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Giannone G, Scotto G, Katsaros D, De Giorgi U, Farolfi A, Borella F, Cosma S, Ferrero A, Mangiacotti S, Villa M, Tuninetti V, Ghisoni E, Turinetto M, Mittica G, Gemmiti S, Zavallone L, Aglietta M, Pasini B, Di Maio M, Valabrega G. Hypersensitivity to platinum salts according to BRCA status in ovarian cancer: A retrospective analysis of clinical outcomes and systematic review of literature. Gynecol Oncol 2021; 162:80-87. [PMID: 33896588 DOI: 10.1016/j.ygyno.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypersensitivity reactions (HSRs) to platinum are an important issue in the treatment of patients (pts) with ovarian cancer (OC). Germline BRCA mutations have been proposed as a risk factor. We aimed at evaluating the incidence and severity of HSRs to platinum in OC pts. with known BRCA status. PATIENTS AND METHODS We retrospectively analyzed 432 pts. from 5 Italian Centers. In addition, we performed a systematic review and meta-analysis of published series. RESULTS Four hundred nine pts. received at least one prior platinum-based treatment line: 314 were BRCA wild type (77%) and 95 were BRCA mutated (23%). There was no statistical difference in exposure to platinum. Incidence of any grade HSRs was higher among BRCA mutated pts. [9% vs 18%, p = 0.019] and the time-to-HSRs curves show that the risk increases with the duration of platinum exposure, in BRCA mutated pts. more than in BRCA wild type. A multivariable analysis showed that harboring a germline BRCA mutation was related to a higher incidence of HSRs (HR: 1.84, 95% CI 1.00-3.99, p = 0.05) while having received pegylated liposomal doxorubicin (PLD) was related to a lower incidence of HSRs (HR: 0.03 95% CI 0.004-0.22, p = 0.001). The systematic review confirmed the higher incidence of HSRs in BRCA mutated pts., though heterogeneity among series was significant. CONCLUSIONS In OC pts. with BRCA mutations, there is a significantly higher incidence of HSRs to carboplatin, not justified by longer drug exposure. On the other hand, PLD exerted a protective role in our series.
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Affiliation(s)
- G Giannone
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy.
| | - G Scotto
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - D Katsaros
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - U De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - F Borella
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - S Cosma
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - A Ferrero
- Academic Department Gynaecology and Obstetrics, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | | | - M Villa
- Academic Department Gynaecology and Obstetrics, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - V Tuninetti
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - E Ghisoni
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - M Turinetto
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - G Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Omegna (VB), Italy
| | - S Gemmiti
- Department of Surgical Science and Gynecology, Azienda Ospedaliero Universitaria, Città della Salute, presidio S. Anna, University of Turin, Turin, Italy
| | - L Zavallone
- Department of Medical Oncology, Infermi Hospital, Biella, Italy
| | - M Aglietta
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
| | - B Pasini
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - G Valabrega
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy; Department of Oncology, University of Turin, Turin, Italy
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Vetter MH, Castaneda A, Khan A, O'Malley DM. A clinical classification system for grading platinum hypersensitivity reactions. Gynecol Oncol 2020; 159:794-798. [PMID: 32951892 DOI: 10.1016/j.ygyno.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Current grading systems for platinum hypersensitivities (pHSR) rely on subjective features rather than objective clinical signs leading to inconsistencies in grading. To standardize classification of pHSR, a clinical grading system was developed at our institution. We report the clinical outcomes our classification system and evaluate its correlation with the classification systems currently published and used in practice. METHODS This was a retrospective review of patients with pHSR from 2011 to 2017. Demographics, chemotherapeutic histories (CT), and details of their initial HSR were collected. Mild reactions were defined as local skin manifestations only. Moderate-low reactions included widespread skin, respiratory or GI findings. Moderate-standard reactions were defined as transient cardiovascular compromise (CVC), hypoxia or neurologic changes whereas sustained changes (>10 min) were used to define severe reaction. Fischer Exact Tests (p < .05) and binary logistic regression analyses were performed. Spearman correlation were used to assess relationships between our grading system and the NCCN and CTCAEv4.0 criteria. RESULTS 87 patients were identified with most having ovarian cancer (n = 55, 63.2%), receiving carboplatin (n = 62, 71.3%), and on second-line CT (n = 34, 42.5%). Chest pain was associated with transient CVC (OR 10.0, 95% CI 1.148-87.133) while nausea/vomiting (OR 8.420, 95% CI 1.263-55.275) was associated with transient hypoxia albeit less closely than transient hypotension (OR 17.010, 95% CI 2.026-142.825). Only presyncope/syncope remained associated with sustained CVC (OR 38.0, 95% CI 2.815-512.912) on logistic regression. The classification system was most strongly correlated with the NCCN grading system (ρ 0.761, p < .001). CONCLUSIONS This classification system offers an objective means of grading pHSR severity and correlates with currently-used grading systems.
