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McBride P, Degar B. Acute infusion-related reactions in pediatric patients receiving etoposide at a tertiary cancer center. J Oncol Pharm Pract 2024; 30:197-200. [PMID: 37960879 DOI: 10.1177/10781552231215087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Etoposide is a key component of many pediatric chemotherapy regimens for both hematologic and solid tumors. It is well documented that patients receiving etoposide may experience infusion-related reactions. METHODS In this study, total doses of etoposide and etoposide phosphate were identified, and infusion-related reactions were retrospectively evaluated at a large pediatric oncology ambulatory clinic. The primary outcome was to determine the rate of acute infusion-related reactions to etoposide. A secondary objective was to identify potential risk factors associated with such reactions. RESULTS Overall, 1463 doses of etoposide were dispensed to 150 unique patients and 15 patients (10%) experienced etoposide infusion-related reactions. Of the 15 patients that experienced etoposide infusion-related reaction, two were successfully able to tolerate subsequent infusions with a slower etoposide infusion rate and pre-medications. The remaining patients changed drug formulation to etoposide phosphate (n = 12) or continued therapy without any formulation of etoposide (n = 1). Patients with classical Hodgkin's lymphoma experienced a higher incidence of infusion-related reactions compared to the overall patient population (30.5% vs. 10%) and made up 73.3% of all infusion-related reactions during the study period. CONCLUSIONS During the examined study period, 10% of patients experienced an acute infusion-related reaction to etoposide. This review builds on previous literature concluding that additional monitoring may be warranted in patients with classical Hodgkin's lymphoma receiving etoposide.
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Affiliation(s)
- Patrick McBride
- Department of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Barbara Degar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Hauben M, Hung E, Chen Y. Potential Signals of COVID-19 as an Effect Modifier of Adverse Drug Reactions. Clin Ther 2024; 46:20-29. [PMID: 37919188 DOI: 10.1016/j.clinthera.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE COVID-19 infection may interact with patients' medical conditions or medications. The objective of this study was to identify potential signals of effect modification of adverse drug reactions by statistical reporting interactions with COVID-19 infection (SRIsCOVID-19) in a large spontaneous reporting database. METHODS Data from the US Food and Drug Administration Adverse Event Reporting System through the second quarter of 2020 were used. Three-dimensional disproportionality analyses were conducted to identify drug-event-event (DEE) combinations, for which 1 of the events was COVID-19 infection, that were disproportionately reported. Effect size was quantified by an interaction signal score (INTSS) when COVID-19 was coreported as an adverse event or an indication (INTSSCOVID-19). An SRICOVID-19 exists when the calculated INTSSCOVID-19 is >2. The analyses focused on pandemic-emergent SRIsCOVID-19. Screening for extreme duplication of cases was applied. To assess possible reporting artifacts during the early pandemic as an alternative explanation for pandemic-emergent SRICOVID-19, we repeated the analyses with an additional year of data to gauge temporal stability of our findings. FINDINGS When examining DEE interactions, 193 emergent SRIsCOVID-19 were identified, involving 44 drugs and 88 events, in addition to COVID-19 infection. Of the 44 drugs recorded, most were immunosuppressant or modulatory drugs, followed by antivirals. Seven drugs (eg, azithromycin) were identified in emergent SRIsCOVID-19 with preferred terms representing off-label use for prevention or treatment of COVID-19 infection. These drugs were in fact repurposed for COVID-19 treatment, supporting assay sensitivity of our procedure. Infections and infestations were the most frequently observed system organ class, followed by the general disorders and respiratory disorders. The psychiatric system organ class had only a few emergent SRIsCOVID-19 but contained the largest INTSSs. Less commonly reported manifestations of COVID-19 (e.g., skin events) were also identified. After excluding DEE combinations that were highly suggestive of extreme duplication, there remained a more robust set of emergent SRIsCOVID-19, which were supported by biological plausibility considerations. Our findings indicate a relative temporal stability, with >90% of SRIsCOVID-19 persisting after updating the analysis with an additional year of data. IMPLICATIONS The signals identified in the analyses could be critical in refining our understanding of the causality of spontaneously reported adverse drug events and thus informing the ongoing care of patients with COVID-19. Our findings also underscore the importance of undetected report duplication as a distorting influence on disproportionality analysis.
