Presenting Author: Le Trang Nguyen, Vinmec Times City International General Hospital, Hai Ba Trung, Hanoi, Vietnam
BACKGROUND: Oxaliplatin is a key component of chemotherapy for gastrointestinal malignancies in both adjuvant and metastatic settings. However, hypersensitivity reactions (HSRs) can result in treatment discontinuation. Rechallenge with desensitization offers a potential strategy to maintain oxaliplatin-based therapy. Real-world data on desensitization protocols and outcomes in Vietnam remain limited.
OBJECTIVES: To characterize oxaliplatin desensitization approaches and evaluate clinical outcomes in patients who developed oxaliplatin-induced HSRs.
METHODS: This retrospective case series included patients at Vinmec Times City International Hospital (Hanoi, Vietnam) from 2022 to 2025 who experienced oxaliplatin-related HSRs and subsequently underwent desensitization. Patient demographics, desensitization protocols, and treatment outcomes were collected and analyzed.
RESULTS: In all, 10 patients were included. The mean age was 63 years. The primary diagnoses were colorectal cancer (60%), gastric cancer (30%), and rectal cancer (10%). Of these patients, 70% were treated in the metastatic setting and 30% received adjuvant treatment. FOLFOX was the most common oxaliplatin regimen associated with HSRs (90%), followed by CAPOX (10%). Initial HSRs occurred after a median of 6 cycles (range, 2-11): 30% were grade 1, 60% were grade 2, and 10% were grade 3. All patients underwent allergy evaluation, and skin prick tests were negative in all cases, whereas intradermal testing was positive in 70%. Among the 10 patients with HSRs, 7 received a 4-bag desensitization protocol, and 3 received a 3-bag protocol; 3 patients later de-escalated from 4-bag to 3-bag regimens following at least 3 successful cycles. Patients completed a median of 4 additional oxaliplatin cycles, with a median infusion duration of 6.5 hours per cycle. In all, 3 (30%) patients experienced recurrent HSRs leading to treatment termination, and 7 (70%) patients successfully completed therapy. Among these 7 patients, 2 achieved disease-free status, 3 achieved partial response, and 2 had disease progression.
CONCLUSION: This study represents one of the earliest real-world experiences of oxaliplatin desensitization in Vietnam. Our findings suggest that desensitization is a feasible strategy that enables the continuation of oxaliplatin therapy in most patients with prior HSRs. Positive intradermal testing may help to guide the desensitization protocol. Further prospective studies are warranted to optimize protocol selection and identify predictors of successful rechallenge.
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