Category: Professional Posters
Purpose: Hypersensitivity reactions prove a significant obstacle in the utilization of oxaliplatin chemotherapy. These interruptions may interfere with treatment goals and effective prevention of cancer recurrence in the adjuvant setting. A common tactic for confronting oxaliplatin-provoked hypersensitivity is desensitization, a gradual presentation of the suspected agent, with the sum dose matching the objective dose. The goal is to drastically limit the symptoms of potential subsequent hypersensitivities. Research was performed at Northwell Health, which utilizes oxaliplatin for the treatment of cancers, primarily colon cancer. The objective is to identify patients imposed by oxaliplatin induced anaphylaxis and examine their response to rechallenge.
Methods: This study is an institutional review board approved retrospective chart review of a standardized oxaliplatin desensitization protocol after encountered hypersensitivity. Patients treated at Northwell Health who had been rechallenged with oxaliplatin were identified from the institution’s electronic medical records database. Patients were included if they received the oxaliplatin desensitization protocol between January 1st, 2015 to December 31st, 2018. Patient demographic and clinical information such as age, ethnicity, gender, diagnosis, cancer staging according to the American Joint Committee on Cancer, body mass index, height, weight, and body surface area were recorded. Oxaliplatin regimen was broken down into parameters concerning cumulative dose before reaction, cumulative rechallenge dose and dose at anaphylactic reaction. When applicable, progression free survival and ultimate outcome of desensitization, whether patient completed the protocol or withdrew, were documented. The primary endpoint is to determine the frequency of patients who successfully underwent Northwell Health’s oxaliplatin desensitization protocol. The secondary endpoint is to evaluate the outcomes of these patients.
Results: Twelve patients were identified as eligible for inclusion. 75% were male with a median age of 56 years at initiation of oxaliplatin chemotherapy and median BMI of 28 kg/m2. Patient breakdown for each cancer are: 10 patients had colorectal cancer and 2 patients had pancreatic cancer. Premedication before rechallenge of successful patients included cetirizine, famotidine, dexamethasone, and montelukast. The median number of treatment cycles until encountering hypersensitivity was 2 cycles. The median dose of oxaliplatin during the cycle of reaction was 85 mg/m2, which approximately half received (n=5). The median cumulative oxaliplatin dose was 191 mg/m2. Five (45%) patients reported allergic reactions to oxaliplatin rechallenge while 6 (55%) were able to successfully complete rechallenge and ensuing therapy.
Conclusion: Standardization of oxaliplatin chemotherapy desensitization for oncology patients threatened by hypersensitivity has improved patient safety and clinical response quality. We demonstrate successful desensitization in approximately half of the patients that underwent our the oxaliplatin hypersensitivity protocol.