Characteristics and management of oxaliplatin hypersensitivity

Hypersensitivity reactions (HSRs) to oxaliplatin are common in patients undergoing long-term chemotherapy. Desensitization is often recommended following initial reactions but is resource-intensive and may delay treatment. This study aimed to evaluate the outcomes of a slower infusion rate when re-challenging patients with previous oxaliplatin HSRs and idenify factors associated with successful re-challenge Methods: A retrospective, observational cohort study was conducted at Northwestern Memorial Hospital, including patients who experienced HSRs to oxaliplatin and were re-challenged with a 4-h infusion between March 1, 2018, and August 1, 2023. Co-primary endpoints were the percentage of patients completing the 4-h infusion without HSR, experiencing any reaction during the infusion, and receiving further doses of oxaliplatin. Logistic regression analyzed factors associated with successful and unsuccessful re-challenge. Results: Data from 62 patients were analyzed, with a median patient age of 58 years. Ninety-seven percent of patients completed the full re-challenge dose, 79% had no documented reaction, and 77% received future doses. The Brown Criteria for grading hypersensitivity reactions was used. Among Grade 1 initial reactions, 93.5% were re-challenged without a subsequent reaction, compared to 67% with Grade 2 or 3 reactions. The grade of the initial reaction was a significant predictor of re-reaction risk upon re-challenge. Conclusion: A slower infusion rate with allowed successful re-challenge of patients with prior oxaliplatin HSRs, particularly those with Grade 1 initial reactions. These findings suggest that extended infusion protocols can effectively manage oxaliplatin HSRs, potentially reducing the need for desensitization and minimizing treatment delays.