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FAQs - Fast Facts (HSR)

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Question: If a patient develops throat swelling or discomfort during oxaliplatin administration, how can I distinguish between a hypersensitivity reaction (HSR) or pharyngolaryngeal dysesthesia (PLD)?

Answer: Primary distinguishing factors are timing of onset and whether the effect has been triggered by cold exposure. In patients who experience a sensation of throat closure or airway obstruction during or immediately after oxaliplatin administration in the absence of cold exposure (eg, cold air or cold liquids), HSR should be suspected. Appropriate measures should be taken to limit its extent, according to your institution's practice guidelines for HSR management. PLD is a relatively rare side effect unique to oxaliplatin therapy. If the patient experiences symptoms long after leaving the clinic and in conjunction with drinking cold liquids or after walking out into the cold, PLD is likely. Encourage the patient to sip warm liquids to make the sensation pass quickly. True HSR will not be reversed by drinking warm liquids or applying warm compresses to the throat.1-5 Click here for more About HSR.

References

  1. Gamelin L, Boisdron-Cell M, Delva R, et al. Prevention of oxaliplatin-related neurotoxicity by calcium and magnesium infusions: a retrospective study of 161 patients receiving oxaliplatin combined with 5-fluoruracill and leucovorin for advanced colorectal cancer. Clin Cancer Res. 10(12, pt 1):4055-4061.
  2. Barhamand B. Management of pharyngolaryngeal dysesthesia associated with oxaliplatin therapy. Clin J Oncol Nurs. 2003;7:452-453.
  3. Wilkes G. Therapeutic options in the management of colon cancer: 2005 update. Clin J Oncol Nurs. 2005;9:31-44. [ Pub Med ]
  4. Viale P, Fung A, Zitella L. Advanced colorectal cancer: current treatment and nursing management with economic considerations. Clin J Oncol Nurs. 2005;9:541-552. [ Pub Med ]
  5. Viale P. Expanded treatment options in the adjuvant therapy of colon cancer: implications for oncology nurses. Oncol Nurs Forum. 2006; 33:81-90. [ Pub Med ]

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Question: Is there a standard desensitization protocol used to prevent hypersensitivity reactions (HSRs) associated with administration of oxaliplatin?

Answer: Currently, there is no standard desensitization protocol to reduce the incidence of HSRs with oxaliplatin; most prevention and treatment recommendations are based on case reports describing protocols that have been successful in these patients. Generally, desensitization protocols involve treating patients with escalating small doses of diluted drug and prolongation of infusion times.1 Because other platinum agents such as cisplatinum and carboplatin also have been associated with HSRs, it is reasonable to assume that successful desensitization protocols using those agents also might be effective with oxaliplatin.2 One protocol described in conjunction with carboplatin administration included serial dilutions beginning at 1:1000 and decreasing to 1:100 and 1:10, each in 50 mL 5% dextrose in water (D5W).3 Markman and colleagues4 expanded on this template with sample oxaliplatin doses:

Step 1 1:1000 0.09 mg oxaliplatin in 50 mL D5W over 30 minutes
Step 2 1:100 0.9 mg oxaliplatin in 50 mL D5W over 15 minutes
Step 3 1:10 9 mg oxaliplatin in 50 ml D5W over 15 minutes
Step 4 Remaining dose 90 mg oxaliplatin in 250 mL D5W over 15 minutes

Another strategy for preventing or minimizing HSRs is to incorporate a treatment premedication protocol and slow the oxaliplatin infusion. One report described successful premedication for HSRs in colorectal cancer patients receiving oxaliplatin that included dexamethasone 20 mg, cimetidine 300 mg, diphenhydramine 25 mg, acetaminophen 650 mg, granisetron 1 mg., and 500 mL D5W with oxaliplatin given over 6 hours instead of the usual 2 hours.5

HSRs have been noted in approximately 10% to 12% of patients receiving oxaliplatin and occur more frequently in the heavily pretreated individual or patient who has received multiple cycles of the drug. Care should be taken with these patients, and oncology nurses should be vigilant to the possibility of HSRs in patients receiving oxaliplatin. Nurses should follow the HSR protocols for their institutions and have emergency medications nearby, as appropriate, during administration of agents associated with HSRs.1 Read more about this topic on the Side Effect and Symptom Management/HSR page.

References

  1. Gobel BH. Chemotherapy-induced hypersensitivity reactions. Oncol Nurs Forum. 2005;32:1027-1035.
    [ Pub Med ]
  2. Bonosky K, Miller R. Hypersensitivity reactions to oxaliplatin: what nurses need to know. Clin J Oncol Nurs. 2005;9:325-330. [ Pub Med ]
  3. Bhargava P, Gammon D, McCormick MJ. Hypersensitivity and idiosyncratic reactions to oxaliplatin. Cancer. 2003;100:211-212.
  4. Markman M, Hsieh F, Zanotti K, et al. Initial experience with a novel desensitization strategy for carboplatin-associated hypersensitivity reactions: carboplatin-hypersensitivity reactions. J Cancer Res Clin Oncol. 2003;130:25-28.
  5. Dold F, Hoey D, Carberry M, et al. Hypersensitivity in patients with metastatic colorectal carcinoma undergoing chemotherapy with oxaliplatin. Proc Am Soc Clin Oncol. 2002;21:370a. Abstract 1478.

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This page was last modified on 12/11/2006, at 4:15:59 pm ET.