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Affiliation(s)
- Manfred Hauben
- Worldwide Safety, Pfizer, New York, New York; Department of Medicine, NYU Langone Health, New York, New York.
| | - Eric Hung
- Worldwide Safety, Pfizer, New York, New York
| | - Yan Chen
- Worldwide Safety, Pfizer, Collegeville, Pennsylvania
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Dodier K, Laverdière I, Roy MJ. Etoposide hypersensitivity reactions associated with in-line filter use: A retrospective cohort study at CHU de Québec-Université Laval. J Oncol Pharm Pract 2023; 29:1687-1694. [PMID: 36544381 PMCID: PMC10612379 DOI: 10.1177/10781552221146801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 10/28/2023]
Abstract
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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Affiliation(s)
- Kelly Dodier
- Faculty of Pharmacy, Université Laval, Québec, Canada
- Department of Pharmacy, CHU de Québec - Université Laval, Québec, Canada
| | - Isabelle Laverdière
- Faculty of Pharmacy, Université Laval, Québec, Canada
- Department of Pharmacy, CHU de Québec - Université Laval, Québec, Canada
- Oncology Axis, CHU de Québec Research Center - Université Laval, Québec, Canada
| | - Marie-Julie Roy
- Department of Pharmacy, CHU de Québec - Université Laval, Québec, Canada
- Oncology Axis, CHU de Québec Research Center - Université Laval, Québec, Canada
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4
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Pringle NR, Gilbar PJ, Grewal GD. Immediate severe hypersensitivity reaction to etoposide phosphate: Case report and review of the literature. J Oncol Pharm Pract 2022; 28:1019-1023. [PMID: 35037804 DOI: 10.1177/10781552211073345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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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Affiliation(s)
- Nicole R Pringle
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,School of Medicine, Griffiths University, Gold Coast, Australia
| | - Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
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Wang LL, Yang HW, Zhu FD, Chi SM, Zhang J, Yang JM, Zhao Y. Host-guest inclusion systems of two bioactive natural products derivantives and three polyamine-modified β-cyclodextrins: Preparation, characterization, biological activity. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2021.102940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Diebert N, Roh L, Fernández KS. Comment on: Six-step etoposide desensitization protocol: A pediatric, adolescent, and young adult case series. Pediatr Blood Cancer 2021; 68:e28881. [PMID: 33381884 DOI: 10.1002/pbc.28881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Nicole Diebert
- Valley Children's Hospital, Cancer and Blood Disorders Center, Madera, California
| | - Lucy Roh
- Valley Children's Hospital, Cancer and Blood Disorders Center, Madera, California
| | - Karen S Fernández
- Pediatric Hematology/Oncology, Valley Children's Hospital, Cancer and Blood Disorders Center, Madera, California
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Ronsley R, Jacques L, Potts JE, Clement K, Dix DB, Mahon P. Association between in-line filtration and Type I hypersensitivity reactions in pediatric oncology patients receiving intravenous etoposide. Pediatr Hematol Oncol 2021; 38:208-215. [PMID: 33150845 DOI: 10.1080/08880018.2020.1838011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to describe hypersensitivity reactions with and without the use of in-line filters during intravenous etoposide therapy in pediatric oncology patients. This was a retrospective review of all patients treated in the Division of Oncology/Hematology/Bone Marrow Transplant at British Columbia Children's Hospital with intravenous etoposide between December 1, 2013 and February 1, 2018. Hypersensitivity reactions and anaphylaxis associated with etoposide infusions were compared over time, including 12 months prior to, 27 months during the use of, and for 12 months after the discontinuation of in-line filtration. There were 192 patients (median age 6.0 (IQR 2.8-13.0) years treated with etoposide and 486 etoposide infusions including 137 (28%) before, 261 (54%) during and 88 (18%) after use of in-line filters at our center. Twenty-six of 486 (5%) and 13/486 (3%) of infusions resulted in a type I hypersensitivity reaction and anaphylaxis, respectively. There were 2/137 (1%), 36/261 (14%) and 1/88 (1%) infusion reactions prior to, during and after in-line filter use, respectively. Infusion reactions during the in-line filter period were higher than during the pre-filter (Z = 3.978; p < 0.001) and post-filter (Z = 3.335; p < 0.001) periods of the study. These data suggest that the use of in-line filtration may be associated with increased frequency of hypersensitivity reactions to etoposide in pediatric cancer patients.
