The reported incidence of
hypersensitivity reactions (HSRs) associated with
oxaliplatin in patients with
colorectal cancer (CRC) is approximately 12%, with 1 - 2% of patients developing grade 3 or 4 in severity. However, the recent rising incidence of HSR to
oxaliplatin observed is the result of increasing clinical use. HSR to
oxaliplatin may manifest as facial
flushing,
rash/
hives,
tachycardia, dyspnoea,
erythema,
pruritus,
fever, tongue swelling,
headache,
chills, weakness,
vomiting, burning sensations,
dizziness and oedema.
Anaphylactic shock is rare but serious, and must be considered in the event of
hypotension. No definitive approaches to prevent and treat HSR associated with
oxaliplatin are available; however, few successful strategies have been reported. Such strategies include: slowing the infusion rate, use of
steroids and antagonists of type 1 and 2
histamine receptors, and desensitisation. Successful implementation of
oxaliplatin desensitisation protocols based on other
platinum-containing compounds have been reported, which could enable a small number of patients who experience severe HSR to further receive an effective
therapy for CRC. However, reintroductions have only been reported as single case studies or small cohorts. Large-scale validation on desensitisation strategies are still missing. Recently, subcutaneous
adrenaline has also been utilised as an alternative approach to manage HSR to
oxaliplatin. Knowledge of this rare but real toxicity of
oxaliplatin is paramount because the use of this drug continues to increase not only for the treatment of patients with stage II-IV CRC, but also other solid
malignancies. In this article, the author discusses the incidence, clinical presentation, pathogenesis, risk factors and current strategies of management of HSR associated with
oxaliplatin.