การศึกษาอุบัติการณ์อาการไม่พึงประสงค์และระดับความรุนแรงของภาวะภูมิไวเกินในผู้ป่วยมะเร็งที่ได้รับยาเคมีบำบัดกลุ่ม Taxanes โรงพยาบาลวชิรพยาบาล

Kampon  Introntakun; Chureeporn  Silaguntsuti; Arveewan  Vittayatigonnasak; Apatnipa Boonlee; Tanatporn  Pinsiri; Thanaporn Sripuk; Rada Wongsri; Gorn  Vrakornvoravuti

Authors

Kampon Introntakun Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Chureeporn Silaguntsuti Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Arveewan Vittayatigonnasak Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Apatnipa Boonlee Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Tanatporn Pinsiri Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Thanaporn Sripuk Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Rada Wongsri Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Gorn Vrakornvoravuti Faculty of Medicine Vajira Hospital, Navamindradhiraj University

Keywords:

Incidence of adverse reactions, Severity levels, Hypersensitivity reactions, Cancer patients, Taxane-based chemotherapy drugs

Abstract

Background: Hypersensitivity reactions (HSRs) are acute adverse reactions that may occur following chemotherapy administration, particularly with Taxane agents such as Paclitaxel and Docetaxel, which have been reported to cause symptoms ranging from mild to severe. Objective: To investigate the incidence and severity of hypersensitivity reactions in cancer patients receiving Taxane-based chemotherapy. Methods: This study was a retrospective descriptive research based on medical records and nursing documentation. The sample included 120 cancer patients who experienced hypersensitivity reactions after receiving Paclitaxel or Docetaxel between January 1st and December 31st, 2024. The Common Terminology Criteria for Adverse Events (CTCAE) was applied for assessment, and data were analyzed using descriptive statistics. Results: Most patients were female (90.8%) and aged ≥41 years (82.5%). Common symptoms included chest tightness (77.5%), facial ﬂushing (67.5%), and dyspnea (46.7%). Symptoms typically occurred within the first 16-30 minutes of infusion (66.7%), with a volume of 11-20 mL (95.8%) and drug concentration between 250-299 mg (39.2%). Severity levels varied: among Docetaxel recipients (n=18), Grade I reactions occurred in 61.1% and Grade II in 38.9%, with no Grade III observed; in contrast, Paclitaxel recipients (n=102) experienced Grade I in 45.1%, Grade II in 53.9%, and Grade III in 1.0%. Conclusion: Paclitaxel was associated with a higher incidence of Grade II-III hypersensitivity reactions, while Docetaxel showed a higher proportion of Grade I cases. These reactions typically occurred during the 2nd-3rd infusion cycles and within the first 30 minutes of administration. Therefore, this period should be defined as a critical monitoring window, and a pre-infusion screening system should be developed for high-risk patients to enhance chemotherapy safety.

References

Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74(1):12-49.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3):229-63.

Bayrak Durmaz MS, Unutmaz DG, Demir M, Goksel O, Dursun AB, Bavbek S. Hypersensitivity reactions to taxanes: a multicenter study for outcomes and safety of rapid drug desensitization. Allergy Asthma Immunol Res 2024;16(2):142-53.

Wu HL. Retrospective evaluation of a rechallenge protocol in patients experiencing hypersensitivity reactions with prior chemotherapy in a tertiary hospital. J Oncol Pharm Pract 2019;25(6):1388-95.

Pagani M, Bavbek S, Alvarez-Cuesta E, Berna Dursun A, Bonadonna P, Castells M, et al. Hypersensitivity reactions to chemotherapy: an EAACI position paper. Allergy 2022;77(2):388-403.

Villarreal-González RV, González-Díaz S, Vidal-Gutiérrez O, Canel-Paredes A, de la Cruz-de la Cruz C, García-Campa M, et al. Hypersensitivity reactions to taxanes: a comprehensive and systematic review of the efficacy and safety of desensitization. Clin Rev Allergy Immunol 2023;65(2):231-50.

Picard M. Management of hypersensitivity reactions to taxanes. Immunol Allergy Clin North Am 2017;37(4):1080-90.

Pluchino LA, D’Amico TA. National comprehensive cancer network guidelines: who makes them? What are they? Why are they important? Ann Thorac Surg 2020;110(6):1789-95.

Lohisaratkul N, Udomphon N, Phanna P. Incidence and associated factors of hypersensitivity reactions from paclitaxel use in cancer patients. Thai Cancer J 2019;39(4):143-52.

Prasannnam T. Drug eruptions in cancer patients who received chemotherapy cancer center Ratchaburi Hospital. Journal of the Mahasarakham Provincial Public Health Office 2021;5(10):55-63.

Chaitosa R, Kumyoo W, Paiwattananupant K. Infusion hypersensitivity reactions occurring beyond the third cycle of paclitaxel in gynecologic cancer patients. Rama Med J 2018;41(4):11-7.

Chaitosa R, Kumyoo W, Israngura Na Ayudhya N, Paiwattananupant K. A comparative analysis on the infusion reactions of paclitaxel between original and generic drugs in patients with gynecologic cancer. Rama Med J 2018;41(2):36-43.

Chaitosa R, Maskasame W. Study of side effects of patients receiving cisplatin in the treatment of cervical cancer by age group. Rama Med J 2020;43(4):28-3.

Shaik H, M V, Sahayaraj C, S S, Y V. Taxanes induced hypersensitivity reactions in cancer chemotherapy patients reported at adverse drug reaction monitoring centre at a tertiary care hospital. Int J Basic Clin Pharmacol 2023;12(1):29-33.

Sakimura K, Bujo H, Kushiya E, Araki K, Yamazaki M, Yamazaki M, et al. Functional expression from cloned cDNAs of glutamate receptor species responsive to kainate and quisqualate. FEBS Lett 1990;272(1-2):73-80.

Jao ME, Indorf AL, Segal E-M, Miske A, Eaton KD, Marsolini T, et al. Impact of institutional interventions on the rate of paclitaxel hypersensitivity reactions. J Oncol Pharm Pract 2024;30(1):105-11.

Mendez S, Culmone K, Ramos R, Sweeney-Moore A. Hypersensitivity reactions: practice recommendations for paclitaxel administration. Clin J Oncol Nurs 2021;25(6):713-6.

Thangwonglers T, Santimaleeworagun W, Therasakvichya S, Saengsukkasemsak N, Pimsi P. Characteristics of immediate hypersensitivity reaction to paclitaxel-based chemotherapy in gynecologic cancer patients. Asian Pac J Allergy Immunol 2023;41(4):340-6.

Castells M. Drug hypersensitivity and anaphylaxis in cancer and chronic inﬂammatory diseases: the role of desensitizations. Front Immunol 2017;8(1):1472.