Infusion Hypersensitivity Reactions Occurring Beyond the Third Cycle of Paclitaxel in Gynecologic Cancer Patients

Rachadapan Chaitosa; Worapun Kumyoo; Krissada Paiwattananupant

doi:10.14456/rmj.2018.38

Authors

Rachadapan Chaitosa Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Worapun Kumyoo Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Krissada Paiwattananupant Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.38

Keywords:

Paclitaxel, Infusion hypersensitivity reaction, Third cycle, Gynecologic cancer

Abstract

Background: Paclitaxel is widely used in standard protocol treatment of patient with gynecologic cancer. Although it is generally well tolerated, infusion hypersensitivity reactions during the first and second cycle had been reported. The reactions occur within few minutes after starting the infusion of the drug. To prevent such adverse effect, all patients receive premedication prior to infusion.

Objective: To study the infusion hypersensitivity reactions of paclitaxel occurred beyond the third cycle of the drug among patients who did not experience the adverse effect in the previous two cycles.

Methods: Medical records of gynecologic cancer patients who received paclitaxel chemotherapy during January, 2013, to December, 2015, were retrospectively reviewed. The patients were treated in Department of Gynecology Oncology, Ramathibodi Hospital. The infusion hypersensitivity reactions of paclitaxel was assessed according to the National Cancer Institute Terminology Criteria for Adverse Event (CTCAE) version 4.03.

Results: There were 84 patients who met the inclusion criteria of infusion hypersensitivity reactions after paclitaxel injection. Eighty cases were classified as having mild reaction, and 4 cases had severe anaphylactoid reactions. Among the 84 cases, 8 (9.5%) had infusion hypersensitivity reactions occurred beyond the third cycle which were classified to grade 1, 3 times; grade 2, 5 times; and grade 3, 2 times. Paclitaxel was successfully administered in all patients after receiving additional antihistamine and dexamethasone.

Conclusions: Among patients who experience the adverse effect after paclitaxel injection, the infusion hypersensitivity reactions occurred beyond the third cycle in 9.5%.

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