RT Book, Section 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 SR Print(0) ID 1162981076 T1 Cancer Pharmacology T2 Hematology-Oncology Clinical Questions YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 978-1-260-02662-7 LK hemonc.mhmedical.com/content.aspx?aid=1162981076 RD 2024/04/23 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.