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.
Keywords
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Article info
Publication history
Published online: January 18, 2022
Accepted:
January 13,
2022
Received in revised form:
January 9,
2022
Received:
December 6,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
