From the Guidelines
Taxol (paclitaxel) can cause respiratory failure through hypersensitivity pneumonitis, interstitial pneumonitis, and fluid retention, and management includes immediate discontinuation of the drug, oxygen therapy, bronchodilators, and corticosteroids. The most common mechanism is hypersensitivity pneumonitis, which typically occurs during infusion or within hours afterward, presenting with dyspnea, bronchospasm, and hypoxemia, due to the Cremophor EL vehicle rather than paclitaxel itself 1. Another serious complication is interstitial pneumonitis, which can develop days to weeks after treatment, causing progressive dyspnea, cough, and hypoxemia. Taxol can also cause fluid retention and pleural effusions that compromise respiratory function. Prevention strategies include premedication with dexamethasone, diphenhydramine, and H2 blockers like ranitidine 30 minutes before administration, as recommended by the ESMO clinical practice guidelines 1. Some key points to consider in the management of infusion reactions to taxanes include:
- All patients should receive premedication with corticosteroids plus antihistamines before taxane administration 1
- Patients who experience severe hypersensitivity reactions to taxanes should not be rechallenged with these drugs 1
- Successful desensitisation protocols have been developed for patients who require continued treatment with taxanes despite a history of hypersensitivity reactions 1. The pathophysiology involves both direct pulmonary toxicity and immune-mediated inflammation triggered by the drug or its vehicle, and patients with pre-existing lung disease or prior chest radiation are at higher risk and should be monitored closely 1.
From the Research
Respiratory Failure from Taxol
- Taxol, also known as paclitaxel, is a chemotherapeutic agent used to treat various cancers, but it has certain disadvantages, including the potential to cause adverse effects on patient health 2.
- One of the adverse effects of Taxol is respiratory failure, which can be life-threatening and requires immediate medical attention.
- The management of respiratory failure due to Taxol or other causes involves mechanical ventilation, which can be invasive or noninvasive, and requires careful monitoring and adjustment of ventilatory support parameters 3, 4, 5.
- In cases of respiratory failure caused by Taxol, the treatment strategy may involve supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause 4.
- Paclitaxel has been associated with significant toxicities, including myelosuppression and peripheral neuropathy, which can limit its effectiveness as a chemotherapeutic agent 6.
- Novel delivery strategies are being developed to limit the toxicities associated with paclitaxel treatment and improve its effectiveness as an anticancer agent 2, 6.