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Affiliation(s)
- Rebecca Ronsley
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Jacques
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Potts
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerri Clement
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David B Dix
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paula Mahon
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
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Stockton W, Lam F, Nguyen T, Nguyen T, Kirov I. Six-step etoposide desensitization protocol: A pediatric, adolescent, and young adult case series. Pediatr Blood Cancer 2021; 68:e28795. [PMID: 33155419 DOI: 10.1002/pbc.28795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 11/08/2022]
Abstract
Etoposide administration can be complicated by hypersensitivity reactions. Desensitization may provide a strategy to prevent hypersensitivity recurrence. One challenge with desensitization is regimen complexity. This case series describes 12 pediatric, adolescent, and young adult patients who received a simplified six-step etoposide desensitization protocol. This protocol contains 50% fewer titration steps compared with previously described protocols and eliminates infusion rate changes during titration. Simplified titration may minimize risk of error during administration and improve safety. This protocol was tolerated by 92% of patients. Given increasing frequency and duration of drug shortages, a simplified desensitization protocol provides a valuable treatment option.
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Affiliation(s)
- Winifred Stockton
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Fionna Lam
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Theresa Nguyen
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Tran Nguyen
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Ivan Kirov
- Division of Oncology, Hyundai Cancer Institute, Children's Hospital of Orange County, Orange, California
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Cotteret C, Rousseau J, Zribi K, Schlatter J. Severe hypersensitivity reaction to etoposide phosphate: A case report. Clin Case Rep 2020; 8:1821-1823. [PMID: 32983504 PMCID: PMC7495780 DOI: 10.1002/ccr3.2732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/09/2022] Open
Abstract
Hypersensitivity to etoposide phosphate has rarely been documented. We report a case of severe hypersensitivity reaction to etoposide phosphate in an old man. The patient experienced anaphylactic shock and has been hospitalized in intensive care unit. Vigilance is required regarding potential severe reactions with etoposide phosphate formulation.
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Affiliation(s)
- Camille Cotteret
- Hôpital universitaire Necker–Enfants MaladesAPHPPharmacieParisFrance
| | - Julia Rousseau
- Hôpital universitaire Necker–Enfants MaladesAPHPPharmacieParisFrance
| | - Kaouther Zribi
- Hôpital universitaire Necker–Enfants MaladesAPHPPharmacieParisFrance
| | - Joel Schlatter
- Hôpital universitaire Necker–Enfants MaladesAPHPPharmacieParisFrance
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10
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Abstract
Abstract
Purpose
The implementation of a pediatric desensitization protocol specific to etoposide in an adolescent with Hodgkin lymphoma is described.
Summary
Etoposide is part of many chemotherapy regimens used to treat malignancies in children and adults, and it is also part of the backbone of many regimens used in clinical trials. Etoposide is known to produce hypersensitivity reactions during administration. Substitution with etoposide phosphate, which has less potential for hypersensitivity reactions, is used in place of etoposide after severe hypersensitivity reactions. Etoposide desensitization protocols (EDPs) have been reported in adult patients.
