Oxaliplatin (Ox) is a key drug in patients (pts) with colorectal cancer (CRC). However, Ox causes a hypersensitivity reaction (HSR) in 15-20% of pts, leading to its discontinuation. There were few reports regarding effect on Ox-free interval for successful Ox rechallenge.
We retrospectively reviewed medical records of consecutive CRC pts who had received an Ox-containing regimen from 2005 to 2016 at our institution. The aim of this study was to investigate effect on Ox-free interval from the onset of the initial Ox-related HSR for successful Ox rechallenge under high-dose dexamethasone (HD-DEX) as premedication which comprise of intravenous DEX of 19.8 mg, chlorpheniramine of 5 mg, and famotidine of 20mg. The success of Ox rechallenge was defined as completion of at least one Ox administration without any HSR.
1,343 pts who had received Ox containing regimens, and HSR occurred in 297 pts (22%). 188 pts who received a further Ox under the HD- DEX premedication were evaluable in this study, excluding 109 pts (70 pts discontinued Ox thereafter and 39 pts received a further Ox without using the HD-DEX). Among the 188 pts, pts with biweekly and tri-weekly Ox administration were 176 (94%) and 12 (6%), respectively. 92 pts (49%) developed a HSR recurrence and the grade 1/2/3 HSR by CTCAE v4.0 occurred in 37/54/1 pts, respectively. No HSR-related death was observed. Median and mean Ox-free intervals were 14 and 55 days, respectively (range, 13- 2,071 days). The 17 pts who had ≥ 55 days of Ox-free interval succeeded Ox rechallenge. In univariate and multivariate analyses, a longer Ox-free interval ≥ 30 days was significantly associated with a lower risk of HSR recurrence (Cutoff value=14 days, Odds Ratio [OR] =0.55, 95% CI: 0.26-1.14, p = 0.11: Cutoff=20 days, OR = 0.48, 95% CI: 0.21-1.08, p = 0.08: Cutoff=30 days, OR = 0.20, 95% CI: 0.05-0.93, p = 0.04: Cutoff=40 days, OR = 0.11, 95% CI: 0.02-0.89, p = 0.04).
This study suggests a longer Ox-free interval ≥ 30 days from the initial HSR may contribute to successful Ox rechallenge in CRC pts who had experienced an Ox–related HSR.
Clinical trial identification
Legal entity responsible for the study
National Cancer Center Hospital East.
Has not received any funding.
All authors have declared no conflicts of interest.