Risk factors of Hypersensitivity Reactions to Carboplatin: A Systematic Review and Meta-analysis

The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive. This systematic review and meta-analysis aim to establish a consensus on the risk factors of HSRs to carboplatin in cancer patients. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were searched across MEDLINE, EMBASE, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in cancer patients. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023. Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (OR of 1.76, 95% CI 1.46 - 2.12), BRCA mutation (OR of 4.03, 95% CI 2.00 - 8.13), carboplatin free interval of 12 months or more (OR of 4.93, 95% CI 2.89 - 8.40), increased cumulative dose (SMD of 0.58, 95% CI 0.41 - 0.75), relapse (OR of 2.26, 95% CI 1.58 - 3.25), and younger age (SMD of -0.15, 95% CI: -0.26 - -0.03). This meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in cancer patients. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.