Severe hypersensitivity reaction to etoposide phosphate: A case report

Cotteret, Camille; Rousseau, Julia; Zribi, Kaouther; Schlatter, Joël

doi:10.1002/ccr3.2732

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…Immediately upon initiation of an etoposide phosphate infusion, a man experienced a severe hypersensitivity reaction leading to anaphylactic shock requiring administration to the intensive care unit. 21 Towards the end of a one-hour infusion of etoposide phosphate, a young girl suffered a hypersensitivity reaction. 22 The following day, etoposide base was substituted.…”

Section: Discussionmentioning

confidence: 99%

“…3 In addition, etoposide phosphate has also been implicated in causing hypersensitivity reactions. [18][19][20][21][22] Several authors have suggested that dextran 40, which is an excipient in the formulation of etoposide phosphate, could be responsible for the observed infusion reactions. 21,22 Severe hypersensitivity reactions to clinical dextrans have been recorded since the 1960s.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22] Several authors have suggested that dextran 40, which is an excipient in the formulation of etoposide phosphate, could be responsible for the observed infusion reactions. 21,22 Severe hypersensitivity reactions to clinical dextrans have been recorded since the 1960s. 24,25 These were likely seen in products containing higher concentrations of dextran, often used as colloid plasma volume expanders, than that present in etoposide phosphate formulations.…”

Section: Discussionmentioning

confidence: 99%

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Immediate severe hypersensitivity reaction to etoposide phosphate: Case report and review of the literature

Pringle

Gilbar

Grewal

2022

J Oncol Pharm Pract

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Introduction Hypersensitivity reactions from intravenous (IV) etoposide have been rarely reported, with these being seen more commonly with etoposide than with etoposide phosphate. This is generally explained by the need for polysorbate 80, a known cause of hypersensitivity, as a solubiliser, in the etoposide formulation. Case report We report a 22-year-old male, being treated with adjuvant BEP (bleomycin/etoposide phosphate/cisplatin) for a testicular germ cell tumour. Bleomycin and cisplatin were administered without incident. Within one minute of etoposide phosphate commencement he experienced a severe hypersensitivity reaction, consisting of widespread erythematous rash, facial swelling, and nausea. Observations included unrecordable blood pressure, tachycardia, hypoxia, and loss of consciousness, confirming a diagnosis of anaphylactic shock. Management and outcome Etoposide phosphate was ceased immediately. He was successfully managed with IV hydrocortisone, IV promethazine, intramuscular adrenaline, IV fluids and oxygen. Following admission for observation, significant improvement occurred over 48 h. Discussion Hypersensitivity reactions to etoposide were first reported in the 1980s. Following reactions to etoposide, substituting etoposide phosphate into chemotherapy regimens has commonly allowed treatment to continue without incidence. Anaphylactic reactions to etoposide phosphate were first documented in 2012, with further cases reported subsequently. Unlike etoposide, etoposide phosphate is highly soluble in aqueous solutions and doesn't require adjuvants in the formulation. Hypersensitivity reactions to etoposide phosphate are therefore likely related to the etoposide drug molecule itself. Clinicians should be aware of this rare, but potentially life-threatening, toxicity when using etoposide-based treatments and have procedures in place to urgently manage any hypersensitivity reactions that may occur.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Immediate severe hypersensitivity reaction to etoposide phosphate: Case report and review of the literature

Pringle

Gilbar

Grewal

2022

J Oncol Pharm Pract

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“…Another form of VP16, etoposide phosphate is a water-soluble prodrug with no trace of polysorbate 80 that has successfully proven a good substitute agent after etoposide HSR [ 87 , 88 ]. Despite being extremely rare, more recently, severe anaphylactic-like reactions to this newer formulation have also been described [ 89 ]. Regarding teniposide, an older comprehensive analysis showed an incidence of 6.5% of HSR to VM-26, with a higher percentage in children with neuroblastoma and brain tumors, compared to hematologic malignancies [ 90 ].…”

Section: Antineoplastic Therapy Involved In Hypersensitivity Reactionsmentioning

confidence: 99%

Allergy in Cancer Care: Antineoplastic Therapy-Induced Hypersensitivity Reactions

