Usefulness of hydrocortisone prophylaxis for oxaliplatin-induced hypersensitivity reactions: A retrospective study.

Abstract

IntroductionOxaliplatin is a platinum-based drug widely used for treating colorectal cancer. However, its use is often complicated by hypersensitivity reactions and other adverse effects, including peripheral neuropathy and myelosuppression. We evaluated the efficacy of prophylactic hydrocortisone administration in preventing hypersensitivity reactions during oxaliplatin therapy in patients with colorectal cancer.MethodsPatients who received oxaliplatin between January 2017 and December 2023 were retrospectively analyzed. Among them, 53 received 100 mg of hydrocortisone as a preventive measure when the cumulative oxaliplatin dose exceeded 400 mg/m² or if they experienced a treatment interruption of >8 weeks. We compared the incidence and severity of hypersensitivity reactions, as well as cumulative oxaliplatin dose, between patients who received routine premedication only (the Routine group) and those who received additional hydrocortisone prophylaxis (the Prophylaxis group).ResultsOverall, 370 patients were included in the study. Hypersensitivity reactions occurred in 23 patients (18 in the Routine group and 5 in the Prophylaxis group), with a significantly higher cumulative dose of oxaliplatin in the Prophylaxis group (644 vs. 1383 mg/m², p = 0.0032). Severe reactions were observed only in the Routine group. Treatment discontinuation owing to hypersensitivity reactions was more common in the Routine group (five patients) than in the Prophylaxis group (one patient).ConclusionsProphylactic administration of hydrocortisone may promote oxaliplatin treatment continuation. This approach is proposed as a potential strategy for preventing oxaliplatin-induced hypersensitivity reactions.