Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration

Chemotherapy. 2005 May;51(2-3):116-9. doi: 10.1159/000085618. Epub 2005 May 9.

Abstract

Background: Taxanes cause hypersensitivity reactions, averted by premedication with H1 blockers and high glucocorticoid (GC) doses. Prolonged weekly taxane administration may lead to GC toxicity.

Purpose: To determine whether patients not hypersensitive to initial paclitaxel (PTX) infusion after high-dose GC premedication will tolerate subsequent, prolonged PTX treatment without GC prophylaxis.

Patients and methods: In 115/122 breast cancer patients not hypersensitive to initial PTX treatment, 20 mg dexamethasone (DXM) doses were tapered by 2.0 mg/week, reaching 0 in those receiving 9 or more courses. After 4 PTX courses, diphenhydramine was administered orally, rather than intravenously.

Results: PTX was administered 143 times after 2.0-5.0 mg of DXM and 357 times without DXM. A total of 46 patients received 1-40 PTX courses without DXM. None of these 115 patients experienced hypersensitivity reactions.

Conclusion: Patients unreactive to their first PTX infusions, after high-dose and tapering GC premedication, may not require GC prophylaxis for subsequent PTX therapy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Allergic Agents / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / therapeutic use
  • Antineoplastic Agents, Phytogenic / administration & dosage*
  • Antineoplastic Agents, Phytogenic / adverse effects
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Breast Neoplasms / drug therapy
  • Dexamethasone / administration & dosage*
  • Dexamethasone / therapeutic use
  • Diphenhydramine / therapeutic use
  • Drug Administration Schedule
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / prevention & control
  • Drug Therapy, Combination
  • Female
  • Humans
  • Middle Aged
  • Paclitaxel / administration & dosage*
  • Paclitaxel / adverse effects
  • Paclitaxel / therapeutic use
  • Prospective Studies

Substances

  • Anti-Allergic Agents
  • Anti-Inflammatory Agents
  • Antineoplastic Agents, Phytogenic
  • Dexamethasone
  • Diphenhydramine
  • Paclitaxel