Oxaliplatin Induced Severe Hypoxemia, Chills and Hypersensitivity Reaction
Abstract
Hypersensitivity reactions to platinum containing compounds are well described and potentially life threatening. The hypersensitivity reactions can occur either during, or shortly after the infusion of drug. The incidence increases with increase in the number of chemotherapy cycles. Hypersensitivity reactions can vary from mild reactions like rashes to severe reactions, which include laryngospasm, tachycardia, hypotension or hypertension. The combination of 5-flurouracil, leucovarin and oxaliplatin has been used in several studies to increase survival rates and reduce the risk of disease progression in patients with metastatic colorectal cancer (CRC) and stage III colon cancer. We report a case of patient treated with oxaliplatin who developed Severe Grade-III Toxicity including Hypoxemia, Chills and hypersensitivity reaction like rashes all over the body with itching sensation about few hrs after the oxaliplatin infusion. Patient tolerated 7 cycles of FLOT chemotherapy well. During cycle 8 chemotherapy after 50% infusion of oxaliplatin patient developed severe reaction to oxaliplatin such as breathlessness, shivering, hypersensitivity reaction like rashes all over the body and itching sensation. The drug infusion was stopped immediately, vitals were checked which shows BP: 170/110mmhg, Temperature 100⁰F, Spo2 85% RA. It was confirmed as grade 3 toxicity of oxaliplatin. The adverse drug reaction assessment was done using Naranjo’s causality assessment scale which showed ‘definite’ type of adverse drug reaction with oxaliplatin. Prompt recognition of this event and symptomatic treatment with supplemental oxygen and corticosteroids and prolonging the infusion time of oxaliplatin can lead to better patient compliance and lesser hypersensitivity reactions to these regimens.
Keywords: Oxaliplatin, Colorectal cancer (CRC), Dyspnoea, Hypersensitivity reactions, Chemotherapy.
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References
2. Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK,Williamson SK, Findlay BP, Pitot HC, Alberts SR: A randomized controlled Trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin Combinations in patients with previously untreated metastatic colorectal Cancer. J Clin Oncol 2004; 22(1):23-30. https://doi.org/10.1200/JCO.2004.09.046
3. Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, et al: Oxaliplatin, Fluorouracil, and leucovorin as adjuvant treatment for colon cancer.N Engl J Med 2004; 350(23):2343-2351. https://doi.org/10.1056/NEJMoa032709
4. Markman M, Kennedy A, Webster K, et al. Clinical features Of hypersensitivity reactions to carboplatin. J Clin Oncol.1999; 17:1141-1145. https://doi.org/10.1200/JCO.1999.17.4.1141
5. Shlebak AA, Clark PI, Green JA. Hypersensitivity and crossreactivity to cisplatin and analogues. Cancer Chemother Pharmacol. 1995; 35:349-351. https://doi.org/10.1007/BF00689458
6. Polyzos A, Tsavaris N, Kosmas C, et al. Hypersensitivity Reactions to carboplatin administration are common but Not always severe: a 10-year experience. Oncology. 2001; 61:129-133. https://doi.org/10.1159/000055363
7. Brandi G, Pantaleo MA, Galli C, Falcone A, Antonuzzo A, Mordenti P, Di Marco MC, Biasco G: Hypersensitivity reactions related to oxaliplatin (OHP). Br J Cancer 2003; 89(3):477-481 https://doi.org/10.1038/sj.bjc.6601155
8. Siu SWK, Chan RTT, Au GKH: Hypersensitivity reactions to oxaliplatin:Experience in a single institute. Ann Oncol 2006, 17(2):259-261. https://doi.org/10.1093/annonc/mdj042
9. Gowda A, Goel R, Berdzik J, Leichman CG, Javle M: Hypersensitivity Reactions to oxaliplatin: incidence and management. Oncology (WillistonPark) 2004
18(13):1671-1675, discussion 1676, 1680, 1683-1674.
10. ELOXATIN Prescribing information. [http://products.sanofiaventis.us/Eloxatin/eloxatin.html].
11. Lee MY, Yang MH, Liu JH, Yen CC, Lin PC, Teng HW, Wang WS, Chiou TJ,Chen PM: Severe anaphylactic reactions in patients receiving oxaliplatin therapy: a rare but potentially fatal complication. Support Care Cancer 2007; 15(1):89-93. https://doi.org/10.1007/s00520-006-0107-9
12. Gammon D, Bhargava P, McCormick MJ: Hypersensitivity reactions to Oxaliplatin and the application of a desensitization protocol. Oncologist 2004; 9(5):546-549. https://doi.org/10.1634/theoncologist.9-5-546
13. Gowda A, Goel R, Berdzik J et al, Hypersensitivity Reactions to oxaliplatin: incidence and management. Oncology 2004; 18:1671-1675
14. Simona Potenza, Guglielmo Nasti et al (2009) severe respiratory symptoms to oxaliplatin infusion : A case report of delayed hypersensitivity reaction. Invest new drugs 2010; 28:185-186 DOI 10.1007/S 10637-009-9250-8 https://doi.org/10.1007/s10637-009-9250-8
15. de Vries RS, Mattijssen EJ, van Sorge AA, Serious delayed hypersensitivity reaction to oxaliplatin. Ann Oncol 2006; 17:1723-1724. doi:10.1093/annonc/mdl116 https://doi.org/10.1093/annonc/mdl116
16. Johnstone TC, Suntharalingam K, Lippard SJ. The next generation of platinum drugs: targeted Pt(II) agents, nanoparticle delivery, and Pt(IV) prodrugs. Chem Rev 2016; 116(5):3436-3486. https://doi.org/10.1021/acs.chemrev.5b00597
17. Maindrault-Goebel F, André T, Tournigand C, Louvet C, Perez-Staub N, Zeghib N, et al. Allergic-type reactions to oxaliplatin: retrospective analysis of 42 patients, Eur J Cancer, 2005; 41:2262-7 https://doi.org/10.1016/j.ejca.2005.06.021
18. Siu SW, Chan RT, Au GK. Hypersensitivity reactions to oxaliplatin: experience in a single institute, Ann Oncol, 2006; 17:259-61 https://doi.org/10.1093/annonc/mdj042
19. Lenz HJ. Management and preparedness for infusion and hypersensitivity reactions. Oncologist. 2007; 12(5):601-9. https://doi.org/10.1634/theoncologist.12-5-601
20.Gamelin L, Boisdron-celle M, Delva R, Ifrah N, Morel A, Gamelin E. Prevention of Oxaliplatin Related Neurotoxicity by Calcium and Magnesium Infusions: A Retrospective Study of 161 Patients Receiving Oxaliplatin Combined with 5-Fluorouracil and Leucovorin for Advanced Colorectal Cancer. Clin Cancer Res. 2004; 10(12):4055-61. https://doi.org/10.1158/1078-0432.CCR-03-0666
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