TY  - CHAP
M1  - Book, Section
TI  - Cancer Pharmacology
A1  - Rowe, Julie H.
A1  - Gonzalez, Anneliese O.
A1  - Jafri, Syed H.
A1  - Cen, Putao
A1  - Kanaan, Zeyad
A1  - Amato, Robert J.
A1  - Rios, Adan
A1  - El-Osta, Hazem
A1  - Mohlere, Virginia
Y1  - 2019
N1  - 
T2  - Hematology-Oncology Clinical Questions
AB  - Table  Graphic  Jump  Location|Download  (.pdf)|PrintKey  conceptHypersensitivity  reactions  (HRs)  can  occur  with  chemotherapeutic  agents  such  astaxanes  (paclitaxel,  docetaxel)platinums  (oxaliplatin,  carboplatin,  and  cisplatin)epipodophyllotoxins  (teniposide  and  etoposide)asparaginaseanthracyclines  (doxorubicin,  daunorubicin,  idarubicin,  and  epirubicin)alkylating  agents  (procarbazine,  dacarbazine,  chlorambucil,  melphalan,  cyclophosphamide,  and  ifosfamide)1Severe  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.2Monoclonal  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.2Clinical  scenarioA  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?Action  itemsManagement  of  acute  HRs1,2:Discontinue  infusionAdminister:  High-flow  oxygenFluid  resuscitationH1  and  H2  antihistamines  (diphenhydramine  or  famotidine)Corticosteroids  (hydrocortisone  or  methylprednisolone)If  severe,  epinephrine  or  vasopressorsGlucagon  if  persistent  hypotension  (if  patient  is  taking  a  beta-blocker)PearlsPaclitaxel  is  associated  with  anaphylactoid-like  hypersensitivity  reaction  due  to  its  solvent,  polyethoxylated  castor  oil,  which  induces  histamine  release  and  hypotension2Desensitization  protocols  can  be  used  to  continue  treatment  in  patients  who  are  benefiting  from  therapy1ReferencesSyrigou  E,  Makrilia  N,  Koti  I,  et  al.  Hypersensitivity  reactions  to  antineoplastic  agents:  an  overview.  Anti-Cancer  Drugs  2009;20(1):1-6.Heinz-Josef  L.  Management  and  preparedness  for  infusion  and  hypersensitivity  reactions.  Oncologist  2007;12:601-9.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - hemonc.mhmedical.com/content.aspx?aid=1162981076
ER  -