Hypersensitivity reactions to carboplatin administration are common but not always severe: A 10-year experience

We have retrospectively evaluated and characterized the hypersensitivity re actions associated with carboplatin administration in ovarian cancer patien ts treated mainly on an outpatient basis at the Laikon Hospital from 1988 t o 1998. A total of 240 patients, who had never been exposed to platinum com pounds previously, received carboplatin plus cyclophosphamide (n = 58) or p aclitaxel (n = 136) intravenously, and intraperitoneal carboplatin plus int ravenous cyclophosphamide (n = 46). The median number of carboplatin course s was 6 (range 3-12) and 5 (range 4-6) for the intravenous and intraperiton eal treatment regimens, respectively. Thirty-two of 194 patients (16%) who were on intravenous carboplatin treatment developed symptoms compatible wit h a hypersensitivity reaction to carboplatin, that was always verified by m anifestation of at least similar symptoms on rechallenging. In contrast, in the group of 46 patients on intraperitoneal carboplatin treatment, no hype rsensitivity reaction was ever noticed. Hypersensitivity reactions always o ccurred after administration of the first 4 intravenous courses of carbopla tin; 4, 19, 4, and 5 reactions occurred at the 5th, 6th, 7th, and 8th cours es, respectively. These reactions could be distinguished in: (a) mild hyper sensitivity reactions in 20 of 194 patients, which manifested as itching (2 0 patients) and small area erythema plus erythema of the palms and soles (1 2 patients), occurring either during intravenous injection when most of the drug scheduled had been administered, or within 3 days, and (b) in severe reactions in 12 of 194 patients, which manifested acutely as itching, diffu se erythroderma, rigor, facial swelling, throat and chest tightness, tachyc ardia (12 patients) and bronchospasm (2 patients), and hypertension or hypo tension in 8 and 4 patients, respectively. With appropriate symptomatic man agement, discontinuation of carboplatin treatment was not required in patie nts with mild hypersensitivity reactions, but none of the 12 patients with severe reactions was able to receive a full subsequent dose of carboplatin on rechallenging. However, in 4 of these 12 patients carboplatin was replac ed by cisplatin, which was given for 4-6 courses without side effects. Thes e findings indicate that although hypersensitivity reactions are common in general, occurring in almost 1 of every 6 patients treated intravenously wi th carboplatin, their clinical picture is variable, leading to discontinuat ion of treatment in only 6% of patients. This is not the case when the intr aperitoneal route of carboplatin administration is used when indicated. Cop yright (C) 2001 S. Karger AG, Basel.