(023) Characteristics and Management of Oxaliplatin Hypersensitivity Reactions

Poster Abstract: Background
Hypersensitivity reactions are a frequent problem for patient receiving oxaplatin chemotherapy occurring in approximately 30-40% of patients who have received between 1 and 11 doses of oxaliplatin. Rash, pruritis, fever, chills, rigors, hypotension, and flushing are the most common sign/symptoms and most literature recommends proceeding to desensitization following these reactions. Desensitization protocols are often clinically successful; however, they are labor intensive, costly, and can result in treatment delays for the patient. In clinical practice, extending the infusion time from 2 to 4 hours and adding premedications (acetaminophen, H1 and/or H2 blockers, corticosteroids and/or montelukast) have been used with anecdotal success at Northwestern Memorial Hospital. Prior studies evaluating an extended infusion and addition of premedication have shown varying success with 58-63% of patients still experiencing reactions.

Objective
The purpose of this project is to assess the efficacy of a slowed infusion (in lieu of desensitization) +/- addition of premedications among those who initially react to oxaliplatin and to explore management strategies and patient-specific factors that predict successful rechallenge. 

Methods 
This single center, retrospective cohort study will include patients between March 2018 and August 2023 at Robert H Lurie Cancer Center of Northwestern University. Patients eligible for inclusion must be >18 years old with a prior hypersensitivity reaction to oxaliplatin and who received a subsequent dose of oxaliplatin using a 4-hour infusion time. Pregnant patients, incarcerated patients, patients with a history of platinum use outside of Northwestern Medicine, and patients desensitized immediately following the first hypersensitivity reaction to oxaliplatin will be excluded.  
The co-primary outcomes will be the incidence (%) of hypersensitivity reactions in patients re-challenged with a 4-hour infusion of oxaliplatin and the frequency at which that dose was fully administered.  Secondary outcomes will be characteristics of patients tolerating and not tolerating re-challenge cancer type, intent of therapy (curative/palliative), concomitant chemotherapy treatment, history of platinum use, pre-medications used, and clinical presentation of initial oxaliplatin reaction.  Multivariate logistic regression will be used to assess independent predictors of successful rechallenge.

Results
Patients eligible for inclusion were initially identified by generation of a list of all oxaliplatin administrations at NMH. After screening inclusion/exclusion criteria, ~75 patients have met criteria for inclusion. Data collection is ongoing and results will be available in March 2024.

References (must also be included in final poster): Parel, M. et al. (2014) Hypersensitivity to oxaliplatin: Clinical features and risk factors. BMC Pharmacol Toxicol. Jan 13;15:1. 
Kim, Bradley, T., Tai, J., & Budman, D. R. (2009). Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and Literature Review. Oncology, 76(4), 231–238.
Otani, I., Wong, J., & Banerji, A. (2017). Platinum Chemotherapy Hypersensitivity: Prevalence and Management. Immunology and Allergy Clinics of North America, 37(4), 663–677. 
Polyzos, A et al. (2009). Clinical Features of Hypersensitivity Reactions to Oxaliplatin: A 10-Year Experience. Oncology, 76(1), 36–41.