|Key concept || |
Hypersensitivity reactions (HRs) can occur with chemotherapeutic agents such as
taxanes (paclitaxel, docetaxel)
platinums (oxaliplatin, carboplatin, and cisplatin)
epipodophyllotoxins (teniposide and etoposide)
anthracyclines (doxorubicin, daunorubicin, idarubicin, and epirubicin)
alkylating agents (procarbazine, dacarbazine, chlorambucil, melphalan, cyclophosphamide, and ifosfamide)1
Severe HRs associated with chemotherapeutic agents are rare and occur in <5% of patients.2 The most common mechanism of HRs to chemotherapeutic agents is usually type I, which is IgE-mediated and results in release of histamines, leukotrienes, and prostaglandins.
Common clinical manifestations include urticarial rash, angioedema, shortness of breath, bronchospasm, and hypotension.2
Monoclonal antibodies (mAb, eg, cetuximab, rituximab, trastuzumab, gemtuzumab, and alemtuzumab) have higher incidence rates of HRs, varying from 5% with fully humanized panitumumab to 77% with rituximab. However, the highest incidences of reactions occur during the first infusion.2 The mechanism of hypersensitivity reactions to mAbs is due to cytokine release and antibody production against the mAb.2
|Clinical scenario || |
A 58-year-old postmenopausal woman is currently receiving paclitaxel for adjuvant therapy for her breast cancer. This is her 6th week. Thirty minutes into administration of paclitaxel, she develops severe shortness of breath, urticaria, and wheezing. What drugs should be administered to treat this hypersensitivity reaction?