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Oxaliplatin desensitization in coloretal cancer: A way to prolong effective treatments
Background
Hypersensitivity reactions (HSR) to oxaliplatin can lead to the suspension of potentially effective treatments. An alternative approach, such as the use of desensitization protocols (DSS), could be considered. This study evaluates the efficacy and safety of DSS in patients with colorectal cancer (CRC), after an HSR to oxaliplatin.
Methods
Single-center, retrospective cohort study that included patients with CRC and history of HSR to oxaliplatin, receiving at least one treatment of DSS between 2015 and 2020 (follow-up until February 2022), in the day care unit. Descriptive analysis of baseline clinical/demographic variables, treatment details and toxicities (CTCAE v.5) were performed. Fisher Kaplan-Meier method was used to estimate median overall (OS) and progression free survival (PFS).
Results
A total of 22 patients were included, 59% (n=13) were female, with a median age of 62 (range: 38-75), the majority had ECOG-PS 0-1 (n=18, 82%). HSR were mainly grade 2 (n=13, 59%), all were immediate. A median of three drug infusions preceded the reactions (range: 1-11). Overall, 86 DSS were performed (median 3, range: 1-12). Treatment intention was curative in eight patients (36%), submitted to 24 DSS (median: 3, range:1-6), and palliative in 14 patients (72%), that completed 62 DSS (median 3, range: 1-12). In the curative setting, seven patients (87.5%) completed the treatment plan, and one chose to suspend. Of the palliative patients, three (21%) were in first-line treatment, five (36%) in second-line, six (43%) in third-line or more, and 57% (n=8) were exposed to oxaliplatin in previous lines. Breakthrough reactions (BR) during DSS occurred in two (9%) patients, all grade 2. None of the patients suspended oxaliplatin due to BR. Median follow-up for the curative cohort was 40.5 months (IQR:31.8-49.5), with a recurrence rate of 37.5% and a survival rate of 75%. For palliative patients, median follow-up was 11.5 months (IQR:8.0-16.8). After initiation of DSS, median PFS was 2.0 months (95%CI: 0.0-4.5) and median OS was 11.0 months (95%CI:7.3-14.7).
Conclusions
This study shows that treatment with oxaliplatin with DSS protocols is feasible and safe, and able to be performed in an outpatient setting. It enables the treatment of CRC patients with an effective drug that otherwise would be permanently suspended. Albeit small, this cohort shows promising efficacy outcomes, that should be further explored.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
