Efficacy and Safety of a Single Dose of Dexamethasone Pre Docetaxel Treatment: the Auckland Experience

Abstract

ABSTRACT Aim: Auckland City Hospital implemented a change to single intravenous (IV) pre-medication (pre-med) 20mg dose of dexamethasone pre-docetaxel treatment, because of patient (pt) reports of un-wanted side effects of insomnia, reflux-oesophagitis, weight gain with multi-dose regimens, and treatment delays to missed oral pre-med doses of dexamethasone. The new pre-med regimen was based on data by Choudham, J Oncol Pharm Practice, 2011. Methods: An audit tool was developed and data were collected prospectively to identify the impact of symptoms and overall safety in pts receiving this regimen. All pts received outpatient treatment at 3 week intervals. 610 cycles of docetaxel were administered to 160 pts with breast, lung, prostate, head & neck cancer who received the following regimens; FEC-D, TC, TH, TCH, Docetaxel, Docetaxel/Carboplatin±trastuzumab, and TPF. Demographics; 126 female and 34 male, median age 53 years (range 28-78). 134 pts commenced treatment with single pre-med dose of dexamethasone (SD). Multi-day (MD) group comprised various IV/PO dexamethasone regimens ranging from day -1 to day 4 (n = 26). The MD group included prostate pts who received IV 20mg dexamethasone plus prednisone 5mg PO BD continuously. Oedema at/before cycle 3 in SD and MD groups were compared. Results: Infusion hypersensitivity reactions (HSR) occurred in 17 cycles (3%) and in 13 patients (8%). 1 pt experienced a severe reaction, leading to treatment discontinuation. Docetaxel was successfully re-administrated after corticosteroids and anti-histamine in all 16 mild/moderate HSR. No HSR occurred after cycle 4. Only 1 pt experienced a weight gain of >10%. Oedema Cycle 3 Nausea & vomiting Cycle 1 Hand/foot syndrome (HFS) Cycle 1 SD 11% 32% 29% MD 12% 35% 11% Conclusions: Single dose dexamethasone is an acceptable first-line pre-med for docetaxel, with the option of adding in additional doses as required. Rates of oedema, N&V and weight gain were comparable to MD regimens. Infusion HSR rate is low and acceptable. Anecdotally it results in less insomnia and reflux-oesophagitis, though a formal comparison would be required to demonstrate this conclusively with validated tools. HFS appears to be more common. Disclosure: All authors have declared no conflicts of interest.