Feasibility of withholding dexamethasone premedication for hypersensitivity reactions associated with paclitaxel administration
Article Category: Brief communication (Original)
Published Online: Jan 31, 2017
Page range: 371 - 377
DOI: https://doi.org/10.5372/1905-7415.1004.500
Keywords
© 2016 Walailuk Tanpipattanakul, Nattaya Poovorawan, Thanapoom Rattananupong, Poranee Laoitthi, Piyada Sithidetphaiboon, Suebpong Thanasanvimon, Virote Sriuranpong, Napa Parinyanitikul
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background
Premedication with dexamethasone is crucial to prevent hypersensitivity reactions (HSR) associated with administration of taxanes. However, high dose and prolonged exposure to dexamethasone may cause adverse effects.
Objectives
To determine the incidence of HSR in patients with early breast cancer who did or did not receive dexamethasone prophylaxis for weekly paclitaxel infusions.
Methods
We retrospectively reviewed the records of a cohort of patients with early breast cancer who received paclitaxel weekly from January 2012 through March 2015 at King Chulalongkorn Memorial Hospital. All patients received a standard premedication protocol including dexamethasone before their first paclitaxel infusion. Dexamethasone was omitted in later cycles in some patients at the discretion of the attending physician. Data concerning the baseline characteristics of the patient, details of the premedication protocol, including dose and schedule of dexamethasone, and HSR events were collected in this observational study.
Results
Data were drawn from 86 breast cancer patients (median age 52.6 years) treated with a total of 984 cycles of paclitaxel chemotherapy. No patient had any history of allergy or HSR to taxanes. Dexamethasone was omitted in 617 later cycles. Six patients had grade II-III HSR (7.0%), which occurred mostly during the first 6 cycles (5/6, 83.3%). The incidence of HRS was 3/367 cycles (0.82%) with dexamethasone premedication (
Conclusions
Withholding dexamethasone premedication for paclitaxel chemotherapy was feasible, and did not result in a higher incidence of HSR. However, an optimal schedule for dexamethasone warrants investigation in a prospective manner.