Successful rapid desensitization to intravenous etoposide using a 14-step protocol

Escallon, Sebastian Garcia; Muniyappa, Pravin K.; Subramanian, S.

doi:10.1016/j.jaip.2014.12.014

Cited by 11 publications

(14 citation statements)

References 8 publications

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“…In previous literature, strategies to prevent hypersensitivity upon re-challenge have included one or more of the following: premedication, decreased infusion rate, decreased infusion concentration, change in formulation, and desensitization protocols. [7][8][9][10][11][12][13][14]17,18,20,25 There have been case reports of patients who tolerated etoposide or etoposide phosphate re-challenge with implementation of desensitization protocols. 17,25 Switching from etoposide to etoposide phosphate formulation has also been reported as successful in several case reports.…”

Section: Discussionmentioning

confidence: 99%

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

Stockton

Nguyen

Zhang

et al. 2019

J Oncol Pharm Pract

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Introduction Etoposide is critical in treating pediatric cancers, although hypersensitivity can be severe and treatment-limiting. Reported rates of hypersensitivity range from 2% to 51%. Hypersensitivity data for etoposide phosphate, a newer product, are lacking. The primary objective of this study was to assess etoposide and etoposide phosphate hypersensitivity incidence. Secondary objectives included evaluation of potential risk factors for hypersensitivity and strategies to prevent recurrence. Methods This retrospective cohort study evaluated pediatric patients who received initial etoposide phosphate or etoposide dose between August 2012 and July 2017. The primary outcome was documentation of hypersensitivity within four months of initial dose. Potential risk factors evaluated included age, allergies, dose, infusion rate, infusion concentration, and premedication. Results Of 246 patients, hypersensitivity reactions occurred in five of 54 patients (9.3%) who received etoposide phosphate and 52 of 192 patients (27.1%) who received etoposide ( p = 0.0061). For etoposide, the mean initial infusion rate was 64.6 ± 40.9 mg/m2/h for patients with hypersensitivity and 49.5 ± 33.4 mg/m2/h without hypersensitivity ( p = 0.0886). Etoposide phosphate rate was not associated with hypersensitivity. Recurrent hypersensitivity occurred in one of nine patients (11.1%) who received etoposide desensitization and one of 38 patients (2.6%) who changed formulation to etoposide phosphate. Conclusions Etoposide was associated with more hypersensitivity than etoposide phosphate in pediatric patients. Etoposide hypersensitivity was associated with higher infusion rates, but not etoposide phosphate. Differences in hypersensitivity incidence and infusion rate influence indicate a formulation-effect. Etoposide hypersensitivity recurrence may be prevented by changing to etoposide phosphate formulation. During etoposide phosphate shortages, etoposide desensitization may prevent recurrent hypersensitivity.

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Section: Discussionmentioning

confidence: 99%

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

Stockton

Nguyen

Zhang

et al. 2019

J Oncol Pharm Pract

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“…This etoposide desensitization protocol, which requires 50% fewer titration steps compared with etoposide desensitization described in previous literature and eliminates infusion rate changes during titration, was safety implemented by nursing staff. [13][14][15][16][17][18] It was tolerated by 92% of pediatric and AYA patients, allowing successful completion of planned treatment protocol avoiding substitutions and omissions. This simplified desensitization protocol provides a valuable, welltolerated option and may minimize risk of error during administration and improve patient safety.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Etoposide desensitization protocols have often utilized three consecutive bags of increasing concentrations, with the rate of each bag increased at least four times during infusion (12-15 total rate changes occurring every 15 minutes). [13][14][16][17][18] The protocol developed at our institution utilizes six consecutive bags of increasing concentrations. The first five bags all have consistent infusion rates at 50 mL/hour and infuse over 1 hour each.…”

Section: This Protocol Is Novel Because It Minimizes Infusion Rate Chmentioning

confidence: 99%

“…12 Subsequently, case reports described etoposide administration with this 12-step protocol or a modified version. [13][14][15][16][17][18] At our institution, etoposide phosphate formulation is traditionally used to allow continuation of first-line therapy. Incidence of etoposide phosphate hypersensitivity is significantly lower than etoposide (9.3% vs 27.1%).…”

Section: Introductionmentioning

confidence: 99%

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Six‐step etoposide desensitization protocol: A pediatric, adolescent, and young adult case series

Stockton

Lam

Nguyen

et al. 2020

Pediatric Blood & Cancer

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Etoposide administration can be complicated by hypersensitivity reactions. Desensitization may provide a strategy to prevent hypersensitivity recurrence. One challenge with desensitization is regimen complexity. This case series describes 12 pediatric, adolescent, and young adult patients who received a simplified six-step etoposide desensitization protocol. This protocol contains 50% fewer titration steps compared with previously described protocols and eliminates infusion rate changes during titration. Simplified titration may minimize risk of error during administration and improve safety. This protocol was tolerated by 92% of patients. Given increasing frequency and duration of drug shortages, a simplified desensitization protocol provides a valuable treatment option.

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“…Additional supporting information may be found online in the Based on previous publications, [5][6][7][8] we initially implemented a modified 13-step rapid drug desensitization protocol (Table 1) These were administered at half the standard rate following repeat pre-medication.…”

Section: S U Pp O Rti N G I N Fo R M Ati O Nmentioning

confidence: 99%

A case series of pediatric oncology patients undergoing successful rapid etoposide desensitization

Wright

Shah

Rider

et al. 2019

Pediatric Allergy Immunology

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1. Solé D, Wandalsen GF, Camelo-Nunes IC, et al. Prevalência de sintomas de asma, rinite e eczema atópico entre crianças e adolescentes brasileiros identificados pelo International Study of Asthma and Allergies in Childhood (ISAAC) -Fase 3. J Pediatr. 2006;82:341-346. 2. Thijs JL, Strickland I, Bruijnzeel-Koomen C, et al. Moving toward endotypes in atopic dermatitis: Identification of patient clusters based on serum biomarkers analysis. J Allergy Clin Immunol. 2017;140:730-737. 3. Laske N, Niggemann B. Does the severity of atopic dermatitis correlate with serum IgE levels? Pediatr Allergy Immunol. 2004;15:86-88. 4. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venerol. 1980;92:44-47. 5. European Task Force on Atopic Dermatitis. Severity scoring of atopic dermatitis: the SCORAD Index (consensus report of the European Task Force on Atopic Dermatitis). Dermatology. 1993;186:23-31.

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Successful rapid desensitization to intravenous etoposide using a 14-step protocol

Cited by 11 publications

References 8 publications

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

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

Six‐step etoposide desensitization protocol: A pediatric, adolescent, and young adult case series

A case series of pediatric oncology patients undergoing successful rapid etoposide desensitization

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