Analyzing the Allergic Reactions Induced by the Chemotherapy Regimens Including Oxaliplatin and Evaluating the Effectiveness of Receiving Preventive Antihistamine Drugs

Autor: Jia-Syuan Wu, 吳佳璇
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
【Background】 According to the latest 2011 cancer registration report announced by Taiwan Health Promotion Administration, Ministry of Health and Welfare, the incidence of gastric cancer is ranked No. 6 in males and No. 8 in females, while the incidence of colorectal cancer ranked No. 1 in males and ranked No. 2 in females. Oxaliplatin is currently one of the main drugs of chemotherapy for colorectal cancer and end-stage gastric cancer. Oxaliplatin is a third- generation platinum compound, which is approved by the National Health Insurance Bureau for treatment of stage III colon-rectal cancer, metastatic colorectal cancer and partially end-stage or metastatic gastric cancer. According to many studies, about 90% of the patients who have received oxaliplatin treatments are accompanied by peripheral neuropathy, whose grade is related to the dosage of oxaliplatin. Most of these adverse events can recover during the chemotherapy cycles. The clinical medical staff can provide patients with instructions to against these adverse drug reactions. However, registered allergic reactions as another adverse drug reaction of oxaliplatin, besides neuropathy, are increasing in recent years, severe allergic reactions even interrupted ongoing oxaliplatin treatments because some of the patients came to the end of endurance. Objective : During the clinical treatment, patients are given antihistamine drugs to alleviate allergic reactions induced by oxaliplatin, and it is successful in most of them. Due to the effect, some clinical doctors give the patients antihistamine drugs in advance to prevent allergic reactions before the patients receive oxaliplatin infusions. However, on the one side, antihistamine drugs often cause dizziness, nausea, or conscious disturbance. On the other side, the antihistamine drugs cannot prevent some patients effectively from oxaliplatin-induced allergic reactions by clinical observation. Because there is no relevant guideline for the prevention from oxaliplatin-induced allergic reactions, this study aims to evaluate the effectiveness of the prevention of antihistamine drugs against oxaliplatin-induced allergic reactions in order to provide information on clinical treatment and post-treatment care. 【Methods】 This is a retrospective case-control study with subjects composed of patients who have allergic reactions after receiving oxaliplatin infusions from January 2008 to May 2013 in a medical center in southern Taiwan. The subjects are divided into two groups: the study group consisted of patients without taking antihistamine drugs before the oxaliplatin infusion; the control group consisted of patients taking antihistamine drugs before the oxaliplatin infusions. By means of case review and combining with the adverse drug reaction registration system in the hospital, we analyze the incidence of oxaliplatin-induced allergic reactions and the grade of allergic reactions. The data are processed and analyzed by SPSS 19.0 for Windows and explained with descriptive statistics of percentage, mean value, median value and standard deviation, as well as inferential statistics of Chi-Square test and 95% confidence interval analysis. 【Results】 There were 545 patients receiving oxaliplatin infusions from January 2008 to May 2013. Finally 535 patients are included for analysis, including 85 patients (15.6%) reported with allergic reactions, which occurred after a median of the eighth infusion of oxaliplatin. 61 patients of them received oxaliplatin re-challenge; 46 of these 61 patients (75.4%) led to further reactions, and 24 patients (28.2%) stopped their oxaliplatin treatment owing to intolerance to oxaliplatin-induced allergic reactions. The symptoms of oxaliplatin-induced allergic reactions are primarily skin rashes (76.5%), secondly shortness of breath and chest tightness (32.3%), sweating, vomiting and so on. These 535 patients receiving oxaliplatin infusions were divided into two groups, 164 patients without receiving antihistamine drugs before the oxaliplatin infusion in the study group, and 371 patients receiving antihistamine drugs before the oxaliplatin infusion in the control group. 27 patients (16.46%) in the study group had allergic reactions, while allergic reactions happened to 58 patients (15.22%) in the control group. The rates of oxaliplatin-induced allergic reactions show no statistically significant difference (P> 0.05) between the two groups, revealing that receiving antihistamine drugs before the oxaliplatin infusion cannot effectively prevent allergic reactions. 【Conclusion】 This study reveals that the effectiveness of giving patients in the study group antihistamine drugs to prevent allergic reactions caused by oxaliplatin had no statistically significant difference from that in the control group. It was also found that giving antihistamine drugs in advance not only increases side effects such as dizziness, nausea and conscious disturbance but also could not effectively prevent allergic reactions caused by oxaliplatin. The findings provide information for clinical treatments that giving antihistamine drugs after allergic reactions occur due to oxaliplatin instead of giving it in advance for prevention not only reduces the complexity of the clinical implementation and adverse reactions caused by antihistamine drugs but also helps increase cost-effectiveness in all the aspects of medical treatment. Clinically, patient instructions about patient’s awareness of allergic reactions and self-care abilities, besides the often seen gastrointestinal side effects and neuropathy, should be enhanced, especially for the patients who have had allergic symptoms due to oxaliplatin and to more than 70% of whom it happens again after oxaliplatin re-challenge. Other preventive methods such as extending the time of oxaliplatin infusions or decreasing oxaliplatin dosage to reduce allergic reactions need more researches to verify their effectiveness.
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