Background: Paclitaxel has a boxed warning for causing severe hypersensitivity reactions, however, the majority (95%) of these reactions occur during the first or second infusion. Corticosteroids can reduce the incidence of paclitaxel hypersensitivity reactions from 30% to around 1%-3% but are not without adverse effects. Current practice at our institution is to prescribe dexamethasone 20 mg to be given orally 12 and 6 hours prior to paclitaxel infusion, however, some medical oncology providers have elected to decrease or omit dexamethasone premedication.
Methods: This retrospective study analyzed dexamethasone dose adjustment(s) prior to paclitaxel and the incidence of hypersensitivity reactions. Patients were included if they were ≥19 years, had breast cancer, received ≥3 doses of paclitaxel as part of (neo)adjuvant therapy, and received reduced or omitted oral dexamethasone prior to paclitaxel between January 1, 2015, and July 31, 2023. The primary outcome was incidence of rescue medication administration in those with reduced or omitted premedication dexamethasone. Secondary outcomes included dexamethasone prescribing practices and the incidence of corticosteroid-associated insomnia and hyperglycemia.
Results: The analysis included 306 infusions (corticosteroid reduction: 283; omission: 23). A hypersensitivity reaction requiring the administration of rescue medications occurred in 5 infusions in the reduction group (1.6%) and 0 infusions in the omission group, leading to a 1.6% overall incidence of infusions requiring the administration of rescue medications.
Conclusion: In conclusion, decreasing home dexamethasone prior to paclitaxel infusions did not increase the incidence of hypersensitivity reactions compared to rates reported in the literature.
Keywords: Corticosteroids; Hypersensitivity reactions; Premedication; Prescribing practices; Taxane chemotherapy.
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