A135
Fatal reaction to Paclitaxel (P) challenge after hypersensitivity reaction (HSR) to Docetaxel (D)
Rahul Peck, Andrew Wardley, Brian Magee, Anne Armstrong, Kin Lee, Sacha Howell
Christie NHS Foundation Trust, Manchester, UK
Background
HSR to taxanes is well described. Several groups have reported the feasibility of switching to D following HSR to P. However there are no reports of the reverse strategy. We report a case of fatal HSR to P after HSR to D and the experience with the switching strategy at our institution.
Case
A 57 year old woman with inflammatory breast carcinoma received 4 cycles of anthracycline based neoadjuvant chemotherapy with excellent response. Shortly after commencing cycle 2 D she developed grade 2 HSR which responded rapidly to infusion discontinuation, chlorpheniramine and oxygen. One week later she was treated with P (80mg/m2 weekly) after standard short-course premedication. Within three minutes of the P infusion starting she suffered a cardiac arrest and died.
Method
Pharmacy databases were searched for patients who had received P within four weeks of D, between 1998 and 2008. Data were extracted from the case notes to identify patients who had experienced HSR to D and the incidence of subsequent reaction to P. Characteristics of these cases were examined.
Results
7 eligible cases (including the index case) were identified, 6 had early stage and 1 advanced breast cancer. HSRs to D were similar and all occurred with the first or second cycle. All patients received short course pre-medication prior to P. Only the index case experienced HSR to P and 5/6 of the other patients completed the planned course of P. No clinical characteristics differentiated the index case from the other 6 cases.
Conclusion
The use of P following a HSR to D is considered too great a risk. The practice has been discontinued at our institution.
