Non-convulsive seizure related to Cremophor EL™-free, polymeric micelle formulation of paclitaxel: a case report

Abstract

Paclitaxel is a chemotherapeutic agent that is effective against ovarian, breast, lung, and other cancers. Although peripheral neurotoxicity is among the most common side effects of paclitaxel treatment, central neurotoxicity is rarely reported. When centrally mediated side effects are observed, they are attributed to Cremophor EL™ (CrEL), a surfactant-containing vehicle used for paclitaxel administration. In the present report, we discuss the case of a 72-year-old woman with ovarian carcinoma who experienced a non-convulsive seizure following administration of a CrEL-free, polymeric micelle formulation of paclitaxel. One week after her fourth round of chemotherapy, she experienced a transient episode of aphasia for 45 minutes. Electroencephalography demonstrated epileptiform discharges. To our knowledge, this is the first reported case of seizure associated with a CrEL-free formulation of paclitaxel. Although rare, patients and clinicians should remain aware of the risk of non-convulsive seizure following infusion of this paclitaxel formulation.

A rare case of generalized tonic‐clonic seizure related to paclitaxel infusion

“…Chemotherapy‐induced seizures are rare and to our knowledge, this case is the third published case of paclitaxel‐related seizure occurring within 2 hours of first infusion of paclitaxel . However, there are a few reported cases of delayed seizures, mostly non‐convulsive, occurring 4‐8 days following paclitaxel infusion …”

A Library of Custom PEG-Lipids reveals a Double-PEG-Lipid with Drastically Enhanced Paclitaxel Solubility and Human Cancer Cell Cytotoxicity when used in Fluid Micellar Nanoparticles

“…7 However, Cremophor EL introduces its own complications, with a subset of Taxol patients being documented as suffering nephro-and neurotoxicity in addition to hypersensitivity reactions such as anaphylaxis, hypotension, and angioedema. 8,9 These side effects are compounded by the low PTX loading (1 wt% relative to Cremophor EL), requiring high doses and long infusion times. 10 The clinical demand for improved PTX formulations resulted in development of albumin-bound PTX, referred to as Abraxane ® .…”