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Medline ® Abstract for Reference 111

of 'Infusion reactions to systemic chemotherapy'

Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration.
Braverman AS, Rao S, Salvatti ME, Adamson B, McManus M, Pierre S
Chemotherapy. 2005;51(2-3):116. Epub 2005 May 9.
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.
Downstate College of Medicine, State University of New York, New York, NY 11203-2098, USA. abraverman@downstate.edu