Impact of carboplatin desensitization therapy on progression-free survival in gynecologic cancers

To compare survival between gynecologic cancer patients with carboplatin hypersensitivity thereafter managed with carboplatin desensitization, cisplatin replacement, and alternative non-platinum therapy.

A retrospective review of patients who experienced a hypersensitivity reaction to carboplatin and were treated at the same comprehensive cancer center between 2010 and 2024 was completed. The primary analysis compared progression-free survival between carboplatin desensitization, cisplatin substitution, and alternative non-platinum therapy patients. Secondary analysis compared survival between platinum therapy and non-platinum alternative therapy patients. Descriptive analysis was further performed to delineate the clinical phenotypes of patients with carboplatin hypersensitivity.

There were 47 gynecologic cancer patients with carboplatin hypersensitivity, and 38 patients with known progression-free survival. Progression-free survival was significantly longer in desensitized patients (31.1 months) vs. cisplatin patients (22.0 months, p = 0.045). There were no significant differences in progression-free survival between desensitized (31.3 months) and alternative therapy patients (36.0 months), as well as platinum (31.1 months) and non-platinum-based alternative therapy patients (36.0 months). A majority of our cohort was observed to have recurrent disease at the time of hypersensitivity (70.2 %), a carboplatin-free interval of 12 months or more (57.4 %), history of adverse reactions to other drugs (76.6 %), advanced stage disease (78.8 %), and serous histology (70.2 %).

Desensitized patients demonstrated increased progression-free survival as compared to cisplatin patients. This progression-free survival advantage may be due to the increased toxicity profiles noted for cisplatin and comparatively better tolerability of carboplatin desensitization. Progression-free survival was similar between carboplatin-desensitized and alternative therapy patients, as well as platinum-based and alternative therapy patients.