Conclusion
The implementation of an etoposide desensitization protocol for pediatric patients is safe and helpful to prevent the elimination of etoposide from treatment protocols. The use of an EDP allowed the patient to remain on clinical trial and complete the prescribed treatment.
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Affiliation(s)
- Nicole Martinez
- Department of Pharmacy, Valley Children’s Hospital, Cancer and Blood Disorders Center, Madera, CA
| | - Ashley Miyasaki
- Department of Pharmacy, Valley Children’s Hospital, Cancer and Blood Disorders Center, Madera, CA
| | - Lucy Roh
- Department of Pharmacy, Valley Children’s Hospital, Cancer and Blood Disorders Center, Madera, CA
| | - William Koole
- Department of Pharmacy, Valley Children’s Hospital, Cancer and Blood Disorders Center, Madera, CA
| | - Karen S Fernandez
- Department of Pharmacy, Valley Children’s Hospital, Cancer and Blood Disorders Center, Madera, CA
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11
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Stockton WM, Nguyen T, Zhang L, Dowling TC. Etoposide and etoposide phosphate hypersensitivity in children: Incidence, risk factors, and prevention strategies. J Oncol Pharm Pract 2019; 26:397-405. [DOI: 10.1177/1078155219858390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Etoposide is critical in treating pediatric cancers, although hypersensitivity can be severe and treatment-limiting. Reported rates of hypersensitivity range from 2% to 51%. Hypersensitivity data for etoposide phosphate, a newer product, are lacking. The primary objective of this study was to assess etoposide and etoposide phosphate hypersensitivity incidence. Secondary objectives included evaluation of potential risk factors for hypersensitivity and strategies to prevent recurrence. Methods This retrospective cohort study evaluated pediatric patients who received initial etoposide phosphate or etoposide dose between August 2012 and July 2017. The primary outcome was documentation of hypersensitivity within four months of initial dose. Potential risk factors evaluated included age, allergies, dose, infusion rate, infusion concentration, and premedication. Results Of 246 patients, hypersensitivity reactions occurred in five of 54 patients (9.3%) who received etoposide phosphate and 52 of 192 patients (27.1%) who received etoposide ( p = 0.0061). For etoposide, the mean initial infusion rate was 64.6 ± 40.9 mg/m2/h for patients with hypersensitivity and 49.5 ± 33.4 mg/m2/h without hypersensitivity ( p = 0.0886). Etoposide phosphate rate was not associated with hypersensitivity. Recurrent hypersensitivity occurred in one of nine patients (11.1%) who received etoposide desensitization and one of 38 patients (2.6%) who changed formulation to etoposide phosphate. Conclusions Etoposide was associated with more hypersensitivity than etoposide phosphate in pediatric patients. Etoposide hypersensitivity was associated with higher infusion rates, but not etoposide phosphate. Differences in hypersensitivity incidence and infusion rate influence indicate a formulation-effect. Etoposide hypersensitivity recurrence may be prevented by changing to etoposide phosphate formulation. During etoposide phosphate shortages, etoposide desensitization may prevent recurrent hypersensitivity.
