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Intravenous Versus Oral Dexamethasone Premedication in Preventing Paclitaxel Infusion Hypersensitivity Reactions in Gynecological Malignancies
  1. Sean M. O’Cathail, MB, BCh, MRCP, MRCPI*,
  2. Roekshana Shaboodien, MBBS*,
  3. Sarah Mahmoud, BSc (Pharm),
  4. Karen Carty,
  5. Patrick O’Sullivan, BSc (Pharm),
  6. Sarah Blagden, MB, BSc, PhD*,
  7. Hani Gabra, MB, BSc, PhD*,
  8. Sue Whear, BSc (Pharm),
  9. Janice S. Kwon, MD§ and
  10. Roshan Agarwal, MB, BSc, PhD*
  1. *Departments of Oncology and
  2. Pharmacy, Imperial College Healthcare NHS Trust, London;
  3. Cancer Research UK Clinical Trials Unit, The Beatson West of Scotland Cancer Centre, Glasgow, UK; and
  4. §Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada.
  1. Address correspondence and reprint requests to Sean M. O’Cathail, MB, BCh, MRCP, MRCPI, Department of Oncology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London, W12 0HS, UK. E-mail: sean.m.ocathail{at}gmail.com.

Abstract

Objective Dexamethasone premedication is required with paclitaxel to prevent infusion-related hypersensitivity reactions (HSRs). Both oral dexamethasone (PO-D; 20 mg 12 and 6 hours before paclitaxel) and intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) regimens are used. The optimal premedication regimen and management of patients after HSR are unclear.

Methods Data on HSRs in women receiving paclitaxel, 175 mg/m2, every 3 weeks at Imperial College Healthcare Trust from May 2011 to February 2012 were obtained from the pharmacy database. During this period, dexamethasone premedication for paclitaxel was administered orally (PO-D; 20 mg 12 and 6 hours before paclitaxel) from May to August 2011, then changed to intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) for 3 months, and then reverted to PO-D from November 2011. There were 93 and 55 patients who received PO-D and IV-D before paclitaxel, respectively. Hypersensitivity reaction rates were pooled with those from published studies for analysis. Gynecologic oncology centers in the UK and Canada were surveyed regarding premedication and post-HSR management. A Markov Monte-Carlo simulation model compared costs and benefits of different strategies.

Results Hypersensitivity reaction rates with PO-D and IV-D were 5.4% (5/93) versus 14.5% (8/55) (P = 0.07) in Imperial College Healthcare Trust patients, and 6.8% (20/290) versus 14.1% (30/212) (P = 0.009) on pooled analysis with data from 2 additional studies (502 patients), respectively. However, IV-D is the most common premedication regimen used in the UK and Canada (48.5% and 34.2% of centers). Post-HSR paclitaxel on a desensitization protocol is a cost-effective alternative to discontinuing paclitaxel altogether.

Conclusion Oral dexamethasone seems to be superior to IV-D in preventing HSRs. Post-HSR patients should be considered for desensitization.

  • Docetaxel
  • Nab-paclitaxel
  • Desensitization

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Footnotes

  • This work was supported by funding from the Imperial Experimental Cancer Medicine Centre and Biomedical Research Centre grants from Cancer Research UK and NIHR.

  • Contribution to authorship: SMO’C is the principal author of the manuscript. SMO’C and RA designed the audit. SMO’C, RS, RR, SM, and SW were involved in data collection. SMO’C and PO’S performed the systematic literature review. KC and JK coordinated the survey of gyne-oncology physicians. SMO’C and RA performed the data analysis. JK performed the cost effectiveness analysis. RA and JK are the senior corresponding authors. All authors were involved in drafting and proofing of the manuscript.

  • The authors declare no conflicts of interest.

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