Premedication strategy for paclitaxel, still an unsolved question after 30 years

BJMO - volume 11, issue 2, march 2017

E. Dewaele MD, C. Verschueren MSc, P. Specenier MD, PhD


Background: For paclitaxel administered 3-weekly, the Food and Drug Administration recommends the use of premedication with dexamethasone 20 mg orally twelve and six hours prior to paclitaxel, histamine–1 and –2 antagonists 30–60 minutes prior to paclitaxel, to prevent hypersensitivity reactions. There are no guidelines for the use of premedication when paclitaxel is given weekly.

Material and methods: MEDLINE was searched using the keywords premedication, dexamethasone, paclitaxel and hypersensitivity in November 2016. Articles were surveyed for additional citations.

Results: We retrieved 28 papers, of which sixteen on prospective trials (four on weekly, nine on 3-weekly paclitaxel). Using a dexamethasone tapering regimen in patients without hypersensitivity reactions after the first weekly paclitaxel administration, hypersensitivity reactions were reported in 1.0%, 2.3% and 5.7% of patients. In five single arm studies, intravenous dexamethasone 20 mg was administered prior to 3-weekly paclitaxel. Hypersensitivity reaction rates varied between 0–15%. Hypersensitivity reaction rates in sequential cohorts, in a single centre, with an intravenous or oral dexamethasone regimen were 14.5% and 5.4%, respectively (p=0.07). In a randomised trial there was no significant difference between an intravenous and oral dexamethasone regimen prior to 3-weekly paclitaxel administration.

Conclusions: Tapering of dexamethasone or no premedication at all seems to be safe in patients without hypersensitivity reactions after the first weekly administration of paclitaxel. Substitution of oral dexamethasone by a single intravenous administration immediately prior to 3-weekly paclitaxel was associated with a higher risk of hypersensitivity reactions, until 17,9%.

(BELG J MED ONCOL 2017;11(2):46–55)

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