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Affiliation(s)
- Winifred M Stockton
- Children's Hospital of Orange County, Department of Pharmacy, Orange, CA, USA
| | - Theresa Nguyen
- Children's Hospital of Orange County, Department of Pharmacy, Orange, CA, USA
| | - Lishi Zhang
- Biostatistics, Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
| | - Thomas C Dowling
- Ferris State University, College of Pharmacy, Big Rapids, MI, USA
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12
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Brooks JP, Azmy V, Thompson A, Luon D, Prozora SD, Price C, Hsu FI. Etoposide phosphate for pediatric orthopedic malignancies after intravenous etoposide hypersensitivity. J Oncol Pharm Pract 2019; 26:228-231. [DOI: 10.1177/1078155219836478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Hypersensitivity reactions to etoposide have been reported and patients have been safely transitioned to etoposide phosphate for continued therapy. However, the safety and efficacy of substituting etoposide phosphate for etoposide has not been well established in pediatric orthopedic malignancies. The aim of this study is to determine whether etoposide phosphate can be substituted for etoposide in pediatric orthopedic malignancies. Methods A chart review of pediatric patients who developed hypersensitivity reactions to etoposide while being treated for orthopedic malignancies was performed at a large academic medical center. Three patients were identified, two with Ewing sarcoma and one with an osteosarcoma. All three patients experienced hypersensitivity reactions to their first doses of etoposide and were switched to etoposide phosphate for further therapy. Results After premedication, all three patients tolerated full doses of etoposide phosphate without a graded dose challenge or desensitization. Two of the patients were premedicated with diphenhydramine alone, while the third received diphenhydramine and dexamethasone. Conclusions Etoposide phosphate is a potentially safe alternative for pediatric patients with orthopedic malignancies who experience etoposide hypersensitivity. However, caution is needed as there are cases of etoposide phosphate hypersensitivity.
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Affiliation(s)
- Joel P Brooks
- School of Medicine, Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University, New Haven, CT, USA
| | - Veronica Azmy
- School of Medicine, Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University, New Haven, CT, USA
| | - Alison Thompson
- School of Medicine, Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University, New Haven, CT, USA
| | - Darren Luon
- Department of Pharmacy, Section of Oncology, Yale New Haven Hospital, New Haven, CT, USA
| | - Stephanie D Prozora
- School of Medicine, Department of Pediatrics, Section of Hematology and Oncology, Yale University, New Haven, CT, USA
| | - Christina Price
- School of Medicine, Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University, New Haven, CT, USA
| | - F Ida Hsu
- School of Medicine, Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University, New Haven, CT, USA
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Leguay Z, Bourneau-Martin D, Pellier I, Le Louet H, Drablier G, Lagarce L, Lainé-Cessac P. Successful Treatment with Etoposide Base after an Acute Hypersensitivity Reaction to Etoposide Phosphate. Pediatr Blood Cancer 2016; 63:571. [PMID: 26468691 DOI: 10.1002/pbc.25797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/18/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Zoé Leguay
- Pharmacovigilance Centre, Department of Pharmacology, University Hospital, Angers Cedex, France
| | | | - Isabelle Pellier
- Pediatric Haematology-Oncology-Immunology Centre, Department of Paediatrics, University Hospital, Angers Cedex, France
| | - Hervé Le Louet
- Pharmacovigilance Centre, University Hospital, Créteil Cedex, France
| | - Guillaume Drablier
- Pharmacovigilance Centre, Department of Pharmacology, University Hospital, Angers Cedex, France
| | - Laurence Lagarce
- Pharmacovigilance Centre, Department of Pharmacology, University Hospital, Angers Cedex, France
| | - Pascale Lainé-Cessac
- Pharmacovigilance Centre, Department of Pharmacology, University Hospital, Angers Cedex, France
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Chu MMY, Ma Y, Tse KY, Chan KKL, Ngan HYS. Cyclophosphamide, Hydroxyurea, Actinomycin D, Methotrexate, and Vincristine in the Treatment of Gestational Trophoblastic Neoplasia: . Int J Gynecol Cancer 2015; 25:498-503. [DOI: 10.1097/igc.0000000000000383] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Abstract
Etoposide phosphate is a prodrug of intravenous etoposide recommended for use in patients with demonstrated allergy to etoposide. We have previously published a case series comprising six patients who were successfully treated with etoposide phosphate following preceding etoposide hypersensitivity. In this new paper we now present the cases of two patients who had allergic reactions to both etoposide and etoposide phosphate. As such, we suggest that whilst most patients with etoposide hypersensitivity can safely be treated with etoposide phosphate, a small number are at risk of an additional allergic reaction to etoposide phosphate. Patients being treated for the first time with etoposide phosphate after etoposide allergy should receive their first dose under medical supervision.
