Anaphylaxis to Pegylated Liposomal Doxorubicin: A Case Report

Abstract

On physical examination, her temperature was 98°F, pulse 83/minute, respiratory rate 18/minute, blood pressure 122/55 mmHg; oxygen saturation was 93% on room air and her weight was 130 lbs. Systemic examination revealed tremors that were related to parkinsonism. Laboratory data showed normal blood counts and normal liver and renal function. The patient was prescribed single agent chemotherapy with liposomal doxorubicin at the dose of 50 mg/m 2 every four weeks.Prior to the administration of the first dose of chemotherapy, she was premedicated with 20 mg of dexamethasone. Twelve minutes after starting the infusion, the patient developed shortness of breath, flushing, feeling warm and dizziness. Her blood pressure increased to 178/75 mmHg, pulse was 74 beats/minute, respiratory rate was 20 breaths/minute and oxygen saturation on room air was 90%. The infusion was discontinued and she was given oxygen via nasal cannula at a rate of two litres per minute, a bolus of 5% dextrose, dexamethasone 20 mg and diphenhydramine 50 mg intravenously. The patient's condition improved over the next 40 minutes and she was discharged in a stable condition.

PEGylated liposomes: immunological responses

“…A representative example is Doxil®, which is a formulation of DXR encapsulated in PEGylated liposomes with several clinical approvals [19,79]. The use of Doxil® has been implicated in acute infusion reactions in up to 45% of the cancer patients who receive the drug without premedication with steroids and antihistamines, while 4-7.1% in pre-medicated patients [80][81][82]. A number of studies have confirmed the crucial role of complement activation in the onset of the HSRs [12,21,83].…”

Extracellular vesicles as a drug delivery system: A systematic review of preclinical studies

“…The severity of CARPA after systemic liposomal administration in patients is influenced by morphological properties, size, surface charge, PEGylation, and cholesterol content, amongst other characteristics of liposomes [268]. A representative example is Doxil Ò , which has been reported to elicit rare but serious acute infusion reactions in cancer patients [269]. Therefore, CARPA has been recognized as a safety issue.…”

Nanotechnology based solutions for anti-leishmanial impediments: a detailed insight

“…LPS, the most widely used lipid nanomaterial is associated with a serious toxic effect—an anaphylactic shock. This incidence was considerably high with conventional LPS; however, the PEGylated LPS have reduced the chances [ 280 , 281 ]. The damaging impact of SLNs over the biological system usually depends upon the ingredient i.e.…”