Docetaxel, the new chemotherapeutic agent (taxoids) derived from the needles of the European yew (Taxus baccata); shows significant antitumor activity in phase II trials of ovarian, breast and non small cells lung cancer.
Cutaneous manifestations (erythema, pruritus, dry skin, macular eruptions, swelling, burning, desquamation): 64.3%. Grade III: 6.4%; grade IV: 1.7%.
Fever: 35.8%. Grade III: 2.8%; grade IV: 0.2%.
Hypersensitivity reactions: 31.3 % (usually occurring in the first or second course).
Mild: pruritus, flushing, rash, fever, chills.
Severe: hypotension, dyspnea, bronchospasm, general urticaria or angioedema.
Grade III: 6.7%; grade IV: 0.6%.
General: hypotension, fever, chills.
Cutaneous: erythrodysesthesia, solitary erythematous to edematous plaque in the infusionarm proximal to the site of infusion, pruritus, urticaria, angioedema, flushing.
Respiratory: dyspnea, bronchospasm.
Skin biopsy (erythrodysesthesia): epidermal dysmaturation with necrotic keratinocytes or sparse superficial perivascular lymphocytic infiltration with eosinophils, focal vacuolar alteration or plain perivascular lymphocytic inflammation.
Non-specific release of vasoactive mediators following mast-cell degranulation is likely.
The usefulness of premedication with antihistamines and corticosteroids is controversial.
Oral pretreatment 12 hours and 3 hours before infusion of docetaxel with 32 mg of methyprednisolone, 10 mg of cetirizine and 1 mg of ketotifen limits the development of acute hypersensitivity reactions (28% -> 7.7%).
Classical prophylactic medication: dexamethasone 8 mg 13 hours, 7 hours, 1 hour before the administration of docetaxel; clemastine 1 mg 13 hours, 7 hours, 1 hour, before the administration of docetaxel; followed by dexamethasone 8 mg p.o. twice daily for 3 days.
Sodium cromoglycate (400 mg orally x 4 daily) could be an alternative to corticosteroids and conventional antihistamines in the treatment of taxoid-induced acute hypersensitivity reactions.
Skin toxicity is not prevented by corticosteroids and antihistamines. Treatment with an ointment of glycerin and chlorhexidine is simple, and improves the condition in most patients.