HIPEC with cisplatin desensitization at the time of secondary debulking in a patient with a prior carboplatin hypersensitivity reaction.

UNLABELLED: BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective adjuvant therapy to cytoreductive surgery in recurrent epithelial ovarian cancer. However, platinum hypersensitivity poses a significant barrier in the platinum-sensitive setting. While intravenous desensitization protocols for platinum hypersensitive patients are standard of care, strategies for safe delivery of platinum agents during HIPEC remain unclear.Case PresentationWe report a 45-year-old woman with high-grade serous carcinoma of the fallopian tube who initially underwent primary cytoreduction followed by adjuvant carboplatin-paclitaxel chemotherapy and PARP inhibitor maintenance. She subsequently developed platinum-sensitive recurrence and was retreated with carboplatin-paclitaxel but experienced a severe hypersensitivity reaction at the 12th total cycle, requiring epinephrine. Given her platinum-sensitive disease and isolated recurrence, she was considered for secondary cytoreductive surgery with HIPEC. A multidisciplinary team created a modified cisplatin desensitization strategy derived from our previous established institution four step carboplatin desensitization regimen, with pre-medications and a stepwise intraperitoneal perfusion protocol with escalating cisplatin concentrations over 90 min for delivery during HIPEC. The patient tolerated the procedure well and recovered uneventfully. She was discharged on postoperative day six.

CONCLUSION

This case, to our knowledge, is the first reported in gynecologic oncology to demonstrate the feasibility of safely delivering HIPEC with cisplatin in a patient with prior carboplatin hypersensitivity. As HIPEC adoption expands in platinum-sensitive recurrent ovarian cancer, platinum hypersensitivity will become an increasing challenge. This report underscores the need for further study of intraperitoneal desensitization strategies and cross-reactivity risks, offering a potential for extending HIPEC to patients with platinum hypersensitivity.