Hypersensitivity reactions to etoposide phosphate

Abstract

Etoposide phosphate is a prodrug of intravenous etoposide recommended for use in patients with demonstrated allergy to etoposide. We have previously published a case series comprising six patients who were successfully treated with etoposide phosphate following preceding etoposide hypersensitivity. In this new paper we now present the cases of two patients who had allergic reactions to both etoposide and etoposide phosphate. As such, we suggest that whilst most patients with etoposide hypersensitivity can safely be treated with etoposide phosphate, a small number are at risk of an additional allergic reaction to etoposide phosphate. Patients being treated for the first time with etoposide phosphate after etoposide allergy should receive their first dose under medical supervision.

Cyclophosphamide, Hydroxyurea, Actinomycin D, Methotrexate, and Vincristine in the Treatment of Gestational Trophoblastic Neoplasia

“…25 However, a small proportion of patients were at risk for additional allergic reaction to etoposide phosphate. 27,28 Because the response rate of CHAMOC was comparable with that of EMA-CO in the primary treatment of high-risk gestational trophoblastic disease, clinicians should consider switching to CHAMOC chemotherapy for patients with hypersensitivity to etoposide.…”

Etoposide and etoposide phosphate hypersensitivity in children: Incidence, risk factors, and prevention strategies

“…6 Many case reports describing etoposide hypersensitivity reactions in children and adults have been published. [7][8][9][10][11][12][13][14][15][16] Reported symptoms of hypersensitivity reactions include flushing, chest pain, dyspnea, bronchospasm, cyanosis, hypotension, and hypertension. 14 Recently, a few reports of hypersensitivity reactions with etoposide phosphate have also emerged.…”

Reações de Hipersensibilidade a Citostáticos em Idade Pediátrica

“…Tem sido usado como substituto em diversos casos de hipersensibilidade prévia ao etoposido, com sucesso. 28 No entanto, estão já descritos casos de hipersensibilidade ao etoposido fosfato, após reação prévia ao etoposido, em crianças 29 e em adultos, 30 mas também sem exposição prévia ao etoposido. 31 Outras abordagens possíveis em caso de hipersensibilidade ao etoposido consistem na exclusão deste fármaco do protocolo terapêutico, com os riscos inerentes de insucesso terapêutico, 2 ou a re-infusão após pré-tratamento com anti-histamínico e/ou corticosteroide e ritmo de infusão mais lento.…”