Hypersensitivity reactions to paclitaxel with a modified dexamethasone intravenous premedication regimen

Abstract

Background: The conventional paclitaxel premedication regimen consists of two oral dexamethasone doses of 20 mg each taken 12 h and 6 h before paclitaxel administration. For the sake of convenience, the premedication regimen has been modified with a single dose of dexamethasone administered intravenously 30–60 min before paclitaxel, omitting the oral doses. We assessed the rate of hypersensitivity reactions (HSRs) when a modified dexamethasone regimen was used. Materials and Methods: This was an observational prospective cohort study in patients receiving paclitaxel chemotherapy. We recorded demographics, prior history of allergy and comorbidities, diagnosis, chemotherapy regimen with schedule, details of HSRs, and details of rechallenge. Descriptive analysis and simple percentages were performed. Results: Between February 2011 and May 2011, 310 patients received 495 cycles of paclitaxel chemotherapy. The median age was 50 years, 77% of patients were female. Sixty-nine percent of patients had breast and gynecologic malignancies. Forty-four percent of patients were chemonaive. Sixty-eight percent of the paclitaxel cycles were once-in-3-week regimens; the remaining 32% were once a week. In all the paclitaxel cycles, a modified premedication regimen was administered. The dose of intravenous dexamethasone was 0 (n = 20), 8 mg (n = 210), 12 mg (n = 1), 16 mg (n = 56), and 20 mg (n = 163). The incidence of HSRs was 1.6%, with 1.2% incidence of severe hypersensitivity. No patient required hospitalization for the management of hypersensitivity. Three patients were rechallenged with paclitaxel after the development of hypersensitivity; all tolerated rechallenge without further infusion reactions. Conclusion: A modified dexamethasone premedication regimen is a safe and convenient option with a low risk of hypersensitivity.