DGI-019 Cisplatin Desensitisation Protocol

• Published in: European journal of hospital pharmacy. Science and practice Vol. 20; no. Suppl 1; p. A102
• Main Authors: Sangrador-Pelluz, C, Martinez-García, M, Pérez-Serrano-Lainosa, MD, Olivares-Pallerols, R, Navarro-Ferrando, JP, Soler-Company, E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.03.2013
• Subjects: Chemotherapy; Lung cancer
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2013-000276.285

Background Hypersensitivity reactions are adverse events that represent a challenge, because in some cases there isn’t an alternative treatment. Consequently, the only option is to desensitise the patient. Purpose To describe a cisplatin desensitisation protocol (CDP) in a patient with a previous anaphylactic reaction. Materials and Methods Male diagnosed with lung cancer, who started chemotherapy with cisplatin 75 mg/m² and oral vinorelbine 60 mg/m². During the cisplatin infusion, he suffered an anaphylactic reaction, so it was decided to perform skin tests, to confirm the possible association with the cytostatic. Due to the cross-reactivity between platinum salts, these tests were performed with all similar substances. Stock solutions used: cisplatin 1 mg/ml, carboplatin 5 mg/ml and oxaliplatin 10 mg/ml. Dilutions prepared for intradermal administration: 1/10000, 1/1000, 1/100 and 1/10. Results Cisplatin skin tests were positive for the stock solution and negative for the other dilutions. All the other platinum salts were negative, so we developed a protocol for administering the next cycle of cisplatin. The CDP consisted of 12 stages in which to administer the total dose (140 mg).Three solutions (250 ml) were prepared with dilutions 1/100, 1/10 and 1/1. The 1/100 solution (0.0056 mg/ml) was administered at 9.25 ml in 1 hour in 4 stages (administration rate increments every 15 minutes: 2 ml/h, 5 ml/h, 10 ml/h and 20 ml/h). The 1/10 solution (0.056 mg/ml) was administered at 18.75 ml in 1 hour in 4 steps (starting with 5 ml/h and doubling the rate every 15 minutes until 40 ml/h). Solution 1/1 (0.56 mg/ml) was administered completely, starting with 10 ml/h and increasing every 15 min to 20, 40 and 80 ml/h, being the final perfusion rate. It was performed under medical supervision, taking in total 5 hours and 37 minutes. The patient didn’t have any complications. Conclusions In this patient, the CDP developed enabled the chemotherapy to be given safely. All this was possible by the interdisciplinary collaboration of allergy, oncology and pharmacy services. No conflict of interest.