La prise en charge des réactions liées a la perfusion induite par les taxanes et les sels de platine.

Abstract

Introduction Taxanes and platinum salts share the ability to induce infusion-related reactions that can impact treatment outcomes. Reactions due to taxanes are anaphylactoid, nonspecific IgE reactions, unresponsive to skin tests, and whose incidence is reduced by oral premedication. In contrast, reactions due to platinum salts are IgE-dependent allergic reactions, responsive to skin tests, and refractory to premedication. The objective of this study is to determine the incidence of these reactions and evaluate their management within the medical oncology department of the CLCC in Sétif. Materials and Methods: This is a descriptive cross-sectional study of a series of cases of 48 patients over a period of 3 months and 21 days, between December 9, 2018, and March 31, 2019. To carry out this work, we used data collection forms administered to the patients, comprising four sections: patient and disease criteria, characteristics of the reaction related to the infusion, the treatment, and the impact on the treatment outcome. Results: This study showed that 81% of the population were women with a mean age of 47 years. The most frequent comorbidity was allergy at 18%. 58% of reactions are due to taxanes and 42% to platinum salts. Docetaxel and oxaliplatin are the most frequently implicated drugs, with an overall incidence of 1.87%. The incidence of reactive protein-induced redness (RPR) due to docetaxel, paclitaxel, oxaliplatin, and carboplatin is 2.65%, 2.31%, 1.97%, and 0.48%, respectively. Preventive treatment was effective in preventing 82% of reactions in 68% of patients, who experienced only one episode. Grade 2 reactions were predominant, while grade 3 reactions were observed in only 19% of patients, most of whom were taking oxaliplatin. The incidence occurred during the first courses of treatment for taxanes and with an average of 4 and 8 courses of treatment for oxaliplatin and carboplatin, respectively. Discussion: The predominance of females for oxaliplatin-induced PDRs was described by an American study. The incidence rates of the four aforementioned products are consistent with the literature (American studies and product summaries). Preventive treatment with corticosteroids and antihistamines is effective in 82% of grade 2 reactions and is in accordance with the 2017 ESMO recommendations. Managing grade 3 reactions appears difficult, especially in the absence of epinephrine use, and is the main reason for treatment discontinuation after a reaction. PDRs due to taxanes occur during the 1st or 2nd cycle, consistent with the literature, unlike platinum salts, which are inconsistent with previous studies, with averages of 4 cycles for oxaliplatin and 8 cycles for carboplatin. Conclusion: Good collaboration between paramedics, physicians, and pharmacists made it possible to prevent 82% of adverse reactions, thus ensuring the continuation of treatments and the availability of additional therapeutic options. Several suggestions can be made to improve the quality of care for these reactions, such as: a reaction registry, computerization of the system, and therapeutic patient education.