Introduction. Hypersensitivity reactions to etoposide are rare but can be life-threatening, and can impede the completion of chemotherapy regimen essential to curable malignancies. This case series highlights the management and outcomes of etoposide hypersensitivity reactions in four patients with gynaecological malignancies.
Case series. Four patients with gynaecological malignancies experienced hypersensitivity reactions to etoposide within the last six months. All patients with etoposide hypersensitivity developed symptoms such as flushing, chest tightness, lower back pain and/or dyspnoea in the first few minutes of the initial infusion.
Outcomes. Three patients with etoposide hypersensitivity had emergency treatment by ceasing the infusion and administering supportive therapy with hydrocortisone and fluids. These three patients were subsequently treated with etoposide phosphate; two of these patients were given additional pre-medications including a corticosteroid, H2 antagonist, and/or antihistamines, and one patient was successfully treated without any additional pre-medications. One of the four patients was successfully rechallenged with etoposide after a brief pause, at a slower infusion rate without requiring any supportive therapy. All four patients completed their chemotherapy regimens with no further issues.
Conclusion. Etoposide is one of the essential components of therapy for potentially curable malignancies, thus it is crucial that these reactions are optimally managed to ensure positive patient treatment outcomes. This case series demonstrates our experience in successfully managing etoposide hypersensitivity reactions in our patients, by either rechallenging with the original etoposide formulation, with additional pre-medications and/or slowing infusion rate, or by switching to etoposide phosphate formulations.