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Affiliation(s)
| | - Sarah Mahmoud
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Arwa Kokache
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Michael Seckl
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Philip Savage
- Department of Medical Oncology, Charing Cross Hospital, London, UK
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Cortijo-Cascajares S, Jiménez-Cerezo MJ, Herreros de Tejada A. Review of hypersensitivity reactions to antineoplastic agents. Farm Hosp 2012; 36:148-58. [PMID: 22484106 DOI: 10.1016/j.farma.2011.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/19/2011] [Accepted: 02/06/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. METHOD We conducted a search in the Pubmed and EMBASE databases for the last 10 years. RESULTS Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients' signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. CONCLUSIONS Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients' therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits.
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CARRINGTON C, WEIR J, DO C. Study to support the standardization of the prescribing, dispensing and labeling of etoposide formulations in Australia. Asia Pac J Clin Oncol 2010; 6:173-86. [DOI: 10.1111/j.1743-7563.2010.01317.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kim YI, Kim KS, Han ER, Kwan YS, Oh IJ, Lim SC, Kim YC. A Case of Anaphylaxis after the Treatment with Etoposide in a Patient with Small Cell Lung Cancer. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.67.2.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young-Il Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyu-Sik Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eui-Ryoung Han
- Department of Internal Medicine, Division of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Soo Kwan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School, Gwangju, Korea
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Collier K, Schink C, Young AM, How K, Seckl M, Savage P. Successful treatment with etoposide phosphate in patients with previous etoposide hypersensitivity. J Oncol Pharm Pract 2008; 14:51-5. [DOI: 10.1177/1078155207085355] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To review the experience of treatment with etoposide phosphate in patients with acute etoposide hypersensitivity treated in a large tertiary referral center hospital specializing in curable malignancies. Case summaries. The cases of 6 patients with advanced malignancies who experienced acute etoposide hypersensitivity are documented. There were 3 male and 3 female patients and their ages ranged from 16 to 68. Four patients had curable malignancies with trophoblast tumors or germ cell tumors and two were receiving palliative chemotherapy for other malignancies. All of the 6 patients who experienced etoposide hypersensitivity developed their symptoms in the first few minutes of the initial infusion. The most common symptoms were chest pain, facial flushing, and bronchospasm. All of the patients had emergency treatment with discontinuation of the infusion and usually the administration of hydrocortisone and chlorpheniramine, which lead to the rapid resolution of their symptoms. For the next cycle of chemotherapy each patient was rechallenged with etoposide phosphate, with steroid cover given in only two of the cases. None of the 6 patients experienced any hypersensitivity symptoms on treatment with etoposide phosphate and in one the steroids were withdrawn for all the subsequent cycles. The 4 patients with curable malignancies all remain disease free, while the 2 palliative patients obtained significant control of their disease. Discussion. Etoposide is one of the most important chemotherapy drugs in the treatment of many curable malignancies but an acute hypersensitivity reaction occurs in around 1% of patients. Retreatment with etoposide in these patients is difficult and generally alternative drugs/regimens have to be used. A small number of case reports have suggested that etoposide phosphate can be safely used in these patients and 6 cases have been found in the pharmacy records where this has been done. In all of the patients, treatment with etoposide phosphate proceeded without any symptoms or the use of repeated steroid cover in 5 of the 6 patients. Conclusion. Etoposide hypersensitivity is a rare clinical problem and responds promptly to drug discontinuation, steroids, and chlorpheniramine. Patients with previous etoposide hypersensitivity can safely be treated with etoposide phosphate and do not need any additional hypersensitivity prophylaxis. J Oncol Pharm Practice (2008) 14: 51—55.
