The Evaluation of Paclitaxel Hypersensitivity Reactions (Hsrs) Following the Discontinuation of Prophylactic Pre-Medications

Abstract

ABSTRACT Aim: Paclitaxel administration is associated with hypersensitivity reactions (HSRs), which are infrequent beyond the second dose. The incidence of HSRs is reported to range from 8-45%, (severe reactions occurring in 2%). Pre-medication with dexamethasone, diphenhydramine, and famotidine are typically administered to reduce the risk of HSRs, but are associated with adverse effects and longer visit time. In January 2014, our institution implemented a policy to discontinue pre-medications for all patients receiving paclitaxel-based regimens beyond paclitaxel dose two. We sought to evaluate this practice change and hypothesize that this policy is unlikely to result in an increased rate of HSRs. Methods: During a four-month period, pre-medications were discontinued in 187 patients receiving paclitaxel-based chemotherapy, who were HSR free on two previous pre-medicated doses. 111 patients received paclitaxel+platinum and 76 patients received paclitaxel +/- trastuzumab. 65 patients received weekly paclitaxel, 7 patients received dose-dense paclitaxel every 2 weeks and 115 patients received paclitaxel every 3 weeks. Surveys were administered to patients receiving weekly paclitaxel to evaluate adverse effects and patient preference. Time required to administer pre-medications was tracked. Results: Two of 111 patients receiving paclitaxel+platinum (1.80%) and 2 of 76 patients receiving paclitaxel +/- trastuzumab (2.63%) had non-severe HSRs (NCI CTCAE grade 2 or lower). An average of 92.6 minutes of chair time per patient (per clinic visit), was saved following the discontinuation of pre-medications. A total of 51, 856 minutes (864 hours) of chair time was saved during the four-month study. Of 52 surveys, 23 (44%) were returned and 86.9% of patients preferred treatment without pre-medications compared to the first two doses with pre-medications. Conclusions: In patients receiving paclitaxel+platinum regimens or paclitaxel +/- trastuzumab, the discontinuation of pre-medications is a safe and feasible option if a patient has not experienced an HSR during the first or second dose of paclitaxel. Disclosure: All authors have declared no conflicts of interest.