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Previous asymptomatic oxaliplatin administration does NOT guarantee safe oxaliplatin retreatment

Published online: February 14, 2018

Oxaliplatin is one of the first line chemotherapeutic agents for colorectal cancer. As adjuvant use of oxaliplatin has increased, more patients have been re-exposed to oxaliplatin years after their initial exposure. However, the potential risk of oxaliplatin hypersensitivity reactions (HSR) on re-exposure is not known in patients who safely completed oxaliplatin treatment without any HSR.

Kang et al. conducted a two-year prospective study on the incidence of oxaliplatin HSR by monitoring 793 patients who newly started oxaliplatin-based chemotherapy and published the findings in The Journal of Allergy and Clinical Immunology: In Practice.

While oxaliplatin HSR incidence was 15.2% in patients who had never been exposed to oxaliplatin, 75.0% of patients who previously had oxaliplatin HSR experienced a recurrence. In addition, oxaliplatin HSR occurred more frequently (31.9% vs. 15.2%, P < .05) and were more severe (grade 3 and 4: 67% vs. 10%) in patients who had completed oxaliplatin without any HSR compared to oxaliplatin-naïve patients. The risk of oxaliplatin HSR increased nearly four times if patients had previous oxaliplatin exposure and was nearly five times greater if the oxaliplatin-free interval was longer than 3 years.

These results show that previous asymptomatic oxaliplatin exposure increases the risk of oxaliplatin sensitization and hypersensitivity.

When starting oxaliplatin treatment, patients with a history of previous oxaliplatin treatment, even if safely completed, should be closely monitored for HSRs.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.