Doxorubicin


Doxorubicin is an anthracycline antibiotic isolated from cultures of Streptomyces peucetius It is used in the treatment of hematological malignancies and solid and soft tissue tumors.
Pegylated liposomal doxorubicin may be less cardiotoxic than free doxorubicin but mucositis is increased.
 
Incidence
Uncommon: urticaria 1/160 to 3%.
 
One death reported.
 
Risk factors
Clindamycin allergy?
 
Intravenous route.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: pruritus, urticaria, rash, flush, flare reaction: erythema, pruritus, urticaria localized or adjacent to the site of infusion, hand-foot syndrome (palmar-plantar dysesthesia).
 
E.N.T.: nasal congestion.
 
Respiratory: bronchospasm.
 
Diagnostic methods
Drug re-challenge.
 
Mechanisms
Direct degranulation of mast cells or circulating basophils without antibody mediation.
 
Activation of alternate complement-activity pathway.
 
Management
The use of pegylated liposomal doxorubicin (PLD) increases the frequency (7 to 9%) of hypersensitivity reactions in the first cycles of treatment (flushing, shortness of breath, facial swelling, headache, chills, back pain, tightness in the chest and throat, hypotension).
 
Concerning use of intravesical doxorubicin:
  • if the reaction is severe; give an other effective intravesical agent
     
  • if the reaction is mild and self-limiting; prophylactic administration of antihistamines may be useful.

References

  1. Alberts D.S, Garcia D.J, "Safety aspects of pegylated liposomal doxorubicin in patients with cancer", Drugs, 1997; 54 (S4): 30-5
  2. Arena F.P, Sherlock S, "Doxorubicin hypersensitivity and clindamycin (letter)", Ann. Intern. Med., 1990; 112 (2): 150
  3. Lee M, Sharifi R, "Generalized hypersensitivity reaction to intravesical thiotepa and doxorubicin", J. Urol., 1987; 138 (1):
    143-4
  4. Solimando D.A Jr, Wilson J.P, "Doxorubicin-induced hypersensitivity reactions", Drug. Intell. Clin. Pharm., 1984; 18 (10): 808-11
    Collins J.A, "Hypersensitivity reaction to doxorubicin", Drug. Intell. Clin. Pharm., 1984; 18 (5): 402-3

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.