Congress Abstracts 2006

151

A RISKY BUSINESS: IMPLEMENTING A PLATINUM-BASED DESENSITIZATION PROTOCOL IN THE OUTPATIENT SETTING. Robin Green, RN, BSN, MSN, OCN^®, New York University (NYU) Hospitals Center, New York, NY; Andrea Downey, RN, MA, NYU Cancer Institute, New York, NY; Kathleen McCaffrey, RN, MSN, and Eileen Fusco, RN, NP, NYU Hospitals Center, New York, NY; and Franco Muggia, MD, NYU Cancer Institute, New York, NY.

Platinum-based therapy represents the cornerstone of treatment for a variety of malignancies. Due to improved survival rates, patients are remaining on chemotherapy longer or receiving more than one platinum-based drug in the course of their treatment. All platinum-based compounds are associated with hypersensitivity reactions (HSR). Continued treatment after a HSR is not recommended by the pharmaceutical companies. However, if a patient has either exhausted other treatment modalities or is having a favorable response to platinum-based therapy, desensitization protocols have been implemented. These protocols often necessitate inpatient admissions and involve heavy allocation of hospital resources.

Implementation of a platinum-based desensitization regimen applicable to the outpatient setting

At this NCI-designated outpatient center we routinely desensitize patients who have experienced a HSR. All patients followed a medication schedule using steroids, H¹ and H² receptor antagonists and Indomethacin. The pharmacokinetics of the protocol was based on the linear relationship between dose concentration and infusion time; an increase in the concentration of the drug corresponded with an increase in the rate of infusion. Infusion times ranged between 5 to 8 hours. The patients were monitored for symptoms of HSR; mild infusion-related symptoms were managed with additional medications and a decrease in infusion rate.

We were able to successfully treat all patients. The protocol was modified to account for dosage differences in the agents. Carboplatin was administered at a MG/ML/MIN rate, with programmed rate increases. Cisplatinum and Oxaliplatin were first divided into serial aliquots; .01mg, .1mg, and 1mg of total dose. If tolerated, the remaining dosage was administered at a fixed rate over 4 hours.

Carboplatin is widely used in recurrent gynecologic cancers; oncology nurses are now seeing an increasing incidence of HSR's. It is critical that the nursing staff has the resources and training to ensure the safe management of these patients. The success of this protocol lends support to the feasibility of accomplishing the initial desensitization to platinum-based HSR'S in the outpatient setting. Some unresolved issues are the safety of intraperitoneal administration in a patient who experiences an HSR, and the extent of cross-sensitization between platinums.