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Carboplatin Desensitisation — SCE Medical Oncology MCQ

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ModerateGynaecological CancersCarboplatin DesensitisationSCE Medical Oncology

A 60-year-old woman with advanced ovarian cancer on carboplatin develops a grade 3 carboplatin hypersensitivity reaction (urticaria, bronchospasm, hypotension) during her 8th cycle. She has responded well to treatment. What options exist for future platinum exposure?

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Correct answer: C — Carboplatin desensitisation protocol (graded reintroduction in HDU/ICU setting) — this allows continued platinum exposure in patients who have responded to treatment and need to complete their course

Carboplatin hypersensitivity occurs in approximately 10-15% of patients, typically after ≥6 cycles (sensitisation). For patients with good tumour response who need to complete platinum therapy, desensitisation protocols (graded dose escalation over 4-6 hours in HDU/ITU setting, with stepwise increases from 1/1000th dose) allow safe re-exposure in ~80-90% of cases. Alternative: switch to cisplatin (partial cross-reactivity ~25-50%). Oxaliplatin has lower cross-reactivity but is not standard in ovarian cancer. Some centres use skin testing to guide management.

Reference: ESMO 2024 Ovarian Cancer; Lee et al Gynecol Oncol 2005; Markman et al JCO 2003