Management of Patients with Hypersensitivity to Platinum Salts and Taxane in Gynecological Cancers: A Cross-Sectional Study by the European Network of Young Gynaecologic Oncologists (ENYGO)

Simple Summary Hypersensitivity reactions (HSRs) to platinum and taxane are common, and desensitization can be used to complete the standard chemotherapy regimen with a good safety profile and high success rate. Our study showed that the use of desensitization for HSRs to taxane and platinum is low in clinical practice. Treatment of HSRs has been shown to be heterogeneous and dependent on the grade of the HSR. Guidelines for the treatment of HSRs to taxane and platinum in gynecologic cancers have been of great interest to clinicians. Our study highlights that the management of platinum and taxane HSRs in gynecological cancers could be standardized and that international guidelines need to be developed. Abstract Platinum and taxane chemotherapy is associated with the risk of hypersensitivity reactions (HSRs), which may require switching to less effective treatments. Desensitization to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen. Therefore, we aimed to investigate the current management of HSRs to platinum and/or taxane chemotherapy in patients with gynecologic cancers. We conducted an online cross-sectional survey among gynecological and medical oncologists consisting of 33 questions. A total of 144 respondents completed the survey, and 133 respondents were included in the final analysis. Most participants were gynecologic oncologists (43.6%) and medical oncologists (33.8%), and 77.4% (n = 103) were involved in chemotherapy treatment. More than 73% of participants experienced >5 HSRs to platinum and taxane per year. Premedication and a new attempt with platinum or taxane chemotherapy were used in 84.8% and 92.5% of Grade 1–2 HSRs to platinum and taxane, respectively. In contrast, desensitization was used in 49.4% and 41.8% of Grade 3–4 HSRs to platinum and taxane, respectively. Most participants strongly emphasized the need to standardize the management of platinum and taxane HSRs in gynecologic cancer. Our study showed that HSRs in gynecologic cancer are common, but management is variable and the use of desensitization is low. In addition, the need for guidance on the management of platinum- and taxane-induced HSRs in gynecologic cancer was highlighted.

[1]  D. Cibula,et al.  ESGO-ESMO-ESP consensus conference recommendations on ovarian cancer: pathology and molecular biology and early, advanced and recurrent disease. , 2024, Annals of oncology : official journal of the European Society for Medical Oncology.

[2]  V. Heinzelmann-Schwarz,et al.  Desensitization in patients with hypersensitivity to platinum and taxane in gynecological cancers , 2023, Cancer medicine.

[3]  J. Ledermann,et al.  Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. , 2023, Annals of oncology : official journal of the European Society for Medical Oncology.

[4]  M. Libra,et al.  SnapShot: Cancer chemotherapy , 2023, Cell.

[5]  A. Oaknin,et al.  Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up†. , 2022, Annals of oncology : official journal of the European Society for Medical Oncology.

[6]  Xueyun Gao,et al.  Platinum-based drugs for cancer therapy and anti-tumor strategies , 2022, Theranostics.

[7]  M. Castells,et al.  Hypersensitivity Reactions to Platinum Agents and Taxanes , 2021, Clinical Reviews in Allergy & Immunology.

[8]  P. Scollo,et al.  A multidisciplinary approach remains the best strategy to improve and strengthen the management of ovarian cancer (Review) , 2021, International journal of oncology.

[9]  P. Bonadonna,et al.  Hypersensitivity reactions to chemotherapy: an EAACI Position Paper , 2021, Allergy.

[10]  A. Yasmeen,et al.  Multiple lines of chemotherapy for patients with high‐grade ovarian cancer: Predictors for response and effect on survival , 2020, International journal of cancer.

[11]  Jenifer R Prosperi,et al.  Mechanisms of Taxane Resistance , 2020, Cancers.

[12]  R. Berardi,et al.  Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management , 2020, Cancer management and research.

[13]  D. Tiezzi,et al.  Analysis of the relationship between hospital characteristics and survival in ovarian cancer: A historical cohort , 2020, Journal of surgical oncology.

[14]  R. Edmondson,et al.  Decision-Making in Gynaecological Oncology Multidisciplinary Team Meetings: A Cross-Sectional, Observational Study of Ovarian Cancer Cases , 2019, Oncology Research and Treatment.

[15]  D. Cohn,et al.  Outpatient desensitization of patients with moderate (high-risk) to severe platinum hypersensitivity reactions. , 2019, Gynecologic oncology.

[16]  F. Landoni,et al.  Corrections to "Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up". , 2018, Annals of oncology : official journal of the European Society for Medical Oncology.

[17]  Gloria S. Huang,et al.  Impact of carboplatin hypersensitivity and desensitization on patients with recurrent ovarian cancer , 2018, Journal of Cancer Research and Clinical Oncology.

[18]  A. Neugut,et al.  Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer. , 2017, Obstetrics and gynecology.

[19]  A. Cervantes,et al.  Management of infusion reactions to systemic anticancer therapy: ESMO Clinical Practice Guidelines. , 2017, Annals of oncology : official journal of the European Society for Medical Oncology.

[20]  D. Cohn,et al.  Outpatient desensitization in selected patients with platinum hypersensitivity reactions. , 2017, Gynecologic oncology.

[21]  I. Christensen,et al.  Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team , 2017, International Journal of Gynecologic Cancer.

[22]  W. Barry,et al.  Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies. , 2016, The journal of allergy and clinical immunology. In practice.

[23]  P. Tchounwou,et al.  Cisplatin in cancer therapy: molecular mechanisms of action. , 2014, European journal of pharmacology.

[24]  J. Boulanger,et al.  Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. , 2014, Current oncology.

[25]  E. Kohn,et al.  Deleterious BRCA1/2 mutation is an independent risk factor for carboplatin hypersensitivity reactions , 2013, British Journal of Cancer.

[26]  P. Demoly,et al.  Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group , 2013, Allergy.

[27]  M. Castells,et al.  Hypersensitivity to antineoplastic agents: mechanisms and treatment with rapid desensitization , 2012, Cancer Immunology, Immunotherapy.

[28]  P. Demoly,et al.  General considerations on rapid desensitization for drug hypersensitivity – a consensus statement , 2010, Allergy.

[29]  M. Pagani The complex clinical picture of presumably allergic side effects to cytostatic drugs: symptoms, pathomechanism, reexposure, and desensitization. , 2010, The Medical clinics of North America.

[30]  J. Coebergh,et al.  Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands. , 2009, Gynecologic oncology.

[31]  Y. Miyagi,et al.  Incidence of Carboplatin-Related Hypersensitivity Reactions in Japanese Patients With Gynecologic Malignancies , 2009, International Journal of Gynecologic Cancer.

[32]  Y. Itoh,et al.  Incidence and risk factors for paclitaxel hypersensitivity during ovarian cancer chemotherapy , 2005, Cancer Chemotherapy and Pharmacology.

[33]  G. Shepherd Hypersensitivity reactions to chemotherapeutic drugs , 2003, Clinical reviews in allergy & immunology.

[34]  P. Sabbatini,et al.  Analysis of patients with epithelial ovarian cancer or fallopian tube carcinoma retreated with cisplatin after the development of a carboplatin allergy. , 2002, Gynecologic oncology.

[35]  C. Genestie,et al.  Multidisciplinary management of advanced ovarian cancer for an optimal therapeutic strategy. , 2017, European journal of gynaecological oncology.

[36]  A. Costello,et al.  The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. , 2016, Cancer treatment reviews.