Best available evidence for the management of oxaliplatin-induced hypersensitivity reactions, with implications for hepatic arterial infusion chemotherapy (HAIC)

Oxaliplatin is widely used to treat gastrointestinal and hepatobiliary cancers, yet hypersensitivity reactions (HSRs) remain a significant safety concern in oncology. Although international guidelines address anaphylaxis and chemotherapy-related HSRs, existing recommendations are fragmented and often lack specificity for oxaliplatin or for hepatic arterial infusion chemotherapy (HAIC), for which evidence is limited. This study aimed to retrieve and synthesize the best available evidence to support standardized management of oxaliplatin-induced HSRs. Guided by the evidence-based “6S” model, we conducted a hierarchical, top-down search of international and domestic databases for clinical guidelines, clinical decision tools, evidence summaries, systematic reviews, and expert consensus documents published from January 2020 to February 2025. Two trained reviewers independently screened studies, appraised quality using the AGREE II and JBI instruments, and extracted and synthesized relevant evidence. Eight documents met the inclusion criteria, including five clinical guidelines, two systematic reviews, and one expert consensus. Twenty-five evidence statements were synthesized across seven domains: (1) risk factor assessment, (2) preventive measures, (3) patient and caregiver education, (4) symptom recognition and severity assessment, (5) acute management strategies, (6) monitoring and follow-up, and (7) documentation and reporting of adverse drug reactions. Attention was given to distinguishing infusion-related reactions, immune-mediated hypersensitivity, and true anaphylaxis based on clinical presentation and diagnostic criteria rather than severity grading scales alone. This review offers the most comprehensive synthesis to date of the best available evidence for managing oxaliplatin-induced HSRs and highlights a significant gap in HAIC-specific guidance. The findings integrate global recommendations with emerging clinical insights and provide an evidence-informed framework to support oncology teams in improving the safety, consistency, and standardization of oxaliplatin administration.