Feasibility of stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction
Paclitaxel-based chemotherapy continues to be an integral component in the treatment of many solid tumors. Prolonged use of paclitaxel may result in repeated doses of premedications and potential unwanted side effects. Infusion hypersensitivity reactions occurring beyond the second dose are infrequent and not well characterized. We hypothesized that patients whose paclitaxel premedications were discontinued after two doses were unlikely to experience infusion hypersensitivity reactions with subsequent paclitaxel doses.
Patients receiving paclitaxel-based chemotherapy who did not experience an infusion hypersensitivity reaction with their first or second dose had their paclitaxel premedications discontinued. The primary endpoint was to estimate the incidence of rescue medication for the treatment of paclitaxel infusion hypersensitivity during doses 3 to 6 for patients whose paclitaxel premedications had been discontinued.
After receiving the first two doses of paclitaxel-based chemotherapy without experiencing an infusion hypersensitivity reaction (any grade), 55 breast cancer patients had their premedications discontinued for all remaining paclitaxel doses. None of these patients required rescue medication to treat an infusion hypersensitivity reaction with subsequent doses.
In patients who have not experienced an infusion hypersensitivity reaction with the first two doses of paclitaxel, discontinuation of paclitaxel premedications may be considered an option without an increased risk of infusion hypersensitivity requiring rescue medication.
- Sparano JA et al (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358(16):1663–1671 CrossRef
- Seidman AS et al (2008) Randomized phase III trial of weekly compared with every-3-weeks paclitaxel for metastatic breast cancer, with trastuzumab for all HER-2 overexpressors and random assignment to trastuzumab or not in HER-2 nonoverexpressors: final results of Cancer and Leukemia Group B protocol 9840. J Clin Oncol 26(10):1642–1649 CrossRef
- Taxol® injection (package insert). Princeton, NJ: Bristol-Myers Squibb Company; July 2007
- Miller K et al (2007) Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 357(26):2666–2676 CrossRef
- Markman M et al (1999) An effective and more convenient drug regimen for prophylaxis against paclitaxel-associated hypersensitivity reactions. J Cancer Res Clin Oncol 125(7):427–429 CrossRef
- Bookman MA et al (1997) Intravenous prophylaxis for paclitaxel-related hypersensitivity reactions. Semin Oncol 24(6 Suppl 19):S19-13-S19-15
- Kloover JS et al (2004) Fatal outcome of a hypersensitivity reaction to paclitaxel: a critical review of pre-medication regimens. Br J Cancer 90:304–305 CrossRef
- Micromedex. Diphenhydramine. v 1.0 2007. http://www.thomsonhc.com/micromedex2/librarian. Accessed March 2007
- Quock J et al (2002) Premedication strategy for weekly paclitaxel. Cancer Invest 20(5–6):666–672 CrossRef
- Koppler H et al (2001) Dose reduction of steroid premedication for paclitaxel: no increase of hypersensitivity reactions. Onkologie 24(3):283–285, English, German CrossRef
- Braverman AS et al (2005) Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration. Chemotherapy 51(2–3):116–119, Epub 2005 May 9 CrossRef
- Lenz HJ (2007) Management and preparedness for infusion and hypersensitivity reactions. Oncologist 12(5):601–609 CrossRef
- Markman M et al (2000) Paclitaxel-associated hypersensitivity reactions: experience of the gynecologic oncology program of the Cleveland Clinic Cancer Center. J Clin Oncol 18(1):102–105
- Zanotti KM, Markman M (2001) Prevention and management of antineoplastic-induced hypersensitivity reactions. Drug Saf 24(10):767–779 CrossRef
- Gradishar WJ et al (2005) Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol 23(31):7794–7803 CrossRef
- Sumikawa T et al (2008) Dexamethasone interferes with trastuzumab-induced cell growth inhibition through restoration of AKT activity in BT-474 breast cancer cells. Int J Oncol 32(3):683–688
- Morita M et al (2007) Dexamethasone inhibits paclitaxel-induced cytotoxic activity through retinoblastoma protein dephosphorylation in non-small cell lung cancer cells. Int J Oncol 30(1):187–192
- Feasibility of stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Supportive Care in Cancer
Volume 20, Issue 9 , pp 1991-1997
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Pharmacy Department, The James Comprehensive Breast Center, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
- 2. Medical Oncology Department, The James Comprehensive Breast Center, The Arthur G. James Cancer Hospital at the Ohio State University Medical Center, Columbus, USA
- 3. Nursing Excellence, The James Comprehensive Breast Center, The Arthur G. James Cancer Hospital at the Ohio State University Medical Center, Columbus, USA
- 4. The Ohio State University Center for Biostatistics, Columbus, USA