D3.54 - Hypersensitivity reactions during therapy with platinum compounds and taxanes – who can benefit from consulting an allergist?

Platinum compounds and taxanes are widely used in oncology, but are known to induce hypersensitivity reactions. This limits the efficacy of patients’ management due to the need to modify the optimal therapeutic regimen. Allergy procedures can be helpful in these situations, but their availability is severely limited because they are resource-intensive and a major administrative challenge. The aim of this study was to estimate the magnitude of this problem at the level of a large university hospital, which may facilitate decisions about the wider implementation of appropriate procedures on a day-to-day basis.

A retrospective analysis of medical record data was conducted by an interdisciplinary oncology-allergy team. It included all consecutive 2059 patients treated at our centre between July 2022 and June 2024, who received a total of 19006 administrations of platinum compounds or taxanes.

Of all patients, 8.5% (n=165) developed symptoms suggestive of drug hypersensitivity reaction in temporal association with 203 courses of chemotherapy with the following drugs: cisplatin (n=13), oxaliplatin (n=72), carboplatin (n=60), docetaxel (n=11), paclitaxel (n=48). The mean age of the patients was 59 years, range 25-86 years; F/M 132/33. Five patients who experienced episodes of oxaliplatin-induced cold dysesthesia were excluded from the analysis. Skin hypersensitivity symptoms were observed in 55% of these patients, respiratory symptoms in 46%, gastrointestinal symptoms in 17%, cardiovascular symptoms in 12% and neurological symptoms in 8%. 47.4% of reactions were classified as mild (grade 1 on Brown's scale), 38.2% as moderate (grade 2) and 14.4% as severe (grade 3). Adrenaline was needed to treat the reaction in 16 patients. In 60% of cases, the initial treatment was continued; in 7% of patients, treatment was discontinued due to progression of the underlying disease or death. The remaining 33% of patients required treatment modification and/or allergological consultation.

Approximately one third of patients with symptoms suggestive of drug hypersensitivity reactions may benefit from complementary allergy testing, e.g. to select a safe alternative drug. Only about 1% of all patients treated with platinum compounds or taxanes experienced severe reactions requiring adrenaline and/or graded at Brown's scale 3.