Innovative strategies for cisplatin desensitization in hyperthermic intraperitoneal chemotherapy of ovarian cancer.

Abstract

We present a case of a 41-year-old female diagnosed with Granulosa Cell Tumor (GCT) EC IVB who developed a hypersensitivity reaction (HSR) to carboplatin during the sixth cycle of treatment and subsequently underwent successful intraperitoneal desensitization with cisplatin during hyperthermic intraperitoneal chemotherapy (HIPEC). The patient experienced a severe HSR 30 min after carboplatin infusion, presenting with generalized rash, pruritus, nausea, chest pain, and dyspnea. The infusion was halted, and she was treated with intramuscular epinephrine (0.50 mg), intravenous chloropyramine (20 mg), and 250 mL saline, resolving symptoms. Platinum skin tests were subsequently performed and yielded negative results for carboplatin, cisplatin, and oxaliplatin. Following multidisciplinary consensus, cytoreductive surgery with HIPEC and intraperitoneal desensitization to cisplatin was planned. The patient had a peritoneal carcinomatosis index (PCI) of 17. Cytoreductive surgery included omentectomy, appendectomy, resection of mesenteric implants, diaphragmatic and parietal peritonectomy, in bloc hysterectomy, bilateral salpingo-oophorectomy, and pelvic peritonectomy, achieving a completeness of cytoreduction (CC-0). HIPEC was performed with cisplatin (100 mg/m²) at 42°C for 140 min. A desensitization protocol with intraperitoneal cisplatin (180 mg in 8 incremental steps over 140 min) was successfully completed without adverse reactions. Platinum-based chemotherapeutics are frequently associated with HSR, with increasing incidence upon repeated exposure. Intraperitoneal administration, as in HIPEC, may reduce systemic hypersensitivity risks. While prior cases have demonstrated safe HIPEC administration of cisplatin in patients with oxaliplatin-induced HSR, no documented cases exist of intraperitoneal drug desensitization in this context. Our case suggests that intraperitoneal desensitization with cisplatin may be a viable alternative for patients with systemic HSR to platinum agents. Further research is required to establish safety protocols, cross-reactivity risks, and efficacy outcomes for this approach.