Desensibilizare carboplatin bemutato
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Transcript of Desensibilizare carboplatin bemutato
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Desensitization treatment
with cisplatin aftercarboplatin hypersensitivity reactionin gynecologic cancer
Akiko Abe, Hiroshi Ikawa, and Saki IkawaDepartment of Obstetrics and Gynecology, Oe Kyodo
Hospital, Tokushima, Japan
The Journal of Medical Investigation
Vol. 57 February 2010
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Introduction
the platinum-based chemotherapy is the standard
carboplatin:- less neuro-, nephro-, gastrointestinaltoxicity
- more myelosuppression
the use of carboplatin has become greater,unfavorable side effect more frequently:hypersensitivity reactions (HR),
incidence of HR with carboplatin increases with
repeated drug exposure (6-21 courses of treatment) serious problem when an extended number of
courses are attempted
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Introduction
proposed preventive procedures: premedication with antihistamines or corticosteroids
substitution with a different platinum salt
desensitization protocol
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Patients
retrospective evaluate: 2001-2007
73 patients treated with carboplatin-basedchemotherapy
identified 17 patients (22%): cervical (n=2),
endometrial (n=4),
ovarian (n=11)
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Patients
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Patients
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Patients
number of prior platinum treatments before thefirst HR observation: 5-27
all reactions during platinum infusion
no patients developed delayed reactions
none of the eight patients with severe HR wasrechallenged with platinum
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Patients
3 patients - mild HR - rechallenged with carboplatinafter providing informed consent without desensitization, rechallenge was not successful - all
experienced HR recurrence.
symptoms did not occur immediately after rechallenge, but ata mean of 40 min (range 30 to 60 min)
other 3 of 17 patients - with mild HR - treatedsuccessfully with a desensitization protocol,
substituting cisplatin (60 mg/m2) for carboplatin
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Patients
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Desensitization protocol
1. day
Premedication: Promethazine 50mg
Dexamethasone 20mg
Ranitidine 50mg
administered 30 min before the initiation
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Desensitization protocol
1. day
paclitaxel (175 mg/m2) infusion
cisplatin 60 mg/m2 60 g/m2 in 100 ml saline
(1 : 1000 dilution of the final therapeutic dose)100 ml / 60 min
600 g/m2 in 100 ml saline
(1 : 100 dilution of the final therapeutic dose)
100 ml / 60 min
6000 g/m2 in 100 ml saline(1 : 10 dilution of the final therapeutic dose)
100 ml / 60 min
infusion was temporarily interrupted
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Desensitization protocol
2. day
cisplatin 60 mg/m2 6000 g/m2 in 100 ml saline
(1 : 10 dilution of the final therapeutic dose)100 ml / 60 min
remainder of the cisplatin at the therapeutic dose
(60mg 12,66mg = 47,34mg/m2)
over 8 hours
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Discussion
mechanism of HR to carboplatin remains unclear(classified as type 1 IgE-mediated allergy ?)
skin test is useful for identifyingpatients for
reappearance of anallergic reaction prolonged use of carboplatin increases the incidence
of HR. (27% of patients who had received more thanseven courses)
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Discussion
once HR is established, rechallenge should not beattempted because the cases very likely willexperience anaphylaxis.
substituting cisplatin for carboplatin after HRdevelopment is a good strategy if continuation ofplatinum-based chemotherapy is highly desirable.
method for preventing HR to carboplatin:
desensitization protocol by gradual re-introductionof small amounts of drug antigens to full therapeuticdoses.
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Conclusion
usefulness and effectiveness of the desensitizationprotocol for the continuation of platinum treatmentin patients who had undergone an extended number
of carboplatin treatments. the aim of this report is to draws the attention for a
possibility to continue succesfully the platinum basedtherapy after the hypersensitivity reaction.
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Thank you