Pérez-Codesido S, Azzi Virgini V, Fertani S, Jandus P
Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland.
Cabinet Médical Prilly Centre (CMPC), Route de Cossonay Prilly, Prilly, Switzerland.
J Oncol Pharm Pract. 2025 Mar;31(2):336-340. doi: 10.1177/10781552241280723. Epub 2024 Sep 2.
IntroductionEtoposide phosphate is a chemotherapeutic agent used to treat various malignant neoplasms. Hypersensitivity reactions may occur with its use, and in rare cases, an anaphylactic reaction can manifest. Available options for patients experiencing hypersensitivity reactions include premedication, changing treatment, or undergoing desensitization. Various pediatric desensitization protocols have been described, ranging from six to fifteen steps, while published adult cases are rare.Case ReportWe report the case of a 61-year-old woman with small-cell lung cancer and brain metastases. In November 2019, she underwent the second cycle of cisplatin and etoposide phosphate treatment. While receiving etoposide phosphate, she experienced dyspnea and suffered a cardiorespiratory arrest, leading to cardiopulmonary resuscitation and subsequent admission to the Intensive Care Unit. Her acute tryptase levels were notably elevated at 18 µg/L (compared to a baseline tryptase level of 6,6 µg/L) during the reaction.Case ManagementWe implemented a 16-step desensitization protocol (without premedication) under close monitoring in an intermediate care unit. The protocol was successfully executed over three cycles until tumor progression mandated a modification in systemic treatment.DiscussionTo our knowledge, this is the first documented case of successful desensitization to etoposide phosphate in a patient who experienced cardiac arrest during a hypersensitivity reaction. Although protocols of varying lengths have been published, we emphasize the importance of individualizing each protocol to fit the severity of the reaction and the resources and experience of each unit.
引言
磷酸依托泊苷是一种用于治疗各种恶性肿瘤的化疗药物。使用过程中可能会发生过敏反应，在极少数情况下，会出现过敏反应。对于发生过敏反应的患者，可用的选择包括预处理、更换治疗方案或进行脱敏治疗。已经描述了各种儿科脱敏方案，从六步到十五步不等，而公开报道的成人病例很少。
病例报告
我们报告了一名61岁患有小细胞肺癌和脑转移瘤的女性病例。2019年11月，她接受了顺铂和磷酸依托泊苷治疗的第二个周期。在接受磷酸依托泊苷治疗时，她出现呼吸困难并发生心肺骤停，导致进行心肺复苏，随后入住重症监护病房。反应期间，她的急性类胰蛋白酶水平显著升高至18μg/L（相比基线类胰蛋白酶水平为6.6μg/L）。
病例管理
我们在中级护理病房的密切监测下实施了一个16步脱敏方案（无预处理）。该方案在三个周期内成功执行，直到肿瘤进展需要对全身治疗进行调整。
讨论
据我们所知，这是第一例记录在案的对磷酸依托泊苷过敏反应期间发生心脏骤停的患者成功脱敏的病例。尽管已经发表了不同长度的方案，但我们强调根据反应的严重程度以及每个单位的资源和经验对每个方案进行个体化的重要性。
