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| |  Carboplatin Hypersensitivity High in Children, But Does Not Affect Progression-Free Survival Rate for Low-Grade Glioma: Presented at ASCO By Bruce Sylvester ATLANTA, G.A. -- June 7, 2006 -- The incidence of carboplatin hypersensitivity (CHSR) in children with low-grade glioma (LGG) is high (41.9%), but continued use of the drug or switching to another chemotherapeutic agent does not affect treatment outcome or progression-free survival (PFS) after 5 years. The findings were presented here on June 5th at the American Society of Clinical Oncology 2006 Annual Meeting (ASCO). "The purpose of our study was to give a true picture of carboplatin hypersensitivity in children with low-grade glioma, because there is a wide range of reporting on this subject in the literature," said lead investigator Lucie LaFay-Cousin, MD, medical resident, Hospital for Sick Children, Toronto, Ontario, Canada. "We found that a high percentage -- 42% -- of these children develop a reaction during carboplatin treatment. However, the more relevant clinical implication of our finding is that you can rechallenge carboplatin hypersensitive patients with further carboplatin or, if necessary, switch to another chemotherapy, and the initial reaction to carboplatin does not appear to impact progression-free survival rates." Dr. LaFay-Cousin and colleagues undertook a national retrospective review of 61 girls and 44 boys who were treated at 10 centers around the country for LGG between 1988 and 2004. Eligibility included age less than 18 years, pathology-designated diagnosis except in neurofibromatosis type 1 (NF1) patients, and no chemotherapy or radiotherapy prior to carboplatin chemotherapy. Median age at diagnosis was 3.5 years (0.3-16.8). Thirty-three patients had NF1, and 75 had diencephalic tumor. Patients received carboplatin monthly (n = 46) or weekly (n = 59). Forty-four (41.9%) of the subjects developed CHSR at a median of 6.5 months (0.4-15.4) following a median of 10.5 (3-39) injections. Girls had a significantly higher risk of developing CHSR (P =.02). Age, NF1 status, and schedule of administration were not significant risk factors. Grade 1 or 2 reactions appeared in 82% of the reactive subjects; 34 of the 36 children with reactions were re-exposed to carboplatin with desensitization/premedication. Of these, 41.2% were able to complete treatment. The majority of these patients (58.8%) showed recurrent allergic reaction and a significant worsening of their symptoms (P =.039). The median number of additional carboplatin injections after initial reaction was 4 (0.5-34). Following carboplatin discontinuation due to CHSR, 18 subjects were switched to another chemotherapeutic agent. At 5 years, progression-free survival was not significantly different among the carboplatin-allergic (53.9%) and nonallergic (45.6%) patients. The research was sponsored by the Canadian Pediatric Brain Tumor Consortium.
[Presentation title: Carboplatin Hypersensitivity Reaction in Pediatric Low Grade Glioma (LGG) Patients: A National Experience. On Behalf of the Canadian Pediatric Brain Tumor Consortium. Abstract 9053]
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