CARBOPLATIN HYPERSENSITIVITY REACTIONS IN PATIENTS WITH OVARIAN AND PERITONEAL CARCINOMA

Platinum is the most active agent in the treatment of ovarian cancer a nd high response rates with platinum retreatment of patients with recu rrent disease have been reported. However, cumulative toxicity of cisp latin and carboplatin allergic reactions may limit further therapy. We describe a retrospective review of patients developing carboplatin al lergy from May 1995-May 1998. Fourteen patients with ovarian and perit oneal cancer with carboplatin allergy were identified. In all but one case, patients received paclitaxel immediately prior to the carboplati n therapy. Following carboplatin infusion durations of 5-60 min, patie nts developed symptoms of a cough, wheezing, flushing, angioedema, bur ning eyes, pruritus of the hands and tongue, and nausea. No deaths occ urred. The median number of courses of carboplatin therapy before an a llergic reaction occurred was 9 (range 2-14). Twelve patients were rec hallenged with a platinum compound. The first patient was retreated wi th cisplatin 50 mg/m(2) with only a minor allergic response controlled with diphenhydramine hydrochloride. The second patient was retreated with carboplatin but developed a recurrent allergic reaction despite p remedication with steroids and diphenhydramine hydrochloride and a 4-h our carboplatin infusion. This patient was successfully rechallenged w ith a prolonged 16-h carboplatin infusion. Seven additional patients w ere treated successfully following premeditation and the prolonged car boplatin infusion. However, 3 patients had recurrent severe carboplati n allergic reactions despite premedication and the prolonged carboplat in infusion. One of these patients was successfully retreated with cis platin. Carboplatin allergies rarely have been reported and may be pot entiated by coadministration of paclitaxel. Prolonged desensitization regimens are effective in the majority of patients with carboplatin hy persensitivity reactions. Alternatively, retreatment with cisplatin ca n be considered in the absence of cumulative cisplatin toxicity.