Micha John P, Goldstein Bram H, Birk Connie L, Rettenmaier Mark A, Brown John V
Gynecologic Oncology Associates, Hoag Memorial Hospital Cancer Center, 351 Hospital Road, Suite 507, Newport Beach, CA 92663, USA.
Gynecol Oncol. 2006 Feb;100(2):437-8. doi: 10.1016/j.ygyno.2005.09.012. Epub 2005 Oct 14.
Paclitaxel is one of the most active agents in the treatment of ovarian carcinoma. However, paclitaxel is solubilized in cremophor, a polyoxyethylated castor oil. Cremophor is allegedly responsible for many paclitaxel-associated hypersensitivity reactions (HSR). Novel agents such as abraxane are solvent free and currently being evaluated to potentially avoid certain patient side effects.
We present a case involving a 60-year-old ovarian cancer patient with a significant history of chemotherapy induced HSR. She underwent optimal cytoreductive surgery and began adjuvant chemotherapy in 2000 until she suffered a severe HSR to paclitaxel. In 2002, she was diagnosed with recurrent disease and underwent subsequent treatment with carboplatin, cisplatin, and doxorubicin, all of which resulted in severe HSR. The patient began abraxane therapy in 2005 and has shown no signs of HSR.
Abraxane is a solvent free taxane, which can be administered without the pre-medications routinely used to prevent HSR. Abraxane may offer paclitaxel HSR patients the benefit of continued taxane treatment. Although the clinical activity of abraxane has not been extensively investigated in ovarian carcinoma, the distinct activity of paclitaxel and good results with recurrent metastatic breast cancer patients suggest additional evaluation with this drug is important.
紫杉醇是治疗卵巢癌最有效的药物之一。然而，紫杉醇溶解于聚氧乙烯蓖麻油克列莫佛中。据称，克列莫佛是许多与紫杉醇相关的过敏反应（HSR）的病因。像白蛋白结合型紫杉醇这样的新型药物不含溶剂，目前正在进行评估，以潜在地避免某些患者的副作用。
我们报告一例涉及一名60岁卵巢癌患者的病例，该患者有化疗诱导的过敏反应的显著病史。她于2000年接受了最佳细胞减灭术并开始辅助化疗，直到她对紫杉醇发生严重过敏反应。2002年，她被诊断为复发性疾病，并随后接受了卡铂、顺铂和阿霉素治疗，所有这些治疗均导致严重过敏反应。该患者于2005年开始接受白蛋白结合型紫杉醇治疗，且未出现过敏反应迹象。
白蛋白结合型紫杉醇是一种不含溶剂的紫杉烷类药物，无需常规用于预防过敏反应的预处理即可给药。白蛋白结合型紫杉醇可能为对紫杉醇过敏反应的患者提供继续紫杉烷类治疗的益处。尽管白蛋白结合型紫杉醇的临床活性在卵巢癌中尚未得到广泛研究，但紫杉醇的独特活性以及复发性转移性乳腺癌患者的良好疗效表明，对该药物进行进一步评估很重要。
