Table 3.
Characteristics of the ten patients with grade 3/4 oxaliplatin hypersensitivity
| No., Gender, Age (years) | Prior plt exp | Metastasis | Regimen | Purpose | Dose/BSA (mg/m2) | Cycle No. at event | Onset of HSR (minutes) | Total cycle | Treatment | Management |
|---|---|---|---|---|---|---|---|---|---|---|
| 1,F,59 | N | N | CAPEOX | A | 130 | 5 | 50 | 5 | 1. CPM 10 mg, Dexamethasone 5 mg IV STAT 2. Hold 30 minutes then slow infusion about 6 hours |
Discontinue and adjust to single capecitabine then re-evaluate |
| 2,M,59 | N | N | CAPEOX | A | 130 | 2 | 90 | 6 | 1. Discontinue 2. Hyoscine-N-butyl bromide 20 mg IV STAT and hydration |
1. Add loperamide 2 mg Sig. 2 caps on CMT day 2. Add CPM 10 mg IV pre CMT 3. Rechallenge with prolonged infusion time (4 hours), finally complete total 6 cycles |
| 3,F,60 | Y | N | mFOLFLOX | A | 85 | 2 | 20 | 12 | 1. Hold and reduce rate of administration to 80 mL/hr 2. CPM 10 mg, Dexamethasone 5 mg IV STAT 3. Adrenaline 0.3 mg IM |
12 step desensitization protocol, finally complete total 12 cycles |
| 4,F,62 | Y | Y | FLOX | P | 80 | 2 | 120 | 4 | 1. Adrenaline 1 mg IM and hydration | 1. 12 step desensitization protocol with mild HSR through desensitization. 2. Patient requested to discontinue after the 4th cycle |
| 5,M,47 | N | N | mFOLFLOX | A | 85 | 3 | 110 | 8 | 1. Discontinue 2. Dexamethasone 10 mg IV STAT 3. Adrenaline 0.5 mg IM |
1. 12 step desensitization protocol, but grade-2 HSR through to the 8th cycle 2. Discontinue after the 8th cycle |
| 6,M,45 | Y | N | CAPEOX | A | 100 | 2 | 15 | 3 | 1. Hold 2. Adrenaline 0.3 mcg IM and hydration 3. Admit and rechallenge oxaliplatin 20-40 mL/hr |
1. Rechallenge with prolonged infusion time (4 hours), grade 2 HSR occurred so discontinue. 2. Skin test: Positive |
| 7,M,47 | Y | N | FLOX | P | 85 | 1 | 90 | 6 | 1. Hold and oxygen therapy 2. Adrenaline 0.5 mg IM and Dexamethasone 10 mg IV 3. Admit and then slow infusion about 4 hours |
1. Skin test: Negative 2. rechallenge (2nd cycle) with prolonged infusion time (6 hours), but mild HSR. 2. 12 step desensitization protocol (3rd -6th cycle) |
| 8,M,56 | N | N | mFOLFLOX | A | 80 | 6 | 80 | 6 | 1. Hold 2. Symbicort™ (160/4.5) 4 puffs and oxygen therapy 3. CPM 10 mg IV 4. Continue infusion rate 80 mL/hr |
Discontinue according to therapeutic plan |
| 9,M,44 | N | N | CAPEOX | A | 90 | 6 | 120 | 6 | 1. Hyoscine-N-butyl bromide 20 mg IV and CPM 10 mg IV STAT | Discontinue according to therapeutic plan |
| 10,F,73 | Y | Y | CAPEOX | P | 120 | 3 | 120 | 3 | 1. Loperamide 2 mg 2 capsules STAT 2. Hydration |
Discontinue [Hand foot syndrome grade 3] |
No.=Number
Prior plt exp= Prior platinum exposure
Purpose: A=Adjuvant, P=Palliative
CMT=Chemotherapy
HSR= Hypersensitivity reaction
mFOLFLOX: Oxaliplatin plus leucovorin and 5-Fluorouracil every 2 weeks
CAPEOX: Intravenous oxaliplatin 130 mg/m2 (day 1) followed by oral capecitabine 1,000 mg/m2 twice daily (day 1, evening to day 15, morning)