Platin desensitizations in thoracic malignancies and risk factors for breakthrough reactions

Gözde Köycü Buhari; İlkay Koca Kalkan; Hale Ateş; Sakine Nazik Bahçecioğlu; Şenay Demir; Selma Yeşilkaya; Gürgün Tuğçe Vural Solak; Kurtuluş Aksu; Ferda Öner Erkekol

doi:10.15586/aei.v51i2.779

Gözde Köycü Buhari

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

İlkay Koca Kalkan

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Hale Ateş

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Sakine Nazik Bahçecioğlu

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Şenay Demir

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Selma Yeşilkaya

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Gürgün Tuğçe Vural Solak

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Kurtuluş Aksu

Division of Immunology and Allergy, Department of Chest Disease, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Ferda Öner Erkekol

Immunology and Allergy Unit, Medicana International, Ankara Hospital, Ankara, Turkey.

Keywords

breakthrough reaction, chemotherapy, desensitization, hypersensitivity reaction, platin

Abstract

Although platin desensitization is a safe and effective alternative for patients with hypersensitivity reactions (HSRs), sometimes breakthrough reactions (BTRs) can be encountered. However, data about the risk factors for BTRs are limited. The aim of this study is to define the outcomes of desensitization, the characteristics of BTRs, and to identify the risk factors for BTRs with platins in thoracic malignancies. This is a retrospective report of patients with thoracic malignancies who underwent platin desensitization. Patients’ demographics, initial HSR characteristics, skin test results, desensitization outcomes, and BTR characteristics were recorded. Thirty-three lung cancer and 14 malignant pleural mesothelioma (MPM) patients were included in the study. The culprit drug was cisplatin in 29 and was carboplatin in 18 patients. Skin test positivity was 43.5% with cisplatin, 50% with carboplatin, and it was found to be higher if the interval between the initial HSR and skin testing (ST) was ˃20 days (p = 0.027). One hundred and five desensitization courses were performed. Twenty-two patients had 33 BTRs. Skin test positivity was higher in the BTR-positive group (p = 0.025). BTRs (18.2%; n = 6) were more severe than initial HSR. In the case of epinephrine administration during initial HSR, epinephrine administration during the first BTR was found to be more (p = 0.036). The target dose was achieved in 92.4% of desensitization courses. The number of previous platin infusions ≥10 was found to be an independent risk factor for BTR development (p = 0.036 OR:17.641, 95% CI: 1.211–256.971). Identification of risk factors for BTR will guide appropriate management and desensitization approaches for platin HSRs.

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