. Of the 61 patients, 56 (91.8%) had
received oxaliplatin for metastatic colorectal cancer. In 32 of the 61 patients (52.5%),
OIIS was associated with grade 4 thrombocytopenia and in 4 (6.6%) with grade 4 anemia.
OIIS was fatal in 4 patients. In 49 patients, oxaliplatin-induced immune system activation
was tested using the Coombs test or by detection of antiplatelet antibodies and was
positive in 87.7% of the patients. The average number of oxaliplatin cycles until
the onset of OIIS was 16.7, and the number was significantly lower when oxaliplatin
was administered as a rechallenge after a period of vacancy of treatment with this
agent (4.6 cycles as rechallenge vs. 13.6 as first-time exposure; P < .00001). OIIS is triggered by cumulative administration of oxaliplatin, characteristically
with a threefold earlier onset when the drug is administered as a rechallenge. Prompt
identification of OIIS can be expected to reduce the risk of iatrogenic morbidity
and mortality.
Keywords
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Article info
Publication history
Published online: February 18, 2016
Accepted:
February 3,
2016
Received in revised form:
December 22,
2015
Received:
November 11,
2015
Footnotes
K. Bencardino and G. Mauri contributed equally as first authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
