Hypersensitivity Reaction after Transarterial Chemoembolization

Transarterial chemoembolization (TACE) is commonly employed in the locoregional therapy (LRT) of patients with hepatocellular carcinoma (HCC). This procedure is generally well tolerated and carries a low overall risk of morbidity, with major adverse events occurring in approximately 2 to 5% of cases.[1] [2] Recognized complications include technical events (e.g., vessel injury), hepatic events (e.g., liver failure, infarction, abscess), extrahepatic events (e.g., cholecystitis, hematologic suppression, gastrointestinal ulceration, contrast-induced nephropathy), and other side effects (e.g., postembolization syndrome).[3] Chemotherapy hypersensitivity reaction is a rare potential adverse event of TACE that may result in acute clinical deterioration, and as such warrants awareness and recognition by interventional radiologists (IRs) performing TACE. This report presents the case of a patient who developed a hypersensitivity reaction after TACE, and provides an overview of the clinical manifestations, diagnostic considerations, and management strategies for this uncommon complication.

Publication History

Article published online:
01 October 2020

• References

• 1 Clark TW. Complications of hepatic chemoembolization. Semin Intervent Radiol 2006; 23 (02) 119-125
• 2 Tu J, Jia Z, Ying X. , et al. The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma. Medicine (Baltimore) 2016; 95 (49) e5606
• 3 Gaba RC, Lokken RP, Hickey RM. , et al. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for transarterial chemoembolization and embolization of hepatic malignancy. J Vasc Interv Radiol 2017; 28 (09) 1210-1223.e3
• 4 Kawaoka T, Aikata H, Katamura Y. , et al. Hypersensitivity reactions to transcatheter chemoembolization with cisplatin and Lipiodol suspension for unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2010; 21 (08) 1219-1225
• 5 Pagani M. The complex clinical picture of presumably allergic side effects to cytostatic drugs: symptoms, pathomechanism, reexposure, and desensitization. Med Clin North Am 2010; 94 (04) 835-852 , xiii
• 6 Markman M, Kennedy A, Webster K. , et al. Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 1999; 17 (04) 1141
• 7 Gobel BH. Chemotherapy-induced hypersensitivity reactions. Oncol Nurs Forum 2005; 32 (05) 1027-1035
• 8 Solimando Jr DA, Wilson JP. Doxorubicin-induced hypersensitivity reactions. Drug Intell Clin Pharm 1984; 18 (10) 808-811
• 9 Kunkeler L, Nieboer C, Bruynzeel DP. Type III and type IV hypersensitivity reactions due to mitomycin C. Contact Dermat 2000; 42 (02) 74-76
• 10 Brown KT. Fatal pulmonary complications after arterial embolization with 40-120- micro m tris-acryl gelatin microspheres. J Vasc Interv Radiol 2004; 15 (02) , Pt 1 197-200
• 11 Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation 2015; 131 (10) 861-870
• 12 Runge JW, Martinez JC, Caravati EM, Williamson SG, Hartsell SC. Histamine antagonists in the treatment of acute allergic reactions. Ann Emerg Med 1992; 21 (03) 237-242
• 13 Shepherd GM. Hypersensitivity reactions to chemotherapeutic drugs. Clin Rev Allergy Immunol 2003; 24 (03) 253-262
• 14 Varela M, Real MI, Burrel M. , et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007; 46 (03) 474-481
• 15 Brown KT, Do RK, Gonen M. , et al. Randomized trial of hepatic artery embolization for hepatocellular carcinoma using doxorubicin-eluting microspheres compared with embolization with microspheres alone. J Clin Oncol 2016; 34 (17) 2046-2053