Paclitaxel
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Hypersensitivity reactions: 5 case reports Five women developed hypersensitivity reactions during treatment with paclitaxel [times to reaction onsets not stated]. Patient 1, a 47-year-old woman, had multiple peritoneal and omental implants; subsequent biopsies revealed welldifferentiated papillary adenocarcinoma. She underwent a staging procedure with suboptimal residual disease, and final pathology showed a poorly differentiated ovarian carcinoma. She began chemotherapy with paclitaxel 175 mg/m2 and carboplatin. After one cycle, she was changed to carboplatin and gemcitabine because of a severe hypersensitivity reaction to paclitaxel (flushing, chest pain, rash and dyspnoea with hypoxia) at the onset of her first paclitaxel infusion. Her disease progressed, and she was eventually started on weekly Abraxane (a different form of paclitaxel) 80 mg/m2; she tolerated the first four doses well. Patient 2, a 50-year-old woman with uterine fibroids, was found to have carcinomatosis with enlarged ovarian masses bilaterally. Following premedication with dexamethasone and antihistamines, she received paclitaxel 175 mg/m2. After receiving 3mL of her first paclitaxel dose, she developed intense flushing, bronchospasm, chest pain, hypotension and dyspnoea with an O2 saturation of 79%. Paclitaxel was discontinued, and she was successfully resuscitated. She then received carboplatin and gemcitabine, and underwent surgical debulking. Her serum cancer antigen 125 (CA-125) normalised, but later increased again; she did not respond to several single-agent therapies. She developed dyspnoea because of pulmonary metastases, and received Abraxane 100 mg/m2. She tolerated the first course well; however, her disease progressed. No further treatment was given, and she died of her disease. Patient 3, a 60-year-old woman, was diagnosed with stage IV papillary serous endometrial cancer. Following premedication with corticosteroids and antihistamines, she received paclitaxel 135 mg/m2 and carboplatin. Soon after the paclitaxel infusion started, she experienced severe flushing, hives and dyspnoea with hypoxia. Paclitaxel was discontinued, and she received fluids and additional antihistamines; her symptoms resolved. She continued treatment with single agent carboplatin; however, her CA-125 level and ascites increased. Her CA-125 level continued to increase despite receiving gemcitabine and carboplatin. She was switched to weekly Abraxane 100 mg/m2. She tolerated treatment well, and her CA-125 levels decreased; however, she developed progressive ascites and died. Patient 4, an 80-year-old woman diagnosed with metastatic papillary serous endometrial cancer, began receiving carboplatin and paclitaxel [dosage not stated]. Despite premedication with corticosteroids and antihistamines, she developed severe pain between her shoulder blades, nausea, hypotension and intense flushing as her paclitaxel infusion was started. Paclitaxel was immediately discontinued, and her symptoms resolved. She was switched to carboplatin and weekly Abraxane 80 mg/m2, wh
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