Etoposide phosphate for pediatric orthopedic malignancies after intravenous etoposide hypersensitivity

Abstract

Background Hypersensitivity reactions to etoposide have been reported and patients have been safely transitioned to etoposide phosphate for continued therapy. However, the safety and efficacy of substituting etoposide phosphate for etoposide has not been well established in pediatric orthopedic malignancies. The aim of this study is to determine whether etoposide phosphate can be substituted for etoposide in pediatric orthopedic malignancies. Methods A chart review of pediatric patients who developed hypersensitivity reactions to etoposide while being treated for orthopedic malignancies was performed at a large academic medical center. Three patients were identified, two with Ewing sarcoma and one with an osteosarcoma. All three patients experienced hypersensitivity reactions to their first doses of etoposide and were switched to etoposide phosphate for further therapy. Results After premedication, all three patients tolerated full doses of etoposide phosphate without a graded dose challenge or desensitization. Two of the patients were premedicated with diphenhydramine alone, while the third received diphenhydramine and dexamethasone. Conclusions Etoposide phosphate is a potentially safe alternative for pediatric patients with orthopedic malignancies who experience etoposide hypersensitivity. However, caution is needed as there are cases of etoposide phosphate hypersensitivity.

Severe hypersensitivity reaction to etoposide phosphate: A case report

“…4,5 Hypersensitivity reactions to etoposide have been reported in 1%-3% of patients characterized by hypotension, bronchospasm, urticaria, and respiratory distress. [6][7][8][9][10] One hypothesis of hypersensitivity reactions was the presence of the polysorbate 80 diluent in which the drug is diluted. 9 As substitution to etoposide, etoposide phosphate (Etopophos), a water soluble prodrug of etoposide that contains neither polysorbate 80 nor benzyl alcohol, has been successfully used without hypersensitivity prophylaxis.…”

“…This antineoplastic agent is used routinely in combination chemotherapy for f various neoplastic diseases such as refractory testicular cancer, small‐cell lung cancer leukemia, lymphomas, and solid tumors . Hypersensitivity reactions to etoposide have been reported in 1%‐3% of patients characterized by hypotension, bronchospasm, urticaria, and respiratory distress . One hypothesis of hypersensitivity reactions was the presence of the polysorbate 80 diluent in which the drug is diluted .…”