title: Intravenous versus oral dexamethasone premedication in preventing Paclitaxel infusion hypersensitivity reactions in gynecological malignancies.
abstract: OBJECTIVE
  Dexamethasone premedication is required with paclitaxel to prevent infusion-related hypersensitivity reactions (HSRs). Both oral dexamethasone (PO-D; 20 mg 12 and 6 hours before paclitaxel) and intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) regimens are used. The optimal premedication regimen and management of patients after HSR are unclear.
  
  
  METHODS
  Data on HSRs in women receiving paclitaxel, 175 mg/m², every 3 weeks at Imperial College Healthcare Trust from May 2011 to February 2012 were obtained from the pharmacy database. During this period, dexamethasone premedication for paclitaxel was administered orally (PO-D; 20 mg 12 and 6 hours before paclitaxel) from May to August 2011, then changed to intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) for 3 months, and then reverted to PO-D from November 2011. There were 93 and 55 patients who received PO-D and IV-D before paclitaxel, respectively. Hypersensitivity reaction rates were pooled with those from published studies for analysis. Gynecologic oncology centers in the UK and Canada were surveyed regarding premedication and post-HSR management. A Markov Monte-Carlo simulation model compared costs and benefits of different strategies.
  
  
  RESULTS
  Hypersensitivity reaction rates with PO-D and IV-D were 5.4% (5/93) versus 14.5% (8/55) (P = 0.07) in Imperial College Healthcare Trust patients, and 6.8% (20/290) versus 14.1% (30/212) (P = 0.009) on pooled analysis with data from 2 additional studies (502 patients), respectively. However, IV-D is the most common premedication regimen used in the UK and Canada (48.5% and 34.2% of centers). Post-HSR paclitaxel on a desensitization protocol is a cost-effective alternative to discontinuing paclitaxel altogether.
  
  
  CONCLUSIONS
  Oral dexamethasone seems to be superior to IV-D in preventing HSRs. Post-HSR patients should be considered for desensitization.
authors.affiliation: Department of Oncology, Imperial College Healthcare NHS Trust, London, UK. sean.m.ocathail@gmail.com
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Cathail
authors.forename: Roekshana
authors.initials: R
authors.lastname: Shaboodien
authors.forename: Sarah
authors.initials: S
authors.lastname: Mahmoud
authors.forename: Karen
authors.initials: K
authors.lastname: Carty
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Sullivan
authors.forename: Sarah
authors.initials: S
authors.lastname: Blagden
authors.forename: Hani
authors.initials: H
authors.lastname: Gabra
authors.forename: Sue
authors.initials: S
authors.lastname: Whear
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
authors.forename: Roshan
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000284:Administration, Oral; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage*; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D006801:Humans; D007275:Injections, Intravenous; D017239:Paclitaxel / Q000627:therapeutic use*; D011292:Premedication; D011379:Prognosis
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D003907:Dexamethasone; D017239:Paclitaxel