Incidence of oxaliplatin hypersensitivity reaction among colorectal cancer patients: A 5-year retrospective study

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Oxaliplatin, Hypersensitivity reaction, Colorectal cancer, Risk factor


Background: Oxaliplatin is a third-generation platinum compound that has efficacy against colorectal cancer. Hypersensitivity reactions during oxaliplatin infusion are a key problem during its use, with the varying incidences and deficiencies of clearly identified risk factors. Objective: To determine the incidence, severity and risk factors of oxaliplatin-related hypersensitivity reaction (HSR). Method: This retrospective study investigated 245 colorectal cancer patients (1,690 treatment cycles) receiving care at King Chulalongkorn Memorial Hospital, Thai Red Cross society between January 1, 2015 and December 31, 2019. The patients’ demographic data, laboratory data and clinical features suggesting hypersensitivity reactions to oxaliplatin were reviewed. The Fisher’s Exact test and unpaired t-test were used to determine the differences among patients with and without oxaliplatin HSR. The potential risk factors for oxaliplatin HSR were analyzed for statistical significance by logistic regression. Results: A total of 245 colorectal cancer patients (1,690 treatment cycles) were included in this study. The incidence of oxaliplatin HSR was 37.96%, according to the US National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (NTCAE) version 5.0, grade 1, grade 2 and higher grades were 27.35% (67 patients), 6.53% (16 patients) and 4.08% (10 patients), respectively. The proportion of male patients and patients with a history of prior exposure to platinum-based chemotherapy were statistically higher in the HSR group. The eosinophil count and serum creatinine level were also significantly greater in the HSR group. On the contrary, the total lymphocyte count and serum albumin level were significantly lower in the HSR group. The multivariate logistic regression found 5 risk factors with a significant difference. Male gender, prior exposure to platinum-based chemotherapy and elevated eosinophil count were associated with increased risk of oxaliplatin HSR, whereas elevated monocyte count and elevated serum albumin were protective factors for the development of oxaliplatin HSR. Conclusion: Colorectal cancer patients treated with an oxaliplatin-based regimen with male gender, prior exposure to platinum-based chemotherapy and elevated eosinophil count have a greater risk of oxaliplatin related hypersensitivity reactions.


