Impact of institutional interventions on the rate of paclitaxel hypersensitivity reactions

Abstract

Purpose Paclitaxel is associated with hypersensitivity reactions (HSRs). Intravenous premedication regimens have been devised to decrease the incidence and severity of HSRs. At our institution oral histamine 1 receptor antagonists (H1RA) and histamine 2 receptor antagonists (H2RA) were adopted as standard. Standardizations were implemented for consistent premedication use in all disease states. The purpose of this retrospective study was to compare the incidence and severity of HSRs before and after standardization. Methods Patients who received paclitaxel from 20 April 2018 to 8 December 2020 having an HSR were included in analysis. An infusion was flagged for review if a rescue medication was administered after the start of the paclitaxel infusion. The incidences of all HSR prior to and post-standardization were compared. A subgroup analysis of patients receiving paclitaxel for the first and second time was performed. Results There were 3499infusions in the pre-standardization group and 1159infusions in the post-standardization group. After review, 100 HSRs pre-standardization and 38 HSRs post-standardization were confirmed reactions. The rate of overall HSRs was 2.9% in the pre-standardization group and 3.3% in the post-standardization group ( p = 0.48). HSRs, during the first and second doses of paclitaxel, occurred in 10.2% of the pre-standardization and 8.5% of the post-standardization group ( p = 0.55). Conclusions This retrospective interventional study demonstrated that same-day intravenous dexamethasone, oral H1RA, and oral H2RA are safe premedication regimens for paclitaxel. No change in the severity of reactions was seen. Overall, better adherence to premedication administration was seen post-standardization.

Elotuzumab: Empiric analysis of dexamethasone administration schedule

“…Overall, the dosage and duration of corticosteroid premedication for anticancer treatments (biologic therapy, chemotherapy, immunotherapy) varies with some regimens starting corticosteroid administration the day before and others the day of treatment administration. [22][23][24] Notably, registration trial safety data was contingent on administration of intravenous dexamethasone 8 mg 45-to 90-minutes prior to start of elotuzumab infusion. 11 It seems prudent to maintain the 45to 90-minute interval between dexamethasone administration using a standard dose amount and start of elotuzumab infusion, particularly with the first treatment cycle.…”