Etoposide

Abstract

Hypersensitivity reaction due to etoposide and Polysorbate 80 excipient: 12 case reports In a retrospective case series involving the patients who underwent etoposide desensitisation from February 2017 to February 2018, 12 patients aged 1–25 years [sexes not stated] were described who developed hypersensitivity reactions following treatment with etoposide and Polysorbate 80 (an excipient in etoposide) for osteosarcoma or unspecified cancer [times to reactions onsets not clearly stated; outcomes not stated]. All the 12 patients, who had osteosarcoma (n=1) or unspecified cancer (n=11), started receiving etoposide infusion at a dose of 72–200 mg/m2. The patients also received various concurrent chemotherapy medications. The patients also received premedications with hydrocortisone, diphenhydramine, cyproheptadine, famotidine, hydroxyzine, prednisone or ranitidine. However during the first etoposide dose–10 doses of etoposide, all 12 patients developed hypersensitivity reaction characterised by various symptoms including anaphylaxis reaction in one patient. The hypersensitivity reactions were attributed to etoposide and polysorbate 80 (an excipient in etoposide). All the 12 patients therefore underwent desensitization of etoposide. A six-step desensitisation protocol (spanning over 15hr) consisted of etoposide 0.02mg in 50mL sodium chloride [normal saline] infused at a rate of 50 mL/hr; etoposide 0.1mg in 50mL sodium chloride infused at a rate of 50 mL/hr; etoposide 0.5mg in 50mL sodium chloride infused at a rate of 50 mL/hr; etoposide 2.5mg in 50mL sodium chloride infused at a rate of 50 mL/hr; etoposide 12.5mg in 50mL sodium chloride infused at a rate of 50 mL/hr; and etoposide remaining dose in sodium chloride (0.2 mg/mL) infused over 10 hours. During desensitisation protocol, the patients received premedication with ranitidine, methylprednisolone, diphenhydramine, salbutamol or hydrocortisone. Out of the 12 patients, one patient developed recurrent hypersensitivity with nausea, tachypnoea, rash and hives during the desensitisation. Therefore, further desensitisation doses were discontinued in that patient. The remaining 11 patients received a total of 3–30 desensitisation doses and tolerated them well.