SCLC allergic to polysorbate 80 - 1288947

mcb0925
Posts:6

Hi everyone,
I was hoping someone could help with this question. My mom is currently done with chemotherapy and radiation. She will be getting a pet scan Friday, she's been more fatigued and coughing. She would like to go on nivolumab or yervoy, but these drugs have polysorbate 80 in them, which she is allergic to. During her chemo, she had to take steroids and during scans she has to follow major allergy protocol. She doesn't want to get contrast for her scan Friday because of the polysorbate 80 and she is afraid to go on a drug with that ingredient. Her reaction is tightness in chest, and rash. Is anyone familiar with this or know of any other options? Thanks so much!
Meredith

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Reply # - October 20, 2016, 06:36 AM

catdander
Posts:

Hi Meredith,

Welcome to Grace. I'm so sorry your mom has this diagnosis and hope she does as well as possible moving forward. How maddening this must be for her and you.

I will ask our oncology pharmacist to comment.

All best,
Janine

Reply # - October 20, 2016, 07:14 AM

dr walko
Posts: 102

Meredith,

Thank you for your question, allergic reactions (especially severe ones like your mother had) can be scary for sure and I understand her hesitation. I'm guessing that the reaction she has was to docetaxel, which is the drug with the highest concentration of polysorbate 80 (also known as Tween 80). The allergic reaction rates are around 20% and even with dexamethasone premedication, are still severe in 2%.

Tween 80 is a very common emulsifying agent used in foods (like ice cream) and mouthwash. The amount used in docetaxel is much higher than these non-drugs obviously. For nivolumab and ipilimumab (Yervoy), the amount of Tween 80 used is much lower than docetaxel.

Each 20 mg of docetaxel contains 540 mg of Tween 80, so if your mother's dose (I'm guessing) was around 120 mg of docetaxel, she received 3240 mg of Tween 80. The standard dose of nivolumab is 240 mg, which would give only 4.8 mg of Tween 80. Ipilimumab (Yervoy) has even less. Outside of patients with lymphoma who are more at risk for infusion reactions due to other reasons, nivolumab and ipilimumab caused infusion reactions in less than 1% of patients who received the drug.

I would encourage you and your mom to discuss these concerns with her healthcare team to help her make the best decision for her.
Best wishes,
Dr. Walko

Reply # - October 20, 2016, 08:33 AM

mcb0925
Posts: 6

Thank you so much, Dr. Walko. I really think your information will help my mom make her choice. It seems like there's a very low amount and the risk might be worth taking.

My mother's first reaction was the polysorbate 80 in the etopocide. That's how she knew of the allergy and she continued to receive the treatments but with steroids.

She's also concerned about her pet scan she's getting tomorrow. She wan't to make sure there's no polysorbate 80 in the pet scan material. She can't get ahold of the radiologist, so in the mean time I'm hoping maybe I can try to find info for her. She can't take steroids before the pet scan because it interferes with the sugar.

Thank you again for your help. I relayed the information to my mother and she found it very helpful!

Best,
Meredith

Reply # - October 20, 2016, 08:56 AM

dr walko
Posts: 102

Meredith,

Etoposide has less Tween 80 than docetaxel but still much more than nivolumab or ipilimumab. There are several formulations of the IV etoposide but in general, about 20 mg of etoposide has 80 mg of Tween 80 and your mother probably got a few hundred mg of Tween 80 with that drug based on typical dosing.

Best wishes,
Dr. Walko

Reply # - October 20, 2016, 10:51 AM

mcb0925
Posts: 6

Thank you. Do you know if there's polysorbate 80 in the pet scan filler?
Thanks again

Reply # - October 20, 2016, 10:59 AM

dr walko
Posts: 102

Meredith,

I'm not sure exactly what tracer they are using for the PET scan your mother is getting so cannot answer that unfortunately. There are several different ones that can be used.

Dr. Walko

Reply # - October 20, 2016, 01:43 PM

mcb0925
Posts: 6

Thanks Dr. Walko. Sloan Memorial was able to provide me with the manufacturer for the pet scan tracer and they confirmed there's no polysorbate 80. Thank you so much for helping out with these questions. You may not realize, but it's extremely helpful for our family, especially when dealing with a large hospital.

I think she feels better knowing there's such a low dose of polysorbate 80 in the clinical drugs(nivolumab, yervoy, etc). I wish they had these drugs in oral form. Intravenously always seems so much more intense.

Thanks again,
Meredith

Reply # - October 21, 2016, 12:21 PM

catdander
Posts:

Meredith, I don't know if Dr. Walko will respond but I know she understands how helpful this is. Our faculty take time out of the busy days to help just for that reason. Dr. Walko never misses an opportunity to respond to our calls for help. She's been there like the rest of us and knows how important this is. Know that you're not alone even though it feels like it too much of the time.

Thanks and good luck,
Janine

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