Administration of cisplatin in three patients with carboplatin hypersensitivity: is skin testing useful?

Our plain-English summary of Administration of cisplatin in three patients with carboplatin hypersensitivity: is skin testing useful?, by E. Syrigou, N. Makrilia, A. Vassias, et al (Anti-cancer Drugs, 2010).

The study

• Authors: E. Syrigou, N. Makrilia, A. Vassias, I. Nikolaidis, V. Xyla, L. Manolopoulos, K. Syrigos
• Journal: Anti-cancer Drugs
• Published: 2010;21(3):333-8
• Type of article: Case report
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Carboplatin is a chemotherapeutic agent approved in the first-line setting of numerous malignancies. Hypersensitivity to carboplatin has been reported in up to 44% of patients receiving this antineoplastic agent, usually occurring after several courses of treatment. The aim of this study was to determine the usefulness of skin tests in ruling out cross-reaction to cisplatin to continue platinum-based chemotherapy in patients who are responsive to these agents. Prick tests and intradermal tests with a series of dilutions of carboplatin and cisplatin were performed on three patients who had exhibited medium and severe hypersensitivity reactions to carboplatin. Prick tests were negative in both the antineoplastic agents. Intradermal tests with carboplatin were positive in all three patients and negative with cisplatin. In all patients, the administration of cisplatin instead of carboplatin was well tolerated without the need of premedication. In conclusion, intradermal skin tests can be a useful tool for detecting a potential cross-reaction between platinum salts. It allows safe administration of a different platinum agent in patients who seem to benefit from platinum-based therapy. Discontinuation of chemotherapy, desensitization protocols and steroid premedication can be avoided.

In plain English

This case report from Sotiria General Hospital in Athens, Greece, described three patients who had allergic (hypersensitivity) reactions to the chemotherapy drug carboplatin. It is not a study of asbestos. Asbestos appears only because the first patient, a 62-year-old man with mesothelioma of the epithelial type, had occupational exposure to asbestos. The article gave no further details of that exposure. The other two patients had lung adenocarcinoma and ovarian cancer. The mesothelioma patient had a grade III reaction to carboplatin even though he was already receiving steroid premedication. All three patients were skin tested with carboplatin and with the related drug cisplatin. Prick tests were negative for both drugs in all three. Intradermal tests were positive for carboplatin in all three and negative for cisplatin at every dilution and reading. All three then received cisplatin with no reported reaction after two or three infusions, and the mesothelioma patient's scans showed partial response. The authors concluded that cisplatin skin testing can help identify patients at low risk of cross-reaction. These are three individual cases, not a measured rate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (case series of three patients)
• Who was studied: Three patients treated at the Oncology Unit, Sotiria General Hospital, Athens, Greece, diagnosed between 2006 and 2008: a 62-year-old man with mesothelioma (epithelial type, with abnormal thickening of the right pleura on CT), a 69-year-old man with non-small-cell lung cancer (adenocarcinoma), and a 65-year-old woman with ovarian cancer.
• Exposure: The exposure studied was the chemotherapy drugs carboplatin and cisplatin, given in skin tests and as treatment. Asbestos is mentioned only for the first patient, as occupational exposure, with no fiber type, job or dose given.
• Main results:
  • The mesothelioma patient had a grade III hypersensitivity reaction during his third carboplatin infusion, despite already receiving steroid premedication for pemetrexed.
  • In all three patients, prick tests were negative at the 20-minute reading.
  • In the first and second patients, the intradermal test was positive for carboplatin at a dilution of 10 to the minus 2 at the 20-minute reading.
  • In the third patient, the intradermal test was positive for carboplatin at a dilution of 10 to the minus 3 at 20 minutes.
  • In all three patients, intradermal tests with cisplatin were negative at all dilutions and at all readings (20 minutes, 24 hours and 48 hours).
  • The first (mesothelioma) patient had no allergic reaction after three cisplatin infusions, and CT scans showed partial response.
  • The second and third patients had no reaction after two cisplatin infusions each.
• The authors' conclusion: The authors concluded that, after carboplatin hypersensitivity, cisplatin is a reasonable option, and that skin testing with cisplatin beforehand can help identify patients at low risk of cross-sensitivity. They also recommended skin testing before the eighth carboplatin dose.

Topics

Medical terms in this study, explained in our Lexicon: Cisplatin, Carboplatin, Chemotherapy.

Related studies

• Potentiation of cisplatin and carboplatin cytotoxicity by amphotericin B in different human ovarian carcinoma and malignant peritoneal mesothelioma cells — L. Poulain, F. Sichel, et al. (1997)
• Retrospective study of hypersensitivity reactions to chemotherapeutic agents in a thoracic oncology service — H. Capelle, C. Tummino, et al. (2018)
• Randomised phase II study of cisplatin-etoposide versus infusional carboplatin in advanced non-small-cell lung cancer and mesothelioma — S.C. White, H. Anderson, et al. (2000)
• Platinum-DNA damage in leukocyte DNA of patients receiving carboplatin and cisplatin chemotherapy, measured by atomic absorption spectrometry — R.J. Parker, I. Gill, et al. (1991)
• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Tokunaga, M. Higashiyama, et al. (2011)
• Malignant pleural mesothelioma: a therapeutic challenge — G. Dimitrakakis, T. BinEsmael, et al. (2011)

Browse more research in Anti-cancer Drugs, or return to medical research.