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Affiliation(s)
- Monica Hagan Vetter
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, United States of America
| | - Antonio Castaneda
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, United States of America
| | - Ambar Khan
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, United States of America.
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Garcia A, Frahm C, Jeter JM, Abraham I, Chambers SK, Cragun JM, McBride A. Incidence of Hypersensitivity Reactions to Carboplatin or Paclitaxel in Patients With Ovarian, Fallopian Tube, or Primary Peritoneal Cancer With or Without BRCA1 or BRCA2 Mutations. J Adv Pract Oncol 2019; 10:428-439. [PMID: 33457057 PMCID: PMC7779569 DOI: 10.6004/jadpro.2019.10.5.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The association of BRCA mutation status with hypersensitivity reactions (HSRs) to carboplatin has gained interest in recent years, particularly in patients with ovarian, fallopian tube, and primary peritoneal cancer. The primary objective of this study is to determine whether the presence of BRCA mutations increased the likelihood of HSRs to carboplatin. The incidence of HSRs to paclitaxel and symptom grade based on the Common Terminology Criteria for Adverse Events, version 4.0, were explored as secondary endpoints. A retrospective chart review of patients with ovarian, fallopian tube, or primary peritoneal cancer at the University of Arizona Cancer Center who underwent treatment with carboplatin-containing regimens and received genetic testing was performed. Institutional review board approval was obtained for this study. Fisher's exact test was used to analyze the primary outcome. Out of 167 initial patients, 62 with germline test results constituted the evaluable sample. 15 of 62 (24.2%) BRCA-tested patients were treated with carboplatin monotherapy, while 44 of 62 (71.0%) patients were treated with paclitaxel-containing regimens. Hypersensitivity reactions occurred in 4 of 13 (30.8%) BRCA-mutated patients and 22 of 49 (44.9%) BRCA wild-type patients (p = .5291). Hypersensitivity reactions to paclitaxel occurred in 1 of 13 (7.7%) BRCA-mutated patients and 26 of 49 (53.1%) BRCA wild-type patients (p = .0039). Overall, there were 11 grade 1 reactions, 14 grade 2 reactions, and 16 grade 3 reactions to carboplatin. All reactions to carboplatin in BRCA-mutated patients were grade 1. All paclitaxel reactions manifested as grade 2. The sample size was the main study limitation. The presence of BRCA mutations was not statistically significantly associated with a higher incidence of HSRs to carboplatin, but was statistically significant with regards to paclitaxel.
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Affiliation(s)
- Andrew Garcia
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | - Corey Frahm
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | - Joanne M. Jeter
- Divisions of Human Genetics and Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ivo Abraham
- From University of Arizona College of Pharmacy, Tucson, Arizona
| | | | | | - Ali McBride
- From University of Arizona College of Pharmacy, Tucson, Arizona
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O'Malley DM, Vetter MH, Cohn DE, Khan A, Hays JL. Outpatient desensitization in selected patients with platinum hypersensitivity reactions. Gynecol Oncol 2017; 145:603-610. [PMID: 28410757 DOI: 10.1016/j.ygyno.2017.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 01/27/2023]
Abstract
Platinum-based chemotherapies are a standard treatment for both initial and recurrent gynecologic cancers. Given this widespread use, it is important to be aware of the features of platinum hypersensitivity reactions and the subsequent treatment of these reactions. There is also increasing interest in the development of desensitization protocols to allow patients with a history of platinum hypersensitivity to receive further platinum based therapy. In this review, we describe the management of platinum hypersensitivity reactions and the desensitization protocols utilized at our institution. We also describe the clinical categorizations utilized to triage patients to appropriate desensitization protocols.
