Oxaliplatin hypersensitivity: case report and successful repeat desensitization

Oxaliplatin is a third generation organoplatinum complex used as an antineoplastic agent in combination with fluorouracil and leucovorin for colorectal carcinoma. Hypersensitivity reactions are commonly observed to oxaliplatin, with an incidence of 12% to 16%. Desensitization protocols for oxaliplatin with premedication using steroids or antihistamines have been previously reported. We present a patient who underwent successful repeat desensitization without premedication.

A 43-year-old Asian male with metastatic rectal adenocarcinoma was started on chemotherapy with oxaliplatin and leucovorin followed by fluorouracil. Three hours after the first infusion of oxaliplatin, he developed generalized urticaria, which resolved with Benadryl. Similar symptoms developed after the second cycle. A desensitization protocol, without premedication, was developed for the third oxaliplatin cycle starting at 1:10,000 of the therapeutic dose followed by doubling doses thereafter until a cumulative goal dose of 175 mg was administered. Fluorouracil and leucovorin were then infused at the usual rates. Skin prick testing, before the procedure, using 5 mg/mL oxaliplatin was negative. Intracutaneous testing using dilutions of 1:1000, 1:100, and 1:10 were also negative. The patient was observed for 2 hours after the procedure without evidence of a hypersensitivity reaction. Two weeks later, the same protocol was successfully implemented for completion of his fourth cycle of chemotherapy and continued biweekly for a total of 11 cycles. Follow-up revealed tumor remission.

A desensitization protocol without premedication may be considered in those patients with a history of oxaliplatin hypersensitivity reactions with avoidance of the cumulative exposure to pretreatment medications.