Clinical Outcomes Using Carboplatin Desensitizations in Patients with Gynecologic Cancer.

BACKGROUND: Carboplatin is a second-generation platinum agent, commonly used as initial chemotherapy and in second-line or salvage therapy in gynecologic cancers. It is often preferred over cisplatin, because of its relative lack of nephrotoxicity, neurotoxicity, and emetogenicity. As its utilization has increased, cases of hypersensitivity reactions (HSRs) have been documented, with an incidence of approximately 16.8% in patients with ovarian cancer. Patients affected by these reactions must either undergo desensitization or avoid the drug completely, with therapeutic alternatives of unknown comparative efficacy. OBJECTIVE: To compare the overall survival and time to progression (TTP) among patients undergoing carboplatin desensitization after HSR, those receiving a non–platinum-containing regimen after HSR, and patients without HSR who received carboplatin-based therapy. METHODS: This was a single-center, retrospective, case control study between January 1, 2009, and June 30, 2014. Women aged ≥18 years with a confirmed diagnosis of an advanced-stage or recurrent platinum-sensitive gynecologic oncology malignancy, including ovarian, fallopian tube, primary peritoneal, or endometrial cancer, were eligible for study inclusion. Patients were placed into 3 groups: patients undergoing carboplatin desensitization after HSR (Group A); those receiving a non–platinum-containing regimen after HSR (Group B); and those without HSR who were receiving carboplatin-based therapy (Group C). The overall survival and TTP outcomes were assessed for each group. RESULTS: A total of 60 patients were identified for study inclusion, including 15 patients who successfully completed 55 carboplatin cycle desensitizations. The median TTP for Group A, Group B, and Group C was 26.4 months, 20 months, and 18.1 months, respectively (P = .42). Group A had a median overall survival of 48.5 months and Group B had a median overall survival of 50.1 months (P = .16). The median overall survival was not reached in Group C. Overall, 11 (73%) patients in Group A tolerated the carboplatin desensitization without a reaction. CONCLUSION: Carboplatin desensitization in patients with gynecologic cancers did not result in a significantly different median TTP or overall survival compared with patients who continued carboplatin therapy without any HSRs or those who switched to a non–platinum-based regimen after the onset of hypersensitivity. [ABSTRACT FROM AUTHOR]