Réaction d'hypersensibilité à l'oxaliplatine: une réintroduction est-elle possible ?

Hypersensitivity reactions to oxaliplatin are observed in approximately 15% of patients. These reactions are more frequent when the patient has been exposed for a long time to the molecule; they appear between the 6th and 9th cycle. Most often they intensify with the repetition of cycles leading to a stop of oxaliplatin and especially preventing its reintroduction. The consequence for some patients is therefore the stopping of a molecule to which their disease remains sensitive. There are no data to quantify the potential loss of survival in the metastatic phase, but given the limited number of cytotoxic agents active in digestive cancer, the impact on survival of early permanent discontinuation appears likely. The main mechanism is a type I allergy with mast cell degranulation that can be controlled by a desensitization protocol. Although desensitization to cytotoxic agents is old and particularly with regard to platinum salts, it is not commonly used in clinical practice. This is unfortunate as oxaliplatin is one of the molecules for which desensitization is very often effective: more than 70% of patients treated again without incident in our experience. A simple protocol presented in this mini-review should therefore be used systematically in cases of oxaliplatin hypersensitization, whether patients receive oxaliplatin intravenously or intra-arterially.