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Burches et al. J Cancer Metastasis Treat 2019;5:63 I http://dx.doi.org/10.20517/2394-4722.2019.012 Page 7 of 8

increases with a relationship between doses following a geometric series) which is called LRDP. We have
implemented this protocol consisting of 13 doses delivery stages, underlining the accurately relationship
between doses in a geometric series. Progression of the doses occurred logarithmically. Each step
delivered exactly twice the dose of previous step, in such a way that all step concentrations arranged in a
geometric series with a factor two. The first term of the series is 1/32 and the common ratio is 2 (1/32, 1/16,
1/8,1/4,1/2, 1, 2, .......). The total quantity of volume in each of the three bags with each of the solutions is
not very different from the volume to administer. Therefore, in case of a potential mistake in the schedule,
the risk for the patient is minimized.

To enhance patient safety, administration of LRDP was performed by a multidisciplinary team including
physicians and nursing staff from the Departments of Allergy, Medical Oncology and Pharmacy. LRDP
with carboplatin is a feasible and safe protocol in patients with previous infusion reaction to carboplatin.

CONCLUSION
We have performed a retrospective study with the aim of assessing the effectiveness and safety of a LRDP
with carboplatin in patients with a previous reaction. It is a promised protocol for administration of
carboplatin after an infusion reaction.

The protocol might allow a safe administration of drugs (it can be applied to other drugs because the
therapeutic dose of the majority of drugs is in a range between 1-1000 mg), that are beneficial for the
management of patients, after certain types of hypersensitivity reactions, and it is indicated in cases in
which there are no reasonable therapeutic alternatives.

DECLARATIONS
Authors’ contributions
Designed the study and wrote the manuscript: Burches E, Pérez-Fidalgo JA
Contributed to data collection: Ferriols F, González-Barrallo I, Cervantes A

Availability of data and materials
Date are available in data base/Clinical Data Repository of Hospital Clinico de Valencia.

Financial support and sponsorship
None.

Conflict of interest
All authors declared that there are no conflicts of interest.

Ethics approval and consent to participate
This retrospective study was approved by the local Ethics Committee of Hospital Clinico Universitario of
Valencia (resolution number 320) in November 2016.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Patil SU, Long AA, Ling M, Wilson MT, Hesterberg P, et al. A protocol for risk stratification of patients with carboplatin-induced
hypersensitivity reactions. J Allergy Clin Immunol 2011;129:443-7.