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1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89-103.
2. Benson AB, Venook AP, Al-Hawary MM, et al. Colon Cancer, Version 2. 2021, NCCN Clinical Practice Guidelines in Oncology. JNatl Compr Canc Netw. 2021;19(3):329-59.
3. Lohsiriwat V, Chaisomboon N, Pattana-Arun J. Current Colorectal Cancer in Thailand. Ann Coloproctol. 2020;36(2):78-82.
4. Huang W-K, Hsu H-C, Chang S-H, et al. Real-World Effectiveness of Adjuvant Oxaliplatin Chemotherapy in Stage III Colon Cancer:A Controlled Interrupted Time Series Analysis. Front Pharmacol. 2021;12:693009.
5. Yoshino T, Arnold D, Taniguchi H, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients withmetastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol. 2018;29(1):44-70.
6. Devanabanda B, Kasi A. Oxaliplatin. In: StatPearls. Treasure Island (FL): StatPearls Publishing LLC.; Dec 28, 2021.
7. Zhao L, Liu R, Zhang Z, et al. Oxaliplatin/fluorouracil-based adjuvant chemotherapy for locally advanced rectal cancer afterneoadjuvant chemoradiotherapy and surgery: a systematic review and meta-analysis of randomized controlled trials. Colorectaldis. 2016;18(8):763-72.
8. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN Guidelines Insights: Colon Cancer, Version 2.2018. J Natl Compr Canc Netw.2018;16(4):359-69.
9. Jeon H-J, Woo J-H, Lee H-Y, et al. Adjuvant Chemotherapy Using the FOLFOX Regimen in Colon Cancer. J Korean Soc Coloproctol.2011;27(3):140-6.
10. Lee C, Gianos M, Klaustermeyer WB. Diagnosis and management of hypersensitivity reactions related to common cancerchemotherapy agents. Ann Allergy Asthma Immunol. 2017;119(5):422-428.e2.
11. Otani IM, Wong J, Banerji A. Platinum Chemotherapy Hypersensitivity: Prevalence and Management. Immunol Allergy ClinNorth Am. 2017;37(4):663-77.
12. Yamauchi H, Goto T, Takayoshi K, et al. A retrospective analysis of the risk factors for allergic reactions induced by theadministration of oxaliplatin. Eur J Cancer Care (Engl). 2015;24(1):111-6.
13. Ohta H, Hayashi T, Murai S, et al. Comparison between hypersensitivity reactions to cycles of modified FOLFOX6 and XELOXtherapies in patients with colorectal cancer. Cancer Chemother Pharmacol. 2017;79(5):1021-9.
14. Kim MY, Kang SY, Lee SY, et al. Hypersensitivity reactions to oxaliplatin: clinical features and risk factors in Koreans. Asian Pac JCancer Prev. 2012;13(4):1209-15.
15. Yu Z, Huang R, Zhao L, et al. Safety profile of oxaliplatin in 3,687 patients with cancer in China: A post-marketing surveillancestudy. Front Oncol. 2021;11:757196.
16. Mori Y, Nishimura T, Kitano T, et al. Oxaliplatin-free interval as a risk factor for hypersensitivity reaction among colorectalcancer patients treated with FOLFOX. Oncology. 2010;79(1-2):136-43.
17. Kim BH, Bradley T, Tai J, et al. Hypersensitivity to Oxaliplatin: An Investigation of Incidence and Risk Factors, and LiteratureReview. Oncology. 2009;76(4):231-8.
18. Seki K, Senzaki K, Tsuduki Y, et al. Risk factors for oxaliplatin-induced hypersensitivity reactions in Japanese patients withadvanced colorectal cancer. Int J Med Sci. 2011;8(3):210-5.
19. Parel M, Ranchon F, Nosbaum A, et al. Hypersensitivity to oxaliplatin: clinical features and risk factors. BMC Pharmacol Toxicol.2014;15:1.
20. Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Published: November 27, 2017. US Department of Healthand Human Services NIoH, National Cancer Institute. 2017.
21. Azam F, Latif MF, Farooq A, et al. Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score forCancer Patients by Oncology Healthcare Professionals. Case Rep Oncol. 2019;12(3):728-36.
22. Ichikawa Y, Goto A, Hirokawa S, et al. Allergic reactions to oxaliplatin in a single institute in Japan. Jpn J Clin Oncol. 2009;39(9):616-20.
23. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.Engl J Med. 2004;350:2343-51.
24. Castells M. Desensitization for drug allergy. Curr Opin Allergy Clin Immunol. 2006;6:476-81.
25. Makrilia N, Syrigou E, Kaklamanos I, et al. Hypersensitivity Reactions Associated with Platinum Antineoplastic Agents: A SystematicReview. Met Based Drugs. 2010;2010:207084.
26. Okayama T, Ishikawa T, Sugatani K, et al. Hypersensitivity Reactions to Oxaliplatin: Identifying the Risk Factors and Judging theEfficacy of a Desensitization Protocol. Clin Ther. 2015;37(6):1259-69.
27. Kuruvilla M, Khan DA. Eosinophilic Drug Allergy. Clin Rev Allergy Immunol. 2016;50:228-39.
28. Shibata Y, Ariyama H, Baba E, et al. Oxaliplatin-induced allergic reaction in patients with colorectal cancer in Japan. Int J Clin
Oncol. 2009;14:397-401.
29. Bourke CD, Berkley JA, Prendergast AJ. Immune Dysfunction as a Cause and Consequence of Malnutrition. Trends Immunol.2016;37(6):386-98.
30. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr.2019;43(2):181-93.
31. Nishihara M, Nishikura K, Morikawa N, et al. Factors Influencing the Appearance of Oxaliplatin-Induced Allergy. B Biol Pharm
Bull. 2017;40(12):2105-9.