Abstract 1848P
Background
Carboplatin and paclitaxel are essential to the management of ovarian malignancy but are associated with high rates of hypersensitivity reactions. Hypersensitivity reactions can limit safe delivery of these drugs, compromising treatment. Management guidelines vary between different UK centres. At the Beatson West of Scotland Cancer Centre in Glasgow, UK, we investigated the incidence, severity and management of reactions occurring in women treated for ovarian cancers in routine practice and implemented new guidelines, which are presented here.
Methods
Patients without ovarian cancer were excluded from retrospective analysis of details of hypersensitivity reactions recorded contemperaneously between April 2019 – January 2020 on excel and chemocare (CIS Oncology, Belfast, UK) by the treating practitioner. Analysis included treatment cycle, causative drug, severity of reaction as per CTCAE v4.0, initial and subsequent management, and whether re-challenge was successfully attempted on that day.
Results
32 reactions occurred to carboplatin (n=17) or paclitaxel (n=15). A majority of reactions were grade 1 (carboplatin 65%, paclitaxel 78%) or grade 2 (carboplatin 35%, paclitaxel 17%). Additional 100mg of hydrocortisone and 10mg Chlorphenamine IV was adequate in all grade 1 reactions to allow completion of that cycle on the same day, and addition of this to future cycles of chemotherapy prevented further reactions. After a grade 2 reaction, only 25% carboplatin and 50% paclitaxel cycles were able to be completed the same day after re-challenge. There was a lack of consistency in subsequent management of grade 2 and grade 3 reactions when administering further cycles.
Conclusions
Grade 1 reactions can be safely re-challenged on the same day after an additional 100mg of IV hydrocortisone and 10mg IV chlorphenamine. However, further reactions after a grade 2 reaction to paclitaxel or carboplatin are not adequately controlled. To achieve consistent management, and enable subsequent evaluation of efficacy, we developed guidelines for management of paclitaxel and carboplatin reactions which will be presented, with evaluation of outcomes following introduction of these guidelines and a protocol for pre-medication prior to subsequent cycles.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.