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Affiliation(s)
- Kathleen Collier
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
| | - Cordula Schink
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
| | - Anna Mary Young
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
| | - Katharine How
- Pharmacy Department, Charing Cross Hospital, London W6 8RF
| | - Michael Seckl
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
| | - Philip Savage
- Department of Medical Oncology, Charing Cross Hospital, London W6 8RF,
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Hartmann JT, Lipp HP. Camptothecin and podophyllotoxin derivatives: inhibitors of topoisomerase I and II - mechanisms of action, pharmacokinetics and toxicity profile. Drug Saf 2007; 29:209-30. [PMID: 16524321 DOI: 10.2165/00002018-200629030-00005] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Camptothecins represent an established class of effective agents that selectively target topoisomerase I by trapping the catalytic intermediate of the topoisomerase I-DNA reaction, the cleavage complex. The water-soluble salt camptothecin-sodium - introduced in early trials in the 1960s - was highly toxic in animals, whereas the semisynthetic derivatives irinotecan and topotecan did not cause haemorrhagic cystitis because of their higher physicochemical stability and solubility at lower pH values. Myelosuppression, neutropenia and, to a lesser extent, thrombocytopenia are dose-limiting toxic effects of topotecan. In contrast to the structurally-related topotecan, irinotecan is a prodrug which has to be converted to SN-38, its active form. SN-38 is inactivated by conjugation, thus patients with Gilbert's syndrome and other forms of genetic glucuronidation deficiency are at an increased risk of irinotecan-induced adverse effects, such as neutropenia and diarrhoea. The cytotoxic mechanism of podophyllotoxin is the inhibition of topoisomerase II. Common adverse effects of etoposide include dose-limiting myelosuppression. Hypersensitivity reactions are more common with etoposide and teniposide than with etoposide phosphate because the formulations of the former contain sensitising solubilisers. Leukopenia and thrombocytopenia occur in 65% and 80%, respectively, of patients after administration of conventional doses of teniposide. Anorexia, vomiting and diarrhoea are generally of mild severity after administration of conventional doses of topoisomerase II inhibitors. Clinical pharmacokinetic studies have revealed substantial interindividual variabilities regarding the area under the concentration-time curve values and steady-state concentrations for all drugs reviewed in this article. Irinotecan, etoposide and teniposide are degraded via complex metabolic pathways. In contrast, topotecan primarily undergoes renal excretion. Regarding etoposide and teniposide, the extent of catechol formation over time during drug metabolism may be associated with a higher risk for secondary malignancies.
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Affiliation(s)
- Jörg T Hartmann
- Department of Oncology/Hematology/Immunology/Pneumology/Rheumatology, Eberhard Karls University Tübingen, UKT - Medical Center II, Tübingen, Germany.
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Abstract
International data from 2002 report 10.9 million new cases of cancer and 6.7 million cancer deaths. Chemotherapy is an essential component in the multidisciplinary management of most cancers. Cutaneous reactions to chemotherapeutics are common and may contribute significantly to the morbidity, and rarely to the mortality, of patients undergoing such treatments. Recognition and management of these reactions is important to provide optimal care. This article aims to present the most common cutaneous reactions to frequently used chemotherapies and provides management guidelines. A MEDLINE search from 1966 through June 2005 was conducted to identify reports of common cutaneous toxicities with systemic chemotherapy and their appropriate management. An analysis of our literature search is presented in review form outlining common chemotherapy-related cutaneous reactions and their management, as well as the chemotherapeutics responsible for the cutaneous toxicity. Chemotherapy-related cutaneous toxicity includes generalized rashes such as the spectrum between erythema multiforme and toxic epidermal necrolysis, and site-specific toxicity such as mucositis, alopecia, nail changes, extravasation reactions, or hand-foot syndrome. Most of the toxicity is reversible with chemotherapy dose reductions or delays. Certain toxicities can be effectively treated or prevented, allowing optimal delivery of chemotherapy (e.g. premedications to prevent hypersensitivity, prophylactic mouthwashes to prevent mucositis). Newer non-chemotherapeutic targeted therapies such as epidermal growth factor receptor inhibitors (e.g. gefitinib, cetuximab) may also be associated with cutaneous toxicity and can be distressing for patients. Recent data suggest that skin toxicity associated with these agents may correlate with efficacy. Cutaneous toxicity occurs frequently with chemotherapy and non-chemotherapeutic biologic therapies. Early recognition and treatment of the toxicity facilitates good symptom control, prevents treatment-related morbidity, and allows continuation of anti-cancer therapy.
