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Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 272-273 Letter to Editor Etoposide? Or polysorbate-80? A Aksahin, D Colak, M Altinbas Ankara Yildirim Beyazit Education and Research Hospital, Medical Oncology Clinic Altindag, Ankara, Turkey Correspondence Address: A Aksahin Ankara Yildirim Beyazit Education and Research Hospital, Medical Oncology Clinic Altindag, Ankara Turkey oguzarzu@yahoo.com Code Number: cn11072 DOI: 10.4103/0019-509X.82903 Sir, Etoposide is an antineoplastic agent from epiphodophylotoxin family. It is used in the treatment of many malignancies as intravenous and oral forms. A rare toxicity of etoposide is a hypersensitivity reaction (HSR) manifested by dyspnea, chest discomfort, hypotension, wheezing, and flushing of face. [1] Hypersensitivity may be due to etoposide itself or the additives used in pharmaceutical form. [2] We report here patient who, despite experiencing a HSR to intravenous etoposide, tolerated the subsequent administration of another pharmaceutical form of etoposide without any allergic reaction. A 44-year-old male admitted to our clinic with the complaint of a mass on his neck. On physical examination, 6 cm × 8 cm mass was detected in the right anterior cervical region. On thorax tomography 10 cm × 9 cm mass filling right lung′s middle lobe and pleural effusion was detected. Tru-cut biopsy from the mass on neck was reported as non-small cell lung carcinoma with neuroendocrine pattern. He was staged as stage IIIB lung carcinoma and cisplatin with etoposide chemotherapy was started. The patient had no known allergies. Following premedication with i.v. granisetron and dexamethasone first chemo cycle was given without any complication. When the patient was admitted for the second cycle, the mass on his neck regressed to 3 cm × 2 cm and chemotherapy was continued. During the first few minutes of etoposide infusion, the patient experienced, generalized discomfort, dyspnea, flushing, chest pain, and tachycardia. On physical examination, he was found to be restless, hypotensive, and tachycardic. Electrocardiography revealed only sinus tachycardia. The infusion was immediately stopped and i.v. hydration was started. Intravenous steroid and antihistaminic was given. His complaints was completely resolved in 1 h. The reaction might be due to etoposide itself or due to the additives used in the pharmaceutical preparation. In the literature, allergic reactions to polysorbate-80 were reported which was the solvent in the form used in this patient. Because of the distinct regression on the size of the mass, it was preferred to continue the treatment by the same combination regimen. Another etoposide preparation which did not contain polysorbate-80 was chosen to continue the treatment. With the same premedication, the treatment was administered without any reaction. It is concluded that the reaction which had occurred is more likely due to polysorbate-80 rather than etoposide itself. The mechanism underlying HSR to etoposide has not been fully elucidated. The concentration of the drug and the rate of infusion are both accused, but there are a wide range of etoposide concentrations and rate to cause HSR to etoposide. [3],[4] Another possible route is that the additive used in preparation to dissolve etoposide (benzyl alcohol, polysorbate-80) may cause hypersensitivity reactions. Polysorbate-80 is a solvent used in nutritive, creams, ointments, lotions, and pharmaceutical preparations and as an additive in tablets. [2] Although the exact mechanism of the hypersensitivity reaction is not known, it is believed to be of nonimmunugenic origin. [5] In animal models, polysorbate-80 has been shown to cause hypersensitivity reaction by means of histamine release. It was reported that substitution of etoposide phosphate in patients with etoposide HSR seems to be appropriate. [6] In our case, we have completed the treatment without any complication after passing to another pharmaceutical form of etoposide which does not contain polysorbate-80. In some clinical situations, etoposide is an indispensable option for treatment. Especially, in such cases with HSR to etoposide, polysorbate-80 allergy should be kept in mind. References
Copyright 2011 - Indian Journal of Cancer |
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