J Gynecol Oncol.  2017 Jul;28(4):e38. 10.3802/jgo.2017.28.e38.

Universal tolerance of nab-paclitaxel for gynecologic malignancies in patients with prior taxane hypersensitivity reactions

• Maurer K
• Michener C
• Mahdi H
• Rose PG

• KMID: 2413426
• DOI: http://doi.org/10.3802/jgo.2017.28.e38

Abstract

OBJECTIVE
To report on the incidence of nab-paclitaxel hypersensitivity reactions (HSRs) in patients with prior taxane HSR.
METHODS
From 2005 to 2015, all patients who received nab-paclitaxel for a gynecologic malignancy were identified. Chart abstraction included pathology, prior therapy, indication for nab-paclitaxel, dosing, response, toxicities including any HSR, and reason for discontinuation of nab-paclitaxel therapy.
RESULTS
We identified 37 patients with gynecologic malignancies with a history of paclitaxel HSR who received nab-paclitaxel. Six patients (16.2%) had a prior HSR to both paclitaxel and docetaxel while the other 31 patients had not received docetaxel. No patients experienced a HSR to nab-paclitaxel. Median number of cycles of nab-paclitaxel was 6 (range 2-20). Twelve patients received weekly dosing at 60 to 100 mg/m². The remainder of patients received 135 mg/m² (n=13), 175 mg/m² (n=9), or 225 mg/m² (n=3). Thirty four patients (91.9%) received nab-paclitaxel in combination with carboplatin (n=28, 75.7%), IP cisplatin (n=1, 2.7%), carboplatin and bevacizumab (n=3, 8.1%), or carboplatin and gemcitabine (n=2, 5.4%). Reasons for discontinuing nab-paclitaxel included completion of adjuvant therapy (n=16), progressive disease (n=18), toxicity (n=1), and death (n=1). There were no grade 4 complications identified during nab-paclitaxel administration. Grade 3 complications included: neutropenia (n=9), thrombocytopenia (n=4), anemia (n=1), and neurotoxicity (n=1).
CONCLUSION
Nab-paclitaxel is well-tolerated with no HSRs observed in this series of patients with prior taxane HSR. Given the important role of taxane therapy in nearly all gynecologic malignancies, administration of nab-paclitaxel should be considered prior to abandoning taxane therapy.

Keyword

Albumin-Bound Paclitaxel; Drug Hypersensitivity; Drug Therapy

MeSH Terms

Adult
Aged
Albumins/administration & dosage/adverse effects
Anemia/chemically induced
Antineoplastic Agents/*adverse effects
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*therapeutic use
Bevacizumab/administration & dosage
Carboplatin/administration & dosage
Cisplatin/administration & dosage
Deoxycytidine/administration & dosage/analogs & derivatives
Drug Hypersensitivity/*etiology
Female
Genital Neoplasms, Female/*drug therapy
Humans
Middle Aged
Nervous System Diseases/chemically induced
Neutropenia/chemically induced
Paclitaxel/administration & dosage/*adverse effects
Retreatment
Retrospective Studies
Taxoids/*adverse effects
Thrombocytopenia/chemically induced
Albumins
Antineoplastic Agents
Taxoids
Deoxycytidine
Bevacizumab
Carboplatin
Paclitaxel
Cisplatin

Reference

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