Updating the Carboplatin Hypersensitivity Protocol: Two Case Studies
Bibliographic record
Abstract
CARBOPLATIN IS A PLATINUM-BASED CHEMOTHERAPEUTIC DRUG that nurses infuse in patients with gynecologic cancers, particularly in patients with ovarian cancer.Women who are reexposed to carboplatin in the recurrent disease setting are at increased risk for a platinum hypersensitivity reaction (HSR).The following are risk factors associated with platinum HSR: six or more cycles of platinum, cumulative platinum dose, increased interval from prior platinum exposure, platinum doublet with paclitaxel, BRCA1/BRCA2 variations, and a history of prior systemic allergic reactions (Vetter et al., 2019).These reactions can include various symptoms ranging from mild (e.g., facial flushing, pruritus), to moderate low risk (e.g., erythema, dyspnea without hypoxia), to moderate high risk (e.g., angioedema without anaphylaxis, hypotension), to severe (e.g., anaphylaxis, death) (Vetter et al., 2019).Despite these risks, clinicians understand the benefit of treating recurrent disease with carboplatin.For patients whose disease recurs more than six months after the last treatment with a platinum therapy, retreating with platinum therapy may improve overall survival (Takase et al., 2015).Carboplatin desensitization (CD) protocols can help safely re-treat patients with hypersensitivity (Altwerger et al., 2017).However, there is no universal CD protocol for clinicians to follow.Altwerger et al. (2017) and Vetter et al. ( 2019) discuss the existence of many protocols described for CD that last between 2 and 16 hours, with some protocols requiring multiple steps.Institutions can standardize protocols that they deem acceptable for their patients.As healthcare costs continue to rise, it is important for institutions to look at cost savings for the institution and the patient.A shorter CD protocol could save the pharmacy money.This could also mean savings for nursing services.The patient benefits of CD include decreased length of stay, reduced exposure to infections, and decreased potential for falls in the hospital setting (Tipton et al., 2021).In addition, patients may save money on co-pays or admission costs not covered by their insurance for an overnight stay in the intensive care unit (ICU) related to their CD.The original CD protocol at an 872-bed academic medical institution in the southeastern United States was 12 diluted bags of carboplatin delivered over 8.5 hours.This was a time-consuming and expensive process.Depending on the length of the CD session, it could involve as many as three nurses receiving overtime pay and the patient potentially staying overnight in the ICU.The inpatient pharmacy made the 12 bags of diluted carboplatin in about one hour; however, other pharmacy duties often took precedence over this task, resulting in additional hours passing before the first bag arrived
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".