Two Cases of Suspected Immunologic-Based Hypersensitivity Reactions to Etoposide Therapy

Kasperek, Cynthia; Black, Curtis D.

doi:10.1177/106002809202601005

Cited by 20 publications

(23 citation statements)

References 6 publications

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“…The etiology and the exact mechanism are unknown, but they are believed to be of nonimmunogenic origin. Nevertheless, there are some hypotheses that the concentration of the drug and the rate of infusion could explain HSR [5]. Another possible way of HSR is that the additive used in the preparation to dissolve etoposide (benzyl alcohol, polysorbate 80) may cause HSR.…”

Section: Discussionmentioning

confidence: 99%

Hypersensitivity to Etoposide in Case of Metastatic Gestational Choriocarcinoma

Lazović¹,

Milenkovic²,

Delić³

et al. 2013

Case Rep Oncol

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Etoposide is commonly used in the treatment of a variety of neoplasms. Hypersensitivity reactions to etoposide are infrequently reported and include hypotension, hypertension, flushing, diaphoresis, chest discomfort, dyspnea, bronchospasm and loss of consciousness. We report the case of a 39-year-old woman who experienced acute bronchospasm, tachycardia, hypoxia and hypotension. The symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine and oxygen. Subsequently, the patient was given etoposide phosphate without incident.

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Section: Discussionmentioning

confidence: 99%

Hypersensitivity to Etoposide in Case of Metastatic Gestational Choriocarcinoma

Lazović¹,

Milenkovic²,

Delić³

et al. 2013

Case Rep Oncol

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“…Bernstein and Troner (1999) have attributed etoposide HSRs to the concentration of the drug and the rate of infusion. However, other authors have reported HRSs in patients receiving a wide range of etoposide concentrations, weakening this hypothesis (Kasperek and Black, 1992;Bernstein and Troner, 1999;Athanassiou et al, 1988;De Souza et al, 1994;Tester et al, 1990;Hoetelman et al, 1996;Siderov and Zalcberg, 1994;Tucci and Pirtoli, 1985;Donegan, 1989;Eschalier et al, 1988;Schacter, 1996). Another suggested hypothesis is that the vehicle used to dissolve the etoposide (benzyl alcohol and polysorbate (tween) 80) is responsible for the HSR (Weiss, 1996).…”

Section: Case Descriptionmentioning

confidence: 96%

“…There are no known risk factors for developing a HSR to etoposide, and in few of the reported cases do the patients have a history of drug allergy (Kasperek and Black, 1992;Bernstein and Troner, 1999;Athanassiou et al, 1988;De Souza et al, 1994;Tester et al, 1990;Hoetelman et al, 1996;Siderov and Zalcberg, 1994;Tucci and Pirtoli, 1985;Donegan, 1989;Eschalier et al, 1988;Schacter, 1996).…”

Section: Case Descriptionmentioning

confidence: 99%

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Safe administration of etoposide phosphate after hypersensitivity reaction to intravenous etoposide

et al. 2002

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Etoposide is commonly used in a variety of malignancies. A well known but rare toxicity are hypersensitivity reactions, usually manifested by chest discomfort, dyspnoea, bronchospasm and hypotension. We report the details of a patient who developed hypersensitivity reactions to intravenous etoposide, but subsequently tolerated the administration of intravenous etoposide phosphate with no sequalae. The podophyllotoxin etoposide has been used clinically for over 30 years. It is active in the treatment of a variety of malignant conditions and can be administered in either an i.v. or in an oral form. Intravenous etoposide is generally well tolerated. A well known but rare toxicity is a type I hypersensitivity reaction, manifested by dyspnoea, chest discomfort, hypotension, bronchospasm and/or skin flushing (Weiss, 1996;O'Brien and Souberbielle, 1992). It remains unclear whether this reaction is due to either the active drug or the solvent (Weiss, 1996).We report here the details of a patient who, despite experiencing a hypersensitivity reaction to intravenous etoposide, tolerated the subsequent administration of intravenous etoposide phosphate without any allergic sequalae. A test dose of etoposide phosphate was not administered, and premedication, which was administered initially, was discontinued. This case highlights three important aspects in patients experiencing hypersensitivity reaction to etoposide: (i) etoposide phosphate can be considered as an appropriate alternative; (ii) premedication may not be required; and (iii) the hypersensitivity reaction is more likely due to the solvent. CASE DESCRIPTIONA 19-year-old male with a newly diagnosed primary mediastinal non-seminomatous germ cell tumour was admitted for treatment with the standard BEP regimen. This consisted of weekly i.v. bleomycin 30 000 iu and 3-weekly cycles of i.v. etoposide 100 mg m 72 day 71 for 5 days and cisplatin 20 mg m 72 day 71 for 5 days (Williams et al, 1987). The patient had no known allergies. Following premedication with i.v. tropisetron (5 mg) and dexamethasone (8 mg) administration of etoposide was commenced (200 mg in 500 ml of sodium chloride 0.9%, over 60 min). Within minutes of commencement of the first dose of etoposide the patient complained of generalized discomfort and shortness of breath. He was found to be hypotensive (BP=95/60), tachycardic (PR=110) and had an oxygen saturation of 80% on room air.The infusion was immediately ceased. Treatment was begun with i.v. hydration, with bolus doses of hydrocortisone (100 mg) and promethazine (50 mg). Oxygen (6 l min 71 ) and nebulized salbutamol were also given. The patient improved rapidly with complete resolution of his symptoms, and was comfortable within 1 h. No bleomycin or cisplatin was administered.Germ cell tumours of the mediastinum are potentially curable, and etoposide is considered to be a critical component of an effective treatment schedule. Thus, it was felt that in this case continued use of etoposide was warranted. In light of this decision, cycle 1 of chemothera...

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“…[3,4] Another possible route is that the additive used in preparation to dissolve etoposide (benzyl alcohol, polysorbate-80) may cause hypersensitivity reactions. The concentration of the drug and the rate of infusion are both accused, but there are a wide range of etoposide concentrations and rate to cause HSR to etoposide.…”

Section: Etoposide? or Polysorbate-80?mentioning

confidence: 99%