Review Article

Hypersensitivity Reactions Associated with Platinum Antineoplastic Agents: A Systematic Review

Table 4

Main desensitization protocols for carboplatin-cisplatin hypersensitivity. We observe that all protocols deliver the platinum agent at escalating concentrations and administer premedication.

PatientsPremedication dose routeStepsDurationSuccess rate

Abe et al. (2010) [50]3 (carboplatin replaced by cisplatin after desensitization)Dexamethasone 20 mg, promethazine 50 mg, ranitidine 50 mgFrom 1 : 1000 to 1 : 10 on 1st day (in 3 steps), from 1 : 10 to 1 : 1 on 2nd day (in 2 steps)2 days (3 hours on 1st day, 9 hours on 2nd day)100%

Gomez et al. (2009) [51]7Dexamethasone at least 20 mg iv 30, clemastine 2 mg ivFrom 1 : 1000 to 1 : 1 in 4 steps2 hours71%

Hesterberg et al. (2009) [52]30Fexofenadine 180 mg po and/or desloratadine 5 mg po BID, Dexamethasone 10 mg poFrom 1 : 100 to 1 : 1 (in 8–10 steps)11 hours99%

Castells et al. (2008) [53]63 (60 hypersensitive to carboplatin, 3 to cisplatin)Diphenhydramine or hydroxyzine 25 mg po or iv, famotidine 20 mg iv or ranitidine 50 mg iv, lorazepam (0.5-1 mg po or iv as needed for anxiety)From 1 : 100 to 1 : 1 in 12 steps5.8 hoursSevere reactions in 6% of courses (full target dose with treatment)

Confino-Cohen et al. (2005) [54]23Dexamethasone 8–12 mg iv, ondansetron ivFrom 1 : 1000 to 1 : 1 in 4 steps6 hours86.9%

Lee et al. (2005) [55]31 (1st desensitization in intensive care unit—subsequent as outpatient)Diphenhydramine 25 mg iv, famotidine 20 mg iv Lorazepam 1 mg (as needed for anxiety)From 1 : 100 to 1 : 1 in 12 steps(higher concentrations as outpatient)5.8 hours (inpatient) 3.8 hours (outpatient)85% courses without symptoms (full target dose with treatment)

Markman et al. (2004) [56]5 (desensitization and retreatment with carboplatin or cisplatin)Zileuton 600 mg po QID (5 days), montelukast sodium 10 mg po QD (5 days), indomethacin 50 mg po TID (1 day), albuterol sulfate 8 mg po BID (1 day), famotidine 20 mg iv, dexamethasone 20 mg iv, diphenhydramine 50 mg ivFrom 1 : 1000 to 1 : 1 in 4 steps90 minutes80%

Jones et al. (2003) [57]5 (carboplatin replaced by cisplatin after desensitization)Dexamethasone 20 mg po (4 days ), diphenhydramine 50 mg po (4 days), ranitidine 50 mg iv, dexamethasone 20 mg iv, ondansetron 8 mg ivFrom 1 : 1000 to 1 : 1 in 4 steps2 hours60%

Rose et al. (2003) [33]33Dexamethasone 20 mg po or iv 6 hours before, Dexamethasone 20 mg iv and diphenhydramine 50 mg iv 30 minutes beforeFrom 1 : 1000 to 1 : 1 in 4 steps16.5 hours79%

BID: twice a day, iv: intravenously, po: by mouth, QD: once a day, QID: four times a day, TID: three times a day.