Is cross reactivity low enough to try cisplatin as an alternative for patients who experience hypersensitivity reaction to carboplatin?
What treatment would you offer for a patient who would benefit from further cisplatin or carboplatin therapy and had a severe hypersensitivity reaction to carboplatin?
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A couple of preparatory comments. First, there is a reasonable review recently published about platinum sensitivity and management questions related to this (Makrilia et al., PMID 20886011). The second comment is that platinum sensitivity reactions can be quite severe, and are relatively rare with < 7 cycles of treatment, and in fact, are much more frequently seen when patients are "re-exposed" to the same agent after a treatment free interval (and, anecdotally, more commonly on the second dose after restarting or re-exposure).
So the first question must go back to basic oncologic principles - why are we treating with platinum this time? If in the curative setting (for example, adjuvant chemotherapy or definitive chemoradiation for a patient with presumably a new cancer - fulfilling the re-exposure comment above), then platinum administration is important. If in the palliative setting, however, one has to examine the need or requirement for continuation of the platinum agent, knowing that these reactions can be severe and even fatal.
If continuing a platinum agent is important, then the next question is how severe was the reaction? Again, my experience is that (unlike paclitaxel reactions), platinum reactions tend to be severe and "scary." Frankly, gynecologic oncologists have more experience than most thoracic oncologists in this area. There are two options: 1) a desensitization protocol (as outlined in the references from the above-mentioned review), or 2) change to different platinum. Finally (to answer the question), if the need for a platinum is great, the reaction is severe, and I have decided to change from carboplatin to cisplatin then I would be inclined to get skin testing performed in order to be more comfortable. It is my understanding that if the skin testing (for cisplatin) is negative, then the likelihood of a severe reaction is relatively low. If positive, then a reconsideration of the rationale, and a "shared" decision with the patient should be considered. If one is to proceed with the platinum, I would take precautions - i.e., appropriate premedications, slower infusion rate, and administration in a setting where appropriate support is readily available.
Cross-reactivity between cisplatin and other platinum salts seems low. I replaced carbo or oxaliplatin with cisplatin several times without any testing or issues.