For those unable to tolerate taxanes due to significant toxicities (e.g. significant neuropathy), Grade 3 or 4 hypersensitivity/allergy or due to contra-indications/excess risk to high dose dexamethasone several alternatives can be considered depending on the clinical scenario.
Alternate taxane- doublet protocols may be suitable:
- GOCABR: Alternative Treatment of Gynecological Malignancies Using CARBOplatin and PACLitaxel NAB (ABRAXANE)
- GOCABRBEV: Alternative Treatment of Gynecological Malignancies Using Bevacizumab, CARBOplatin and PACLitaxel NAB (ABRAXANE)
- GOOVCAD
Alternate non-taxane doublet protocols may be suitable:
- GOOVPLDC – carboplatin and liposomal doxorubicin
- GOOVCAG – carboplatin and gemcitabine
Alternate single agent protocols may also be suitable under some circumstances:
- GOOVCARB –carboplatin
- GOOVLDOX – liposomal doxorubicin
- GOOVTOP – topotecan
- GOOVGEM - gemcitabine
- GOOVETO) - etoposide
- GOOVVIN – vinorelbine
- GOOVCYCPO - cyclophosphamide
In some instances, a request to the Compassionate Access Program may be required.
Carboplatin allergic reactions/hypersensitivity require special consideration. Protocol SCPLATRX is developed to address the management of carboplatin hypersensitivity. This protocol contains more detailed background information, a grading system and management options.
It is important for treating clinicians to understand that most platinum reactions are IgE mediated, differentiating them from other drug infusion reactions which are more commonly anaphylactoid and not IgE mediated. IgE mediated reactions can progress to anaphylaxis and unlike other hypersensitivity reactions, cannot be reduced in frequency with pre-medications (e.g., steroids, H1 inhibitors, anti-histamines).
Platinum reactions tend to occur upon re-exposure to platinums (e.g., not usually with the first or second infusion as can be the case with most other chemotherapy hypersensitivity reactions) and typically start within minutes of infusion (rather than being delayed to hours/days)4. Symptoms can start as mild and escalate to severe (e.g., anaphylaxis) upon rechallenge. Initial symptoms can be difficult to interpret (e.g., itchy palms). The timing relative to the infusion and onset upon drug re-exposure (see below) should raise the index of suspicion.
Non-platinum options should be considered. However, in appropriate cases, cisplatin may be substituted for carboplatin.
Desensitization is not an option available at BC Cancer.
