Abstract
Docetaxel is a major anticancer drug that can induce hypersensitivity reactions leading to deleterious treatment interruptions. Blood hypereosinophilia could be a biological sign, potentially lethal, of delayed visceral hypersensitivity reactions. We hypothesized this biological event is probably underreported. In this prospective observational study, we followed up 149 patients treated with docetaxel monotherapy for breast or lung cancer. For each patient, blood eosinophil counts were recorded during docetaxel treatment and up to 3 months after the end of docetaxel treatment. For all patients, blood eosinophil counts significantly increased under docetaxel chemotherapy (P < 0.01). Seven percent had persistent eosinophilia after the end of treatment. Four patients had blood eosinophil counts over 1000/mm3 with severe cardiac, cutaneous and digestive toxicities, and docetaxel imputability was confirmed using drug‐imputability scales. For two of these four patients, tissue biopsies were performed during the time of hypereosinophilia and of severe toxicities. Specific immunostainings and electron microscopy found numerous degranulating mast cells and eosinophils. Our study demonstrated that eosinophilia is frequent under docetaxel and could lead to severe complications, implicating eosinophils and mast cells, and possibly IgE. One way of treating hypersensitivity reactions could be by targeting IgEs with omalizumab, an anti‐IgE monoclonal antibody approved for the treatment of severe allergic asthma, and successfully used in food and poison‐induced anaphylactic reactions.
Highlights
Docetaxel, a semi‐synthetic taxane inhibiting microtubule depolymerization, is approved for breast and lung cancer treatment
We recently reported a case of docetaxel‐induced blood hypereosinophilia with a severe digestive allergic reaction.[8]
We considered that the increase in blood eosinophil counts was significant when it was at least twice as high compared to the count before initiation of docetaxel treatment
Summary
A semi‐synthetic taxane inhibiting microtubule depolymerization, is approved for breast and lung cancer treatment. It is frequently responsible for drug‐induced hypersensitivity reactions in up to 50% of patients,[1,2] leading to deleterious treatment interruptions. We recently reported a case of docetaxel‐induced blood hypereosinophilia with a severe digestive allergic reaction.[8] We hypothesized that drug‐induced blood eosinophilia, probably underreported, could be a biological sign of hypersensitivity reaction, and could predict severe delayed visceral hypersensitivity reactions. We aimed to determine the incidence of docetaxel‐induced eosinophilia, and whether it could be an early biological event predictive for the risk of delayed visceral hypersensitivity reactions
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