Rapid Drug Desensitization to Platinum-based Chemotherapy Agents: A Single-center Experience.

Abstract

Objective: To characterize the clinical features of patients with platinum-based hypersensitivity reactions (HSRs) and to evaluate rapid drug desensitization (RDD) outcomes across different platinum agents.

Material and methods: This retrospective study included patients who underwent RDD for platinum agents between 2019 and 2023 at a tertiary adult allergy clinic. Index reaction characteristics, RDD procedures, and breakthrough reactions (BTRs) were systematically recorded and analyzed.

Results: Of 2,131 patients receiving chemotherapy, 105 (5.0%) developed platinum-induced HSRs and were included in the analysis. The cohort comprised 75 (71.4%) females, with a mean age of 61.3±10.3 years. Carboplatin was the most frequently implicated agent (n = 56, 53.3%), followed by oxaliplatin (n = 35, 33.3%) and cisplatin (n = 14, 13.3%). Index reactions occurred at a median of 5 cycles (range: 1-20) and, according to Brown's classification, were mild in 26 patients (24.8%), moderate in 73 patients (69.5%), and severe in 6 patients (5.7%). A total of 430 RDD procedures were performed, with 62 (14.4%) BTRs occurring in 40 patients (38.1%). The proportion of RDD procedures completed without BTRs did not differ significantly among carboplatin (226/266, 85.0%), oxaliplatin (110/126, 87.3%), and cisplatin (32/38, 84.2%) (P = 0.800). Overall, 414 (94.1%) desensitization procedures were successfully completed. Sex distribution differed significantly by culprit platinum agent, with a male predominance observed among patients reacting to oxaliplatin compared with those reacting to cisplatin and carboplatin (P < 0.001).

Conclusion: This study demonstrates that desensitization to platinum-based chemotherapy achieved high success rates and produced comparable outcomes across different platinum agents. Notably, HSRs to oxaliplatin were observed significantly more frequently among male patients than HSRs to other platinum agents.