Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration.
BACKGROUND
Taxanes cause hypersensitivity reactions, averted by premedication with H1 blockers and high glucocorticoid (GC) doses. Prolonged weekly taxane administration may lead to GC toxicity.


OBJECTIVE
To determine whether patients not hypersensitive to initial paclitaxel (PTX) infusion after high-dose GC premedication will tolerate subsequent, prolonged PTX treatment without GC prophylaxis.


METHODS
In 115/122 breast cancer patients not hypersensitive to initial PTX treatment, 20 mg dexamethasone (DXM) doses were tapered by 2.0 mg/week, reaching 0 in those receiving 9 or more courses. After 4 PTX courses, diphenhydramine was administered orally, rather than intravenously.


RESULTS
PTX was administered 143 times after 2.0-5.0 mg of DXM and 357 times without DXM. A total of 46 patients received 1-40 PTX courses without DXM. None of these 115 patients experienced hypersensitivity reactions.


CONCLUSIONS
Patients unreactive to their first PTX infusions, after high-dose and tapering GC premedication, may not require GC prophylaxis for subsequent PTX therapy.
Braverman
Albert S
AS
Downstate College of Medicine, State University of New York, New York, NY 11203-2098, USA. abraverman@downstate.edu
Rao
Sujatha
S
Salvatti
Mary Ellen
ME
Adamson
Barbara
B
McManus
Margaret
M
Pierre
Shirley
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004155:Diphenhydramine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies
D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D000972:Antineoplastic Agents, Phytogenic; D003907:Dexamethasone; D004155:Diphenhydramine; D017239:Paclitaxel