Oncology Unit, Third Department of Medicine, Sotiria General Hospital, Athens Medical School, Athens, Greece.
Int Arch Allergy Immunol. 2011;156(3):320-4. doi: 10.1159/000324454. Epub 2011 Jun 29.
Docetaxel (DT) is an extensively used taxane, frequently associated with hypersensitivity reactions. The aim of this study was to record the epidemiological and clinical features of hypersensitivity to DT in non-small cell lung cancer patients in order to obtain useful information concerning the management of these patients. We also developed a desensitization protocol and evaluated its clinical application.
We retrospectively reviewed records of 620 non-small cell lung cancer patients treated with DT-containing regimens in the adjuvant, first-, second- or next-line setting. Data from 102 patients who had exhibited hypersensitivity reactions were analyzed according to the Common Toxicity Criteria for Adverse Events version 3.0. Five patients were chosen for the desensitization protocol. We applied the standard protocol for parenteral desensitization to β-lactam antibiotics, and DT treatment was carried out with a series of 10-fold dilutions in sufficient volume to administer the total dose.
One hundred and two patients (16.5%) were recorded as having hypersensitivity to DT. Reactions were observed after approximately 2.5 ± 1.0 cycles. Only 14 patients (14/620, 2%) developed grade 3-4 hypersensitivity. Reactions were more likely in patients during second- or third-line chemotherapy, but no other correlation (age, gender, atopic status) was observed. Five patients completed a parenteral desensitization protocol and continued their treatment uneventfully.
Hypersensitivity reactions to DT respond quickly to discontinuation along with appropriate supportive care. Premedication and increased infusion time may allow readministration. The desensitization protocol that we developed provides a reliable alternative to permanent discontinuation of DT.
多西他赛（DT）是一种广泛使用的紫杉烷类药物，常与过敏反应相关。本研究旨在记录非小细胞肺癌患者对 DT 过敏的流行病学和临床特征，以获取有关此类患者管理的有用信息。我们还制定了脱敏方案，并评估了其临床应用。
我们回顾性分析了 620 例接受含 DT 方案辅助、一线、二线或后线治疗的非小细胞肺癌患者的记录。根据不良事件通用毒性标准 3.0 版本，对 102 例出现过敏反应的患者的数据进行了分析。我们选择了 5 例患者进行脱敏方案。我们应用了β-内酰胺类抗生素的标准静脉内脱敏方案，并用足够体积的系列 10 倍稀释液进行 DT 治疗，以给予总剂量。
102 例患者（16.5%）被记录为对 DT 过敏。反应大约在 2.5±1.0 个周期后出现。仅有 14 例患者（14/620，2%）出现 3-4 级过敏反应。在二线或三线化疗的患者中更可能发生反应，但未观察到其他相关性（年龄、性别、特应性状态）。5 例患者完成了静脉内脱敏方案，继续治疗未出现不良事件。
DT 过敏反应迅速，停药并给予适当支持治疗即可缓解。预先用药和增加输注时间可能允许重新给药。我们开发的脱敏方案为永久性停止 DT 提供了可靠的替代方案。
