Acute Chemotherapy related reactions

Adverse chemotherapy reactions Hypersensitivity / anaphylaxis Oxaliplatin induced laryngopharyngeal dysaesthesia Irinotecan induced cholinergic syndrome

Treatment of anaphylaxis 1. Mild reaction: stop administration administer antihistamine & steroids IV if prescribed medical review and assessment 2. Severe reaction: stop administration administer adrenaline IM oxygen and IV fluids call for urgent medical assistance

Chemotherapy most likely to cause anaphylaxis Carboplatin: - rare 1st line - 25% risk for 2nd line - can occur well into infusion Taxanes: paclitaxel or docetaxel - commonly react after only a few mls - can often be safely restarted

Oxaliplatin induced laryngopharyngeal dysaesthesia Acute sensation of difficulty in breathing / tightness in throat Usually at the end of infusion or in the first few hours afterwards Can be triggered by exposure to cold air / drinks Not accompanied by drop in O2 sats, reduced air entry or hypotension

Prevention of laryngopharyngeal dysaesthesia Prepare patient Do not leave immediately after end of infusion, have a warm drink at end of infusion No cold drinks for 24 -48 hours Wear warm scarf to cover nose and throat on leaving Do not drive yourself home Bring car close to exit

Treatment of laryngopharyngeal dysaesthesia Assess & ensure this is not anaphylaxis Reassure Provide warm drink Warm patient Observe closely – BP, O2 sats, resps Lorazepam sublingual may be helpful if does not settle quickly

Irinotecan induced cholinergic syndrome Symptoms occur during or shortly after completion of infusion; Abdominal pain / stomach cramps Diarrhoea Sweating Blurred vision Hypotension Increased salivation

Treatment & prevention of cholinergic syndrome Treatment of acute symptoms: Assess patient administer atropine 250mcg subcutaneous injection Prevention: As distressing symptoms will occur in 80 -90% of patients administer atropine 250mcg prophylaxis immediately pre infusion