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.