Ovarian cancer is the leading cause of death among gynecologic malignancies and ranks fifth in overall cancer-related mortality among women in the United States.1 Chemotherapy, particularly with a taxane and platinum combination, is key to improving survival in patients with advanced newly diagnosed ovarian cancer and in those with recurrent cancer that remains sensitive to platinum.2 However, adverse reactions to these drugs can greatly limit their use and, because of the frequent lack of equally effective alternative agents, patients’ chances of survival may be compromised.2,3 Recent advances have been made in the management of chemotherapy hypersensitivity reactions (HSRs), especially in ovarian cancer, that for some patients offer promise for circumventing those reactions.
Four types of drug HSRs have been well characterized.4 In type I, drug-specific IgE antibodies coat the surface of mast cells and basophils. On antigen binding, cross-linking occurs and cell activation ensues, causing the immediate release of mediators, such as histamine and tryptase, responsible for the classic signs and symptoms of those reactions (Table 1).4 Mast cell and basophil degranulation can also be triggered by nonspecific pathways, such as complement activation, creating a clinical picture identical to classic type I reactions.5 Regardless of the underlying mechanism, these reactions have the potential to lead to anaphylaxis.5 Type I reactions are the most common HSRs seen in patients with ovarian cancer, and are also referred to as allergic or infusion reactions.2 Type II reactions involve antibody-mediated cytotoxicity (eg, drug-induced immune hemolytic anemia), and type III are mediated by antigen-antibody complexes (eg, serum sickness) but are infrequently encountered.4 Type IV reactions are T-cell mediated, have a delayed onset, and range from benign maculopapular skin eruption to Stevens-Johnson syndrome.4 Finally, a common type of HSR seen with monoclonal antibodies does not fit into this classification; these reactions involve fever and chills and seem to result from the nonspecific release of cytokines.6 This article focuses mainly on the management of type I-compatible HSRs to taxanes and platinum drugs and the recommended approach for patients experiencing these reactions.
Signs and Symptoms of Hypersensitivity Reactions to Taxanes and Platinum Drugs
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