Etoposide Desensitization After Cardiac Arrest in Metastatic Small Cell Lung Cancer

What happened, in summary

A 61-year-old woman was diagnosed in October 2019 with Stage IV small cell lung cancer that had spread to the brain. She began cisplatin and etoposide phosphate. During her second cycle, she developed severe bronchospasm while etoposide was being given and went into cardiorespiratory arrest, requiring resuscitation and intensive-care treatment.

Chemotherapy was changed to carboplatin and irinotecan, but severe diarrhea made that alternative difficult to continue. Because etoposide remained an important treatment option, she was referred to an allergy team for a closely monitored desensitization approach. A 16-step protocol allowed etoposide phosphate to be given again. The dose was later reduced because of severe blood-count toxicity, and she successfully completed additional cycles through the desensitization process.

The cancer eventually progressed and systemic treatment was changed again. She died in September 2021. The documented cause of death was multifactorial progressive leukoencephalopathy, meningopyoventriculitis, and brain atrophy rather than a simple attribution to lung-cancer progression. Her case centers on maintaining access to a key chemotherapy drug after a life-threatening hypersensitivity reaction.