Hypersensitivity reactions from taxol.

TLDR

Taxol, an antitumor agent effective against advanced ovarian carcinoma and melanoma, is associated with hypersensitivity reactions of unknown origin, possibly due to the drug or its Cremophor EL excipient. The study aims to provide guidelines for preventing and managing taxol‑induced hypersensitivity reactions. Among 301 patients, 32 (≈10 %) experienced taxol hypersensitivity reactions—mostly on first or second exposure—manifesting as dyspnea, hypotension, bronchospasm, urticaria, or rash; premedication failed in 41 % of cases, and extended infusion only partially mitigated the risk.

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.