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Affiliation(s)
- David M O'Malley
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA. david.o'
| | - Monica Hagan Vetter
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA
| | - David E Cohn
- Division of Gynecology Oncology, Department of Gynecology and Obstetrics, The Ohio State University College of Medicine, Columbus, OH 43220, USA
| | - Ambar Khan
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43220, USA
| | - John L Hays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Goodrich A, Wagner-Johnston N, Delibovi D. Lymphoma Therapy and Adverse Events: Nursing Strategies for Thinking Critically and Acting Decisively. Clin J Oncol Nurs 2017; 21:2-12. [PMID: 28107339 DOI: 10.1188/17.cjon.s1.2-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple treatment options, combined with disease heterogeneity, have created nursing challenges in the management of adverse events (AEs) during antilymphoma therapy. Testing has revealed that less than half of participating nurses correctly graded peripheral neuropathy and neutropenia related to antilymphoma regimens. OBJECTIVES This article identifies nursing challenges in the management of AEs associated with therapy for lymphomas and describes how strategies in critical thinking can help meet those challenges. METHODS A comprehensive literature search in oncology nursing, nursing education, and critical thinking was conducted; participant responses to pre- and post-tests at nursing education programs were evaluated; and a roundtable meeting of authors was convened. FINDINGS Oncology nurses can cultivate critical thinking skills, practice thinking critically in relation to team members and patients, leverage information from the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events, and manage workflow to allow more opportunity for critical thinking.
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Affiliation(s)
- Amy Goodrich
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
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Ferrari LAM, Fanetti G, Rossi FG, Brambilla MC, Re B, Buzzoni R. Are Antineoplastic Drug Acute Hypersensitive Reactions a Submerged or an Emergent Problem? Experience of the Medical Day Hospital of the Fondazione IRCCS Istituto Nazionale Tumori. TUMORI JOURNAL 2014. [DOI: 10.1177/1430.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laura AM Ferrari
- Day Hospital and Oncologic Outpatient Therapy Unit, Medical Oncology Department
| | - Giuseppe Fanetti
- Day Hospital and Oncologic Outpatient Therapy Unit, Medical Oncology Department
| | - Fabio G Rossi
- Day Hospital and Oncologic Outpatient Therapy Unit, Medical Oncology Department
| | - Maria C Brambilla
- Day Hospital and Oncologic Outpatient Therapy Unit, Medical Oncology Department
- Pharmacy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Re
- Pharmacy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Buzzoni
- Day Hospital and Oncologic Outpatient Therapy Unit, Medical Oncology Department
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Randall JM, Bharne AA, Bazhenova LA. Hypersensitivity reactions to carboplatin and cisplatin in non-small cell lung cancer. J Thorac Dis 2013; 5:E53-7. [PMID: 23585959 DOI: 10.3978/j.issn.2072-1439.2012.06.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/21/2012] [Indexed: 01/16/2023]
Abstract
Non-small cell lung cancer (NSCLC) treatment has changed in the past ten years due to the acceptance of platinum-based adjuvant chemotherapy. In the event of relapse, patients are often retreated with platinum agents. Hypersensitivity reactions to carboplatin are well documented among gynecologic oncology patients. Now that adjuvant chemotherapy is a component of NSCLC treatment, platinum hypersensitivity is also a concern in the lung cancer population. A 74-year-old male developed relapsed NSCLC two years after a lobectomy and adjuvant chemotherapy including carboplatin. He was treated with a carboplatin containing regimen, and experienced hypersensitivity during his 2(nd) cycle (post-relapse). We briefly report four additional cases of platinum sensitivity in NSCLC patients, to highlight the increasing likelihood of platinum hypersensitivity in this "at risk" group. Hypersensitivity reactions to platinum chemotherapeutics occur in NSCLC patients, and patients and treating medical staff should be aware of this serious, treatment-related complication.
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Affiliation(s)
- J Michael Randall
- Department of Medicine, University of California, San Diego, Moores Cancer Center, 3855 Health Sciences Drive, #0829, La Jolla, CA 92093-0829, USA
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