Paclitaxel pre-medication: A comparison of two steroid pre-medication protocols

Abstract

Purpose

To evaluate and compare the rate of hypersensitivity reactions between two low-dose steroid pre-medication regimens for paclitaxel-based treatments.

Methods

This was a single-center, retrospective, descriptive study, comparing the incidence of hypersensitivity reactions in two different dexamethasone pre-medication regimens that took place between July 2013 to December 2014. Patients who were paclitaxel-naïve with a diagnosis of breast or gynecological cancers were included. Patients in the early termination protocol were pre-medicated with a standard pre-medication regimen and if tolerated with no hypersensitivity reaction occurrence, all pre-medications were discontinued after the first two infusions. Patients in the low-dose steroid continuation protocol were pre-medicated with lower doses of dexamethasone, and if the infusion was tolerated with no hypersensitivity reaction, dexamethasone doses were further reduced after the first two infusions.

Results

A total of 120 patients were included for data analysis. The hypersensitivity reaction rate in the early termination protocol group was 7% (4 out of 60 patients). The hypersensitivity reaction rate in the low-dose continuation protocol group was 5% (3 out of 60 patients). All hypersensitivity reactions occurred during the first infusion, with no hypersensitivity reactions occurring once the dexamethasone pre-medications were discontinued or dose-reduced. All of the patients who experienced a hypersensitivity reaction were successfully re-challenged with paclitaxel and were able to continue their therapy uninterrupted.

Conclusion

Discontinuing dexamethasone pre-medication altogether after two uneventful infusions or decreasing the dose of dexamethasone paclitaxel pre-medication are both safe alternatives to high-dose steroid pre-medications recommended in product labeling.

Keywords

Paclitaxel hypersensitivity reaction hypersensitivity reactions infusion reactions Cremophor

Get full access to this article

View all access options for this article.

References

Weiss

Donehower

Wiernik

et al.

Hypersensitivity reactions from taxol. J Clin Oncol 1990; 8: 1263–1268.

Taxol® injection [package insert]. Princeton, NJ: Bristol-Myers Squibb Company, 2007.

Zanotti

Markman

. Prevention and management of antineoplastic-induced hypersensitivity reactions. Drug Saf 2001; 24: 767–779.

Peereboom

Donehower

Eisenhauer

et al.

Successful re-treatment with Taxol after major hypersensitivity reactions. J Clin Oncol 1993; 11: 885–890.

Lenz

. Management and preparedness for infusion and hypersensitivity reactions. Oncologist 2007; 12: 601–609.

Quock

Dea

Tanaka

et al.

Premedication strategy for weekly paclitaxel. Canc Investig 2002; 20: 666–672.

Bookman

Kloth

Kover

et al.

Short-course intravenous prophylaxis for paclitaxel-related hypersensitivity reactions. Ann Oncol 1997; 8: 611–614.

National Cancer Institute. Common Terminology Criteria for Adverse Events v.4.0 (CTCAE), http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm (2009, accessed 21 June 2015).

Berger

Dunlea

Rettig

et al.

Feasibility of stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction. Support Care Canc 2012; 20: 1991–1997.

10.

Berger

Vargo

Vincent

et al.

Stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction. Support Care Canc 2015; 23: 2019–2024.