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Hypersensitivity reactions from taxol
R B Weiss1, R C Donehower, P H Wiernik
1Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307.
Abstract:
Taxol is an antitumor agent in clinical trial that has been shown to have activity against advanced ovarian carcinoma and melanoma. Hypersensitivity reactions (HSRs) have been one of the toxicities observed with administration of this drug. Of 301 patients treated, 32 patients have had definite (27 patients) or possible (five patients) hypersensitivity reactions to taxol. All but one patient had the reaction from the first or second exposure to this agent. Reactions occurred at a variety of doses and were characterized most frequently by dyspnea, hypotension, bronchospasm, urticaria, and erythematous rashes. Thirteen (41%) patients had received premedication designed to prevent such toxicity; nevertheless, they sustained HSRs. Prolonging the drug infusion appears to have somewhat reduced, but not obviated, the risk of HSRs. The cause (taxol itself or its excipient Cremophor EL; Badische Anilin und Soda-Fabrik AG [BASF], Ludwigshafen, Federal Republic of Germany) and the mechanism of these reactions to taxol are unknown. We provide guidelines to prevent or minimize such toxicity and treat reactions if they still occur.
Insights
Hypersensitivity reactions (HSRs) to the antitumor drug Taxol occurred in 32 of 301 patients, often during initial exposures. These reactions, characterized by symptoms like dyspnea and rash, necessitate management guidelines.
Area of Science:
- Oncology
- Pharmacology
- Clinical Toxicology
Background:
- Taxol (paclitaxel) is an investigational antitumor agent demonstrating efficacy against advanced ovarian carcinoma and melanoma.
- Hypersensitivity reactions (HSRs) are a noted toxicity associated with Taxol administration during clinical trials.
Purpose of the Study:
- To report the incidence and characteristics of hypersensitivity reactions (HSRs) observed in patients treated with Taxol.
- To provide clinical guidelines for preventing, minimizing, and treating Taxol-induced HSRs.
Main Methods:
- Retrospective analysis of 301 patients treated with Taxol.
- Documentation of hypersensitivity reactions, including onset, symptoms, and patient history (e.g., premedication, infusion duration).
Main Results:
- 32 out of 301 patients (10.6%) experienced definite or possible HSRs to Taxol.
- Reactions predominantly occurred during the first or second drug exposure.
- Common symptoms included dyspnea, hypotension, bronchospasm, urticaria, and erythematous rashes; premedication did not prevent HSRs in 41% of affected patients.
- Prolonging infusion time reduced but did not eliminate HSR risk.
Conclusions:
- Taxol-induced HSRs are a significant clinical concern, often occurring early in treatment.
- The exact cause and mechanism of Taxol HSRs remain undetermined.
- Clinical guidelines are necessary for managing Taxol-related hypersensitivity toxicity.