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Affiliation(s)
- Angela J Wyatt
- Department of Dermatology, New York Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York, USA.
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Affiliation(s)
- Philippe Camus
- Pulmonary and Critical Care Medicine, Centre Hospitalier Régional et Université de Bourgogne, F-21079 Dijon, France.
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Abstract
The non-ionic surfactants Cremophor EL (CrEL; polyoxyethyleneglycerol triricinoleate 35) and polysorbate 80 (Tween) 80; polyoxyethylene-sorbitan-20-monooleate) are widely used as drug formulation vehicles, including for the taxane anticancer agents paclitaxel and docetaxel. A wealth of recent experimental data has indicated that both solubilisers are biologically and pharmacologically active compounds, and their use as drug formulation vehicles has been implicated in clinically important adverse effects, including acute hypersensitivity reactions and peripheral neuropathy.CrEL and Tween 80 have also been demonstrated to influence the disposition of solubilised drugs that are administered intravenously. The overall resulting effect is a highly increased systemic drug exposure and a simultaneously decreased clearance, leading to alteration in the pharmacodynamic characteristics of the solubilised drug. Kinetic experiments revealed that this effect is primarily caused by reduced cellular uptake of the drug from large spherical micellar-like structures with a highly hydrophobic interior, which act as the principal carrier of circulating drug. Within the central blood compartment, this results in a profound alteration of drug accumulation in erythrocytes, thereby reducing the free drug fraction available for cellular partitioning and influencing drug distribution as well as elimination routes. The existence of CrEL and Tween 80 in blood as large polar micelles has also raised additional complexities in the case of combination chemotherapy regimens with taxanes, such that the disposition of several coadministered drugs, including anthracyclines and epipodophyllotoxins, is significantly altered. In contrast to the enhancing effects of Tween 80, addition of CrEL to the formulation of oral drug preparations seems to result in significantly diminished drug uptake and reduced circulating concentrations. The drawbacks presented by the presence of CrEL or Tween 80 in drug formulations have instigated extensive research to develop alternative delivery forms. Currently, several strategies are in progress to develop Tween 80- and CrEL-free formulations of docetaxel and paclitaxel, which are based on pharmaceutical (e.g. albumin nanoparticles, emulsions and liposomes), chemical (e.g. polyglutamates, analogues and prodrugs), or biological (e.g. oral drug administration) strategies. These continued investigations should eventually lead to more rational and selective chemotherapeutic treatment.
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Affiliation(s)
- Albert J ten Tije
- Department of Medical Oncology, Erasmus MC - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Siderov J, Prasad P, De Boer R, Desai J. Safe administration of etoposide phosphate after hypersensitivity reaction to intravenous etoposide. Br J Cancer 2002; 86:12-3. [PMID: 11857004 PMCID: PMC2746527 DOI: 10.1038/sj.bjc.6600003] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2001] [Accepted: 12/19/2001] [Indexed: 11/08/2022] Open
Abstract
Etoposide is commonly used in a variety of malignancies. A well known but rare toxicity are hypersensitivity reactions, usually manifested by chest discomfort, dyspnoea, bronchospasm and hypotension. We report the details of a patient who developed hypersensitivity reactions to intravenous etoposide, but subsequently tolerated the administration of intravenous etoposide phosphate with no sequelae.
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Affiliation(s)
- J Siderov
- Pharmacy Department, Austin & Repatriation Medical Centre, Studley Road, Heidelberg, Australia.
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