Document Type : Case Report

Authors

1 Emergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, Iran

2 Emergency Medicine Department, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Cisplatin was the first of the platinum drugs. Second-generation platinum derivative was carboplatin that its efficacy in the treatment of many malignancies is equal to cisplatin, and its toxicity profile is more favorable. Here we report on a 50-year-old woman with a history of cervix cancer who developed a severe hypersensitivity reaction (HSR) to carboplatin. She was admitted to the emergency department (ED) with shortness of breath, tachypnea, restless, agitation, and lethargy. On arrival, the patient was hemodynamically unstable; we initiated treatment immediately with hydration, oxygen therapy with mask, hydrocortisone, midazolam, and adrenalin. After 1 hour, BP and O2 sat improved to 100/70 mm Hg and 92% respectively, but there was not any significant improvement in tachycardia as well as tachypnea and she was still lethargic and agitated. Her symptoms improved gradually after 18 hours of admission. She was discharged after 36 hours. HSRs to cisplatin and carboplatin can be potentially life-threatening. The symptoms can range from a mild rash to severe anaphylaxis. Doctors should be aware of these reactions, determine appropriate treatment, and know the cross-reactivity among these drugs.
 

Keywords

Main Subjects

1. Jamieson ER, Lippard SJ. Structure, recognition, and processing of cisplatin-DNA adducts. Chem Rev 1999; 99(9): 2467-98.
2. Charalabopoulos K, Karkabounas S, Ioachim E, Papalimneou V, Syrigos K, Evangelou A, et al. Antitumour and toxic effects on Wistar rats of two new platinum complexes. Eur J Clin Invest 2002; 32(2): 129-33.
3. Covens A, Carey M, Bryson P, Verma S, Fung Kee Fung M, Johnston M. Systematic review of first-line chemotherapy for newly diagnosed postoperative patients with stage II, III, or IV epithelial ovarian cancer. Gynecol Oncol 2002; 85(1): 71-80.
4. Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003; 21(17): 3194-200.
5. Syrigos KN, Vansteenkiste J, Parikh P, von Pawel J, Manegold C, Martins RG, et al. Prognostic and predictive factors in a randomized phase III trial comparing cisplatin-pemetrexed versus cisplatin-gemcitabine in advanced non-small-cell lung cancer.Ann Oncol 2010; 21(3): 556-61.
6. Joy J, Nair CK. Amelioration of Cisplatin induced nephrotoxicity in Swiss albino mice by Rubiacordifoliaextract. J Cancer Res Ther 2008; 4(3): 111-5.
7. Kannarkat G, Lasher EE, Schiff D. Neurologic complications of chemotherapy agents. Curr Opin Neurol 2007; 20(6): 719-25.
8. Maina A, Richiardi G, Danese S, Defabiani E, Giardina G. Symptomatic hypocalcemia and hypomagnesiemia in cisplatinum-based chemotherapy treated patients: case report. Eur J Gynaecol Oncol 1996; 17(4): 281-2.
9. Callahan MB, Lachance JA, Stone RL, Kelsey J, Rice LW, Jazaeri AA. Use of cisplatin without desensitization after carboplatin hypersensitivity reaction in epithelial ovarian and primary peritoneal cancer. Am J Obstet Gynecol 2007; 197(2): 199.e1-4.
10. Mohammadianpanah M, Omidvari S, Mosalaei A, Ahmadloo N. Cisplatin-induced hypokalemic paralysis. Clin Ther 2004; 26(8): 1320-3.
11. Koren C, Yerushalmi R, Katz A, Malik H, Sulkes A, Fenig E. Hypersensitivity reaction to cisplatin during chemoradiation therapy for gynecologic malignancy. Am J Clin Oncol 2002; 25(6): 625-6.
12. Markman M, Kennedy A, Webster K, Elson P, Peterson G, Kulp B, et al. Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 1999; 17(4): 1141.
13. Kook H, Kim KM, Choi SH, Choi BS, Kim HJ, Chung SY, et al. Life-threatening carboplatin hypersensitivity during conditioning for autologous PBSC transplantation: successful rechallenge after desensitization. Bone Marrow Transplant 1998; 21(7): 727-9.
14. Sliesoraitis S, Chikhale PJ. Carboplatin hypersensitivity. Int J Gynecol Cancer 2005; 15(1): 13-18.
15. Morris DJ, Carr B. Hypersensitivity reaction to carboplatin followed by reaction to cisplatin. Community Oncol. 2005; 324-326. Available from: http://www.oncologypractice.com/co/journal/articles/0204324b.pdf
16. Novak KM. Drug Facts and Comparisons. 59th ed. Chicago, Ill: Wolters Kluwer Health; 2005.
17. Weidmann B, Muelleneisen N, Bojko P, Niederle N. Hypersensitivity reactions to carboplatin. Report of two patients, review of the literature, and discussion of diagnostic procedures and management. Cancer 1994; 73(8): 2218-22.
18. Tonkin KS, Rubin P, Levin L. Carboplatin hypersensitivity: case reports and review of the literature. Eur J Cancer 1993; 29(9): 1356-7.
19. Ottaiano A, Tambaro R, Greggi S, Prato R, Di Maio M, Esposito G, et al. Safety of cisplatin after severe hypersensitivity reactions to carboplatin in patients with recurrent ovarian carcinoma. Anticancer Res 2003; 23(4): 3465-8.
20. Libra M, Sorio R, Buonadonna A, Berretta M, Stefanovski P, Toffoli G, et al. Cisplatin may be a valid alternative ap-proach in ovarian carcinoma with carboplatin hypersensitivity: report of three cases. Tumori 2003; 89(3): 311-3.
21. Shukunami K, Kurokawa T, Kubo M, Kaneshima M, Kamitani N, Kotsuji F. Hypersensitivity reaction to carboplatin during treatment for ovarian cancer: successful resolution by replacement with cisplatin. Tumori 1999; 85(4): 297-8.
22. Jones R, Ryan M, Friedlander M. Carboplatin hypersensitivity reactions: re-treatment with cisplatin desensitisation. Gynecol Oncol 2003; 89(1): 112-5.
23. Shlebak AA, Clark PI, Green JA. Hypersensitivity and cross reactivity to Cisplatin and analogues. Cancer Chemother Pharmacol 1995; 35(4): 349-51.
24. Windom HH, McGuire WP 3rd, Hamilton RG, Adkinson NF Jr. Anaphylaxis to carboplatin, a new platinum chemotherapeutic agent. J Allergy Clin Immunol 1992; 90(4 Pt 1): 681-3.
25. Abe A, Ikawa H, Ikawa S. Desensitization treatment with cisplatin after carboplatin hypersensitivity reaction in gynecologic cancer. J Med Invest 2010; 57(1-2): 163-7.