Taxane desensitization protocol - any experiences? - 1259660

Jazz
Posts:279

Forgive me for reviving this subject as we've discussed this a bit on a couple of threads, but not in depth. I've used all the chemo agents available to me except for vinorelbine/Navelbine, which some of my previous docs pooh-poohed. This leads me to believe that efficacy isn't great, particularly in someone as heavily pretreated as myself.

To that end, my new oncologist has suggested a Taxane Desensitization Protocol so I might have another option, in this case probably Abraxane. He has not attempted the protocol, but printed out the abstract from a Spanish study for me to consider.
http://www.jiaci.org/issues/vol21issue2/4.pdf

I've also read of the Harvard protocol, which seems to differ a little from the Spanish one.
http://www.oncologypractice.com/co/journal/articles/0710452.pdf

Anyone have experience with this 8-9 hour procedure? It's frightening but at this point I need a fall-back in case none of the clinical trials I'm exploring pan out.

To refresh: Airway closed up within 3 minutes of Taxol infusion, inspite of benadryl and decadron. Heavy premeds and very slow infusion allowed two cycles of Taxotere, however it oozed out my veins and burned my skin, and I experienced excruciating back pain. Switched to Gemzar for fear of anaphylactic shock.

Any hope for desensitization to the taxane molecule?

Thanks a million,

Jazz

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Reply # - October 4, 2013, 03:02 PM

catdander
Posts:

Hi Jazz, I sure hope the trials pan out. I believe Ned was on navelbine for a while after being heavily treated. I may be wrong on that but it has definitely shown efficacy in some.

I will ask a doctor to comment on your question.

You know you're in my thoughts.
varoom varoom,
Janine

Reply # - October 4, 2013, 05:16 PM

JimC
Posts: 2753

Hi Jazz,

As usual, Janine is absolutely right about Ned (recce101). He had a year of some tumor shrinkage and overall stability with Navelbine, and found it to be the mildest treatment he'd received in terms of side effects, although he did have some issues with blood counts.

Hoping for the best with whatever choice you make.

JimC
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Reply # - October 4, 2013, 06:59 PM

Dr West
Posts: 4735

I don't have experience with the taxane desensitization protocol. With several comparable agents out there, I have never been so wedded to one drug that I would be inclined to persist with it in the face of significant intolerance. Instead, I'd just move on to an alternative agent with likely pretty comparable activity.

Navelbine (vinorelbine) is completely comparable in the first line setting and has lost traction because it is an older and therefore less sexy drug that hasn't been actively marketed in several years, and also that it was the comparator drug that Taxotere (docetaxel) beat in one of the pivotal trials as second line therapy. For this reason, we might sometimes cling to a choice of an agent like gemcitabine or Abraxane as being a potentially superior option to Navelbine not because the evidence is stronger that they are better, but just that there isn't as clear evidence that they fell short of Taxotere.

Even so, it's not as if Navelbine is ineffective, and in some patients it can be a very fine choice, as Ned's case illustrated. He's not the only one: I know Dr. Weiss has favored Navelbine as well for previously treated patients, and I have also come around to using it here and there for certain patients. If there's anyone in whom I'd favor it, it's someone like you who has done so well on several prior lines of therapy.

Good luck.

-Dr. West

Reply # - October 4, 2013, 09:27 PM

Jazz
Posts: 279

Thanks, Dr. West, Janine, Jim -

Yes, our dear, dear Ned!
This certainly gives me more confidence in trying Navelbine before I attempt something like the desensitization protocol. I'm somehow not convinced that it's natural to overcome the allergy, as I'm allergic to so many things as it is - penicillin, sulfa, aspirin, grass... all sorts of plant-based substances, actually. I suppose if there's some way to tell, as with the skin prick test, if the allergy is surmountable, I'd be less skeptical. With any luck, there are enough agents in trials that may be helpful.

Jazz

Reply # - October 5, 2013, 12:29 PM

dr walko
Posts: 102

Jazz,

Sorry for the delayed reply. I completely agree with trying a drug like Navelbine over the desensitization, but will provide a little information about the desensitization process for your knowledge. I've done several of these protocols for a variety of drugs including platinums, monoclonal antibodies like cetuximab and taxanes. The process involves several different infusions of very diluted drug over longer infusion protocols, working your way up to full dosing. These infusions are done back to back as one long "infusion", sometimes over 24 hours. Patients are usually admitted to the hospital for close monitoring.

Since your reaction was with paclitaxel, the most common reason patients have reactions to this drug is due to what the drug is mixed in: Cremophor EL. Without premedications, up to 30-40% of patients will have a reaction to Taxol. This is decreased to less than 5% with the premedications but they are definitely still seen. Another formulation of paclitaxel called Abraxane still has the same paclitaxel active drug but is mixed in Albumin instead of Cremophor. Reaction rates are much less to this formulation.

Best wishes,
Dr. Walko

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