Oxaliplatin desensitization for gastrointestinal cancer patients with hypersensitivity reactions: real-world experience from Vietnam.

INTRODUCTION

Oxaliplatin-induced hypersensitivity reactions (HSRs) can interrupt clinically indicated treatment for gastrointestinal malignancies. We evaluated the early implementation of a multidisciplinary oxaliplatin desensitization pathway at Vinmec Times City International Hospital.

METHODS

We conducted a retrospective case series of patients who underwent oxaliplatin desensitization between 2022 and 2025 following an index HSR. Clinical characteristics, skin testing results, desensitization procedures, breakthrough reactions (BTRs), and subsequent oxaliplatin treatment completion were reviewed.

RESULTS

Ten patients underwent desensitization after index HSRs occurring at a median of six oxaliplatin cycles (range, 2-11); six index reactions were Brown grade 2. Skin prick testing was negative in all patients, whereas intradermal testing was positive in six, negative in three, and equivocal in one. Three patients initially underwent a three-bag desensitization procedure and seven a four-bag procedure. Eight BTRs occurred in six patients, none requiring epinephrine. Seven patients completed all additional oxaliplatin cycles planned by their oncology team, receiving a median of four additional cycles. Three patients discontinued oxaliplatin after BTRs: two because of recurrent reactions despite procedure modification and one because the patient declined further treatment after a single BTR in the metastatic setting.

DISCUSSION: Multidisciplinary oxaliplatin desensitization enabled most patients in this early case series to continue and complete planned oxaliplatin treatment, although BTRs were common. Given the small, retrospective cohort, these findings are descriptive and require further study to establish comparative safety or efficacy, superiority of a specific desensitization procedure, or predictors of treatment completion.