Gălățeanu

Puscasu

Tîrcol

et al. 2023

IJMS

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As the backbone of oncological treatments, systemic chemotherapy is still one of the main pawns in cancer care, alone or in combination with newer targeted agents. All chemotherapy agents can be associated with a type of adverse event called an infusion reaction, which can be characterized as unpredictable, non-dose related, and unexplained by the cytotoxic profile of the drug. For some of these events, a certain immunological mechanism can be identified by blood or skin testing. In this case, we can speak of true hypersensitivity reactions that occur as a response to an antigen/allergen. The current work summarizes the main antineoplastic therapy agents and their susceptibility to induce hypersensitivity reactions and also includes a review of clinical presentation, diagnostic methods in hypersensitivity reactions, and perspectives to overcome these negative events in the treatment of patients suffering from various types of cancer.

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“…pediatric leukemia) and more rarely reaction to etoposide itself are discussed in the literature. [1][2][3][4][7][8][9][10][11][12][15][16][17] Etoposide can be administered undiluted or diluted. In the latter case, it should be diluted in dextrose 5% or normal saline to obtain a concentration between 0.2 and 0.4 mg/mL.…”

Section: Introductionmentioning

confidence: 99%

Etoposide hypersensitivity reactions associated with in-line filter use: A retrospective cohort study at CHU de Québec-Université Laval

Dodier

Laverdière

Roy

2022

J Oncol Pharm Pract

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Introduction A case series of hypersensitivity reactions (HSRs) during intravenous administration of etoposide was observed following the introduction of in-line filters (ILFs) at a specialized university-affiliated center. This raised questions about the possible involvement of filters in these reactions. Despite there being very little published evidence to inform clinical decision making in this potentially clinically significant situation, the use of ILFs was discontinued at this center pending further investigation. The aims of this study were to evaluate the cumulative incidence of etoposide-related HSR with and without the use of ILF and to describe the reactions in adult and pediatric patients with cancer. Methods A retrospective cohort study was performed among all pediatric and adult patients treated with intravenous etoposide at a maximal concentration of 0.4 mg/mL at our center between 30 September 2015 and 16 August 2018. This covered periods of time during which ILFs were used, as well as 6 months before their implementation and after their withdrawal. Data were extracted from medical records and cumulative incidence was calculated for each of the time periods (pre-ILF, ILF, and post-ILF) as the proportion of patients who recorded an HSR (one or more). Confidence intervals were calculated for each proportion using Fisher's Exact 95%. Comparisons of proportions between time periods were performed using Exact Pearson Chi-squared tests. Data were stratified by a number of perfusion cycles (single cycle or multiple cycles) and by patient population (adult and pediatric). Results A total of 284 patients were included in the study. The overall cumulative incidence of etoposide HSR was 9.9%. The cumulative incidence of HSR tended to be higher during ILF use when compared with combined pre- and post-ILF periods (12.2% [95% CI: 7.9–17.8] vs. 5.2% [95% CI: 1.7–11.7], p = 0.09). In patients who received multiple cycles of etoposide, the cumulative incidence of HSRs was higher during ILF use when compared with combined pre- and post-ILF periods (15.0% [95% CI: 9.6–21.8] vs. 3.9% [95% CI: 0.8–11.0], p = 0.01). The majority of HSRs' maximal severity were grade 1 or 2 (85.7%) according to Common Terminology Criteria for Adverse Events ( CTCAE) version 4.0. Conclusions This study suggests a link between the use of ILFs and increased incidence of HSR during etoposide perfusion.

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Severe hypersensitivity reaction to etoposide phosphate: A case report

Cited by 5 publications

References 20 publications

Immediate severe hypersensitivity reaction to etoposide phosphate: Case report and review of the literature

Immediate severe hypersensitivity reaction to etoposide phosphate: Case report and review of the literature

Allergy in Cancer Care: Antineoplastic Therapy-Induced Hypersensitivity Reactions

Etoposide hypersensitivity reactions associated with in-line filter use: A retrospective cohort study at CHU de Québec-Université Laval

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