Desensitization to carboplatin in ovarian cancer

• Autores: María Teresa Alonso Domínguez, Ana María Mora González, Ignacio Fernando de Gorostiza Frías, Juan Luis Alonso Domínguez, Alberto Espuny Miro
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 19, Nº. 6, 2017, págs. 387-392
• Idioma: inglés
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• Resumen

  • Objective: To describe the safety of carboplatin desensitization (CD) in patients who have presented a hypersensitivity reaction (HSR) to the drug. Analyze (HSRS) and possible related factors. Method: A retrospective study (2012-2016) evaluating the safety of a CD protocol in patients with a diagnosis of ovarian cancer who underwent HRS to treatment. The protocol used has a duration of 6 hours, 12 steps, with three solutions: A, B and C containing: X/100, X/10, X/l, X being the mg of carboplatin, respectively, diluted in 250 ml of Glucose 5% each. Solution A was used for steps 1 to 4; The B from 5 to 8 and the C from 9 to 12. The time between each step was 15 minutes apart. Prior to the protocol, skin tests with carboplatin were performed: Prick 10 mg/ml and serial intradermal-actions (ID) at 0.01, 0.1 and 1 mg/ml. Data collected: age, diagnosis, chemotherapy cycles before and after DC, adverse reactions and rescue treatment. Data source: clinical history and Oncofarm®. Results: Ten patients with ovarian carcinoma II (1), III (6) and IV (3), with a median age of 65 years (51-82) were candidates for CD as an irreplaceable. They received a median of 11 cycles (7-22) before the first HSRS. The reactions that justified CD were: mild in four patients (water urticaria, erythema and pruritus); And in six, of moderate (angioedema). The skin tests, prick and ID, were both positive in four patients. And in three, both were negative. Three patients were negative to the prick test and positive to the ID test. During the first cycle of desensitization, five patients had HSRS; four of which were mild reactions: skin rash and pruritus. In two patients it occurred in the last step of the administration, one in the penultimate and another in the first step. In all cases, the infusion was discontinued, the patient was treated and administration was resumed at a slower infusion rate. The fifth patient who suffered moderate HSRS (skin redness, pruritus, facial angioedema, colicky abdominal pain and diarrhea) occurred in the third step. The infusion was stopped and sent with corticosteroids. A total of 42 cycles were administrated to nine patients more with a median of five cycles per patient (2-8). 36 were administered without HSRS, in five (11.9%) cycles, it appeared mild HSRS with pruritus (grade <2). In one (2.3%) cycle, it appeared moderate HSRS that caused the suspension. Conclusions: Desensitization was successfully performed in 90% (9) of patients without severe HSRS, allowing continuation of carboplatin treatment