Journal of Clinical Oncology, Vol 8, 1263-1268, Copyright © 1990 by American Society of Clinical Oncology
Hypersensitivity reactions from taxol
RB Weiss, RC Donehower, PH Wiernik, T Ohnuma, RJ Gralla, DL Trump, JR Baker Jr, DA Van Echo, DD Von Hoff and B Leyland-Jones
Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307.
Taxol is an antitumor agent in clinical trial that has been shown to have
activity against advanced ovarian carcinoma and melanoma. Hypersensitivity
reactions (HSRs) have been one of the toxicities observed with
administration of this drug. Of 301 patients treated, 32 patients have had
definite (27 patients) or possible (five patients) hypersensitivity
reactions to taxol. All but one patient had the reaction from the first or
second exposure to this agent. Reactions occurred at a variety of doses and
were characterized most frequently by dyspnea, hypotension, bronchospasm,
urticaria, and erythematous rashes. Thirteen (41%) patients had received
premedication designed to prevent such toxicity; nevertheless, they
sustained HSRs. Prolonging the drug infusion appears to have somewhat
reduced, but not obviated, the risk of HSRs. The cause (taxol itself or its
excipient Cremophor EL; Badische Anilin und Soda-Fabrik AG [BASF],
Ludwigshafen, Federal Republic of Germany) and the mechanism of these
reactions to taxol are unknown. We provide guidelines to prevent or
minimize such toxicity and treat reactions if they still occur.

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