Results:
We identified 32 patients experiencing etoposide related ADRs (TABLE 2).
Two ADRs occurred in 2012, and 30 occurred between 2017-2020. Overall,
17,134 doses of etoposide were administered to 3,326 unique patients and
32 patients (1%) experienced ADRs. At RH, 7,489 doses of etoposide were
administered to 577 patients and three patients (0.5%) experienced
ADRs. At CMH, 9,645 doses of etoposide were administered to 2,749
patients and 29 patients (1%) experienced ADRs.
The age of patients experiencing ADRs was 8.5±5.8 years (mean ± SD),
with 17 male and 15 female patients, 27 (84%) were white/non-Hispanic,
3 Hispanic (9%), 1 black (3%), and 1 multiracial (3%). Fifty percent
of patients had a history of a previous food or drug allergy, and 19%
had a documented past medical history of an allergic or inflammatory
condition.
Infusion reactions occurred with the first dose in 53% patients.
Seventy-five percent were characterized as The ADR was characterized as
moderate in 75% and 25% as severe reactions, yet no patients required
admission to the intensive care unit and all fully recovered.
Eighty-eight percent of patients experienced multiple symptoms during
the etoposide infusion, with an average of 2.8±1.1 symptoms per patient.
The most common symptoms were flushing and difficulty breathing
(including chest or throat tightness) which occurred in 71% of
patients. Coughing was described in 50% of patients, facial or lip
swelling 45%, redness or rash and nausea and vomiting were both
reported to occur in 33% of patients.
Multiple treatments were administered to 59% of patients with an
average of 2.2±1.5 treatments per patient. The most common treatment was
diphenhydramine which was given to 94% of patients, hydrocortisone in
25% of patients, histamine H2-receptor antagonist in 18% of patients,
and IV fluids in 16% of patients. The infusion time was extended in
28% of patients,
Thirteen patients (41%) were re-challenged with etoposide after the
reaction, and all were initially able to tolerate at least one future
dose with either pre-treatment, and/or extending infusion duration.
However, three of the 13 patients re-challenged did subsequently
experience a second reaction with etoposide resulting in a change to
etoposide phosphate formulation. Nineteen patients (59%) were never
re-challenged with the standard etoposide formulation. Overall, 22
patients ultimately received etoposide phosphate and no ADRs were
reported with this formulation.