内容紹介
Safety and Efficacy of Cisplatin Treatment after Carboplatin Hypersensitivity Reactions in Gynecologic Malignancies
Summary
To investigate the safety and efficacy of cisplatin(CDDP)treatment after carboplatin(CBDCA)hypersensitivity reactions(CHSR)in gynecologic malignancies, we retrospectively reviewed the clinical records of 544 patients who underwent paclitaxel and CBDCA therapy(TC therapy). CHSR was observed in 18 patients. Eight patients were administered weekly paclitaxel and CDDP therapy(wTP therapy)continuously, to confirm that there was no CDDP hypersensitivity following intravenous administration of 10 mg CDDP. At the onset of CHSR, the patients had received a median of 9 TC therapy cycles, and the median number of CBDCA administrations was 14. The frequency of CHSR was significantly higher in patients who received 7 cycles or more of TC therapy and CBDCA administration(p<0.0001). The median number of wTP therapy administrations was 8. Although CDDP hypersensitivity reactions were observed in 2 patients, their symptoms were mild(Grade 2, CTCAE v4.0). Of the 6 patients who received wTP therapy and had evaluable disease sites, 1, 2, 2 and 1 patients showed CR, PR, SD, and PD, respectively. The median progression-free survival in these 6 patients was 9.5 months. For patients with the platinum-sensitive disease who have CHSR, CDDP could improve their prognosis.
要旨
carboplatin(CBDCA)は反復投与による過敏反応(CBDCA hypersensitivity reaction: CHSR)が知られている。CHSR発症後のcisplatin(CDDP)による治療の安全性と有効性を解析した。paclitaxel/CBDCA(TC)療法(一括もしくは週ごと分割投与)を施行した544例中18例(卵巣・卵管・腹膜癌12例,子宮体癌5例,子宮頸癌1例)にCHSRが生じた。CHSR例の年齢中央値57歳,発症時のTC療法サイクル数中央値9サイクル,CBDCA投与回数中央値は14回であった。TC療法7サイクル,CBDCA投与7回を超えるとCHSRを発症する頻度は有意に上昇した(p<0.0001)。CHSRの重症度(CTCAE v4.0)はGrade 1～2 14例(77.8%),Grade 3が4例(22.2%)であった。CHSR 18例中8例(卵巣癌3例,子宮体癌4例,子宮頸癌1例)に対し,CDDP 10 mgの静脈内試験投与後,週毎paclitaxel/CDDP(wTP)療法を継続した。wTP療法のCDDP投与回数中央値は8回であった。過敏反応による治療中止が2例(25.0%)あり,症状はGrade 2と軽微であった。wTP療法の奏効率は50.0%で,無増悪期間は中央値9.5か月であった。以上より,CHSRが生じた白金製剤感受性症例には,CDDPに薬剤変更し白金製剤による治療を継続できる可能性がある。
目次
Summary
To investigate the safety and efficacy of cisplatin(CDDP)treatment after carboplatin(CBDCA)hypersensitivity reactions(CHSR)in gynecologic malignancies, we retrospectively reviewed the clinical records of 544 patients who underwent paclitaxel and CBDCA therapy(TC therapy). CHSR was observed in 18 patients. Eight patients were administered weekly paclitaxel and CDDP therapy(wTP therapy)continuously, to confirm that there was no CDDP hypersensitivity following intravenous administration of 10 mg CDDP. At the onset of CHSR, the patients had received a median of 9 TC therapy cycles, and the median number of CBDCA administrations was 14. The frequency of CHSR was significantly higher in patients who received 7 cycles or more of TC therapy and CBDCA administration(p<0.0001). The median number of wTP therapy administrations was 8. Although CDDP hypersensitivity reactions were observed in 2 patients, their symptoms were mild(Grade 2, CTCAE v4.0). Of the 6 patients who received wTP therapy and had evaluable disease sites, 1, 2, 2 and 1 patients showed CR, PR, SD, and PD, respectively. The median progression-free survival in these 6 patients was 9.5 months. For patients with the platinum-sensitive disease who have CHSR, CDDP could improve their prognosis.
要旨
carboplatin(CBDCA)は反復投与による過敏反応(CBDCA hypersensitivity reaction: CHSR)が知られている。CHSR発症後のcisplatin(CDDP)による治療の安全性と有効性を解析した。paclitaxel/CBDCA(TC)療法(一括もしくは週ごと分割投与)を施行した544例中18例(卵巣・卵管・腹膜癌12例,子宮体癌5例,子宮頸癌1例)にCHSRが生じた。CHSR例の年齢中央値57歳,発症時のTC療法サイクル数中央値9サイクル,CBDCA投与回数中央値は14回であった。TC療法7サイクル,CBDCA投与7回を超えるとCHSRを発症する頻度は有意に上昇した(p<0.0001)。CHSRの重症度(CTCAE v4.0)はGrade 1～2 14例(77.8%),Grade 3が4例(22.2%)であった。CHSR 18例中8例(卵巣癌3例,子宮体癌4例,子宮頸癌1例)に対し,CDDP 10 mgの静脈内試験投与後,週毎paclitaxel/CDDP(wTP)療法を継続した。wTP療法のCDDP投与回数中央値は8回であった。過敏反応による治療中止が2例(25.0%)あり,症状はGrade 2と軽微であった。wTP療法の奏効率は50.0%で,無増悪期間は中央値9.5か月であった。以上より,CHSRが生じた白金製剤感受性症例には,CDDPに薬剤変更し白金製剤による治療を継続できる可能性がある。