Feasibility of withholding dexamethasone premedication for hypersensitivity reactions associated with paclitaxel administration

Abstract

Abstract 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 (P = 0.99) and 5/617 (0.81%) without. 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.