Cross-sensitivity between paclitaxel and docetaxel in a women’s cancers program
Authors: D. S. Dizon, A. Rojan, J. Miller, J. Schwartz, M. E. Gordinier, L. Pires, P. Disilvestro, R. Moore, C. O. Granai, J. Gass, R. D. Legare
Journal: Journal of Clinical Oncology (2005)

2052 Background: Taxanes are used to treat both breast and gynecologic cancers. The incidence of severe hypersensitivity reactions (S-HSR) to paclitaxel (P) is estimated to be 2% or lower, especially with the use of steroids and anti-histamines. For those who develop a S-HSR to paclitaxel, docetaxel (D) has been employed as an alternative agent but the presence of cross-sensitivity has not been documented. We sought to define the presence of S-HSR to D following a P S-HSR in women treated for breast or gynecologic cancers. Methods: Patients treated with either P or D between 11/1999 and 8/2004 were identified through our pharmacy database. Records were reviewed and data collected on those patients who had a S-HSR to P, D, or both, defined as symptoms for which drug was discontinued. Data collected included type of cancer, type of reaction, dates of treatment, and time interval between taxane therapy. Characteristics were compared using Fisher's exact test or Chi Square for categorized variables. Results: A total of 717 pts received P and 92 received D. 57 received D following treatment with P. The presence of S-HSR for P was 1.95% (14/717 pts) and for D was 7.6% (7/92 pts). The presence of S-HSR in patients treated with D after P was 12.3% (7/57). Table 1 shows the symptoms seen with both drugs. All pts reacting to D also reacted to P for a cross-sensitivity rate of 50% (7/14 pts). Of the 57 pts treated with both drugs, those treated with D ≤4 weeks after P had a cross-sensitivity rate of 24% (6/25 pts). For those patients treated >4 weeks, it was 3% (1/32) (p=.036). There was no association between type of cancer treated and the presence of cross-sensitivity (p=.699). Conclusions: Cross-sensitivity of D after P was 50% in our experience. Given the different vehicles used in P and D, it is likely attributed to the taxane moiety. Although D may be used, caution should be exercised in those with a prior P S-HSR, particularly if treated within four weeks. Author Disclosure Paclitaxel and Docetaxel reactions Patient Primary tumor P symptoms Medications given Time between taxanes (days) D symptoms Medications given A Ovary back pain rechallenge unsuccessful 21 epigastric pressure, facial flushing, dysarthria, SOB, palpitations Diphenhydramine, Oxygen B Ovary chest pain, abdominal pain, nausea, hypotension, tachycardia Diphenhydramine, Hydrocortisone, Lorazepam, Cimetidine 21 tachycardia Diphenhydramine, Hydrocortisone, Ativan, Cimetidine C Ovary back pain, abdominal pain Hydrocortisone 42 chest tightness, back pain Diphenhydramine D Ovary light-headed, chest pressure, dyspnea, facial flushing Diphenhydramine, Hydrocortisone 2 flushing, dyspnea, back pain Diphenhydramine, Hydrocortisone E Peritoneal facial flushing, facial edema, hypotension, tachycardia Hydrocortisone, dexamethasone 21 facial flushing Infusion aborted F Endometrial flushing, back pain Hydrocortisone 21 back pain, facial flushing, tachycardia Diphenhydramine, Methylprednisone G Breast back pain, chest heaviness, facial flushing, rash, back pain, facial edema Diphenhydramine, solumedrol 9 back pain, chest tightness, hypertension, tachycardia, tremor Diphenhydramine, Solumedrol No significant financial relationships to disclose.