title: 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.
authors.affiliation: 1 Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Ayberk
authors.initials: A
authors.lastname: Yenilmez
authors.affiliation: 2 Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Annette P
authors.initials: AP
authors.lastname: Hood
authors.affiliation: 2 Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Lien H
authors.initials: LH
authors.lastname: Nguyen
authors.affiliation: 2 Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Man Y
authors.initials: MY
authors.lastname: Merl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000008:administration & dosage*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D017239:Paclitaxel / Q000008:administration & dosage*; D011292:Premedication / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D017239:Paclitaxel
keywords: Cremophor; Paclitaxel; hypersensitivity reaction; hypersensitivity reactions; infusion reactions