Paclitaxel hypersensitivity reactions: Prevalence and outcomes.

e16518 Background: Paclitaxel is an effective and commonly used chemotherapeutic. Severe hypersensitivity reactions (HSRs) to this drug are characterized by a combination of erythroderma, chest/back pain, dyspnea, and hyper- or hypotension. The frequency of HSRs is not well characterized for a general oncology population; and management is not standardized, including the approach to retreatment. With this retrospective analysis, we sought to identify the prevalence of paclitaxel HSRs and characterize the outcome of these patients, especially after retreatment. Methods: All cancer patients who received paclitaxel at Mayo Clinic Rochester from January to December 2008 were identified by electronic query of chemotherapy records. Medical records of these patients were manually reviewed to identify those who had HSRs. Treatment and outcome following the reactions were assessed by review of treatment records. Results: Of the 460 patients who received paclitaxel in 2008, 47 (10.2%) had a hypersensitivity reaction, with a female predominance (women: 40 of 327, 12.2%; men: 7 of 133, 5.3%). The most common malignancies for paclitaxel administration and percent of HSRs were breast (137; 12.4%), gynecologic (129; 13.2%) and lung (94; 5.3%). The prevalence among the remaining patients was 8%. By infusion type, the prevalence was 8.5% (14 of 165) for 1 hour IV infusion, 11.3% (32 of 284) for 3 hour IV infusion, and 9.1% (1 of 11) for IP administration. Regarding outcome, 39 of the 47 patients with HSRs received further paclitaxel without incident, most (37) on the same day after diphenhydramine (32) or diphenhydramine and dexamethasone (4) administration and symptom resolution. One patient was switched to 24 hour IV infusion, 4 patients were given alternative chemotherapy agents, and 3 stopped therapy altogether. Conclusions: Paclitaxel HSRs occur fairly commonly, especially in women. The large majority of patients are able to tolerate retreatment without a desensitization procedure. No significant financial relationships to disclose.