Interdisciplinary Healthcare Team Experience of Carboplatin and Oxaliplatin Desensitizations in a Tertiary Referral University Hospital

Figures & data

Figure 1 Flowchart diagram of the standard operating procedure of the interdisciplinary desensitization healthcare team.

Abbreviation: HSR, hypersensitivity reaction.

Table 1 Patient and Initial HSR Characteristics

Case No	Age (Years)	Gender	Diagnosis	Initial HSRDrug: Cycle	Initial HSR Grade	HSR Definition	Skin Test Results (Induration/Erythema; mm)
1	54	F	Peritonitis carcinomatosa	Carboplatin: 8	5	Burning sensation in the face	Carboplatin prick: 3/5
				Cisplatin: 3		Loss of consciousness and intubation
2	54	F	Ovarian CA	Carboplatin: 6	3	Flushing, face edema, tightness of chest, dyspnea	Carboplatin prick: (-)
				Cisplatin: 5
3	64	F	Ovarian CA	Carboplatin: 2	3	Tachycardia, chest discomfort, dyspnea	Carboplatin prick: (-)
							Intradermal: (-)
4	62	F	Breast CA, Ovarian met	Carboplatin: 3	5	Flushing, hypotension (60/30 mmHg), palpitations, confusion, weakness, difficulty in speaking	Carboplatin prick: 17/15
5	57	F	Colon CA, Liver met	Oxaliplatin: 6	3	Shortness of breath, lip swelling, numbness, feeling faint and weak, palpitations, flushing	Oxaliplatin prick: (-)
							Intradermal: 18/25
6	66	F	Colon CA	Oxaliplatin: 2	4	Bronchospasm, hypertension (200/100 mmHg)	Oxaliplatin prick: (-)
							Intradermal: (-)
7	58	F	Colon CA	Oxaliplatin: 5	CR	Severe back pain	Oxaliplatin prick: (-)
							Intradermal: (-)

Abbreviations: CA, cancer; CR, cytokine release; F, female; HSR, hypersensitivity reaction; met, metastasis.

Figure 2 Grades of initial and breakthrough reactions and related symptoms. The numbers in the columns represent symptom frequency by affected systems. (A) Carboplatin, (B) Oxaliplatin.

Abbreviations: BTR, breakthrough; CRS, cytokine release syndrome; G, grade; HSR, hypersensitivity reaction.

Table 2 Desensitization Protocols, Breakthrough HSRs, and Their Management

Case No	Desensitization Cycle No and Protocol	Breakthrough HSR		Breakthrough HSR Definition	Tryptase; ng/mL (0–11.4)		HSR Treatment
		Step	Grade		Basal	HSR
1	1^st – 12-step carboplatin	–	–	None	5.6	NA	–
	2^nd – 17-step carboplatin	17	1	Flushing			–
	3^rd – 17-step carboplatin	9	2	Tingling sensation on one hand, mild pain in the abdominal region, erythema on the back and chest			AH, CS
	4^th – 12-step carboplatin	12	1	Urticaria on arms and abdomen			AH, CS
	5^th– 12-step carboplatin	12	1	Urticaria on arms and abdomen			AH, CS
2	1–3^rd – 12-step carboplatin	–	–	None	NA	NA	–
3	1^st – 12-step carboplatin	–	–	None	4.8	NA	–
	2^nd – 12-step carboplatin	12	3	Weakness, anxiety, flushing, tachycardia, dyspnea, O2 saturation: 89%		16.0	O2, AH, CS, E
	3^rd – 12-step carboplatin*	12	3	Weakness, anxiety, flushing, tachycardia, dyspnea, O2 saturation: 90%		NA	O2, AH, CS
4	1^st – 12-step carboplatin	12	3	Flushing, tachypnea, cough, tachycardia (116 bpm), hypertension (151/77 mmHg), O2 saturation: 88%	4.99	6.91	O2, AH, CS
	2^nd – 16-step carboplatin*	12	3	Flushing, dyspnea		11.7	O2, AH, CS
	3^rd – 12-step carboplatin*	11	1	Mild flushing, rare dry coughs		6.24	AH, CS
	4^th – 12-step carboplatin*	12	1	Mild flushing, rare dry coughs		NA	AH, CS
5	1–5^th – 12-step oxaliplatin	–	–	None	3.4	NA	–
6	1^st – 12-step oxaliplatin**	12	3	Shortness of breath, O2 saturation: 90%, hypertension (190/110 mmHg)	5.11	NA	AH, CS, salbutamol
7	1^st – 12-step oxaliplatin	12	CRS	Back pain	4.97	11.2	AH, CS
	2^nd – 12-step oxaliplatin	12	CRS	Back pain		NA	AH, CS
	3^rd – 12-step oxaliplatin	12	CRS	Back pain		4.97	AH, CS
	4^th – 12-step oxaliplatin	12	CRS	Back pain		NA	AH, CS

Notes: *Protocol was modified to allow a lower infusion rate in the last step, **In addition to the routinely administered premedication, IV magnesium and calcium were also administered before starting oxaliplatin infusion.

Abbreviations: AH, antihistamines; CRS, cytokine release; CS, corticosteroids; E, epinephrine; HSR, hypersensitivity reaction; NA, not available.