Feasibility of withholding dexamethasone premedication for hypersensitivity reactions associated with paclitaxel administration
, , , , , , and | Jan 31, 2017
About this article
Article Category: Brief communication (Original)
Published Online: Jan 31, 2017
Page range: 371 - 377
DOI: https://doi.org/10.5372/1905-7415.1004.500
Keywords
© 2016 Walailuk Tanpipattanakul, Nattaya Poovorawan, Thanapoom Rattananupong, Poranee Laoitthi, Piyada Sithidetphaiboon, Suebpong Thanasanvimon, Virote Sriuranpong, Napa Parinyanitikul
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1
Hypersensitivity reaction (HSR) in 6 patients after weekly paclitaxel administration
| Age (y) | Paclitaxel cycle in | Premedication with | ||
|---|---|---|---|---|
| which HSR | dexamethasone | Signs and | Note** | |
| (cycle) developed | (dose, mg) | symptoms of HSR | ||
| 33 | 1st | 10 mg | Flushing | After HSR in the 1st cycle, she received dexamethasone 10 mg premedication in all other cycles |
| 54 | 2nd | 0 mg | Sweating, abdominal and back pain | In the 1st cycle, she received 10 mg dexamethasone; it was withheld in the 2nd cycle |
| 43 | 4th | 0 mg | Flushing premedication | No history of dexamethasone |
| 49 | 8th | 0 mg | Back pain | No history of dexamethasone premedication in 1st, 2nd, 4th, 5th, 6th, and 7th cycles. However, she received dexamethasone 5 mg iv in the 3rd cycle |
| 56 | 4 th and 5th | 0 mg and 0 mg | Flushing | In the 1st cycle, received 10 mg dexamethasone; it was withheld in the 2nd, 3rd, 4th, and 5th cycles |
| 44 | 5 th and 6th | 10 mg and 20 mg | Flushing | Received dexamethasone premedication 10-20 mg iv in all cycles |
Baseline characteristics of patients and tumors
| Baseline characteristic | Breast cancer patients (n = 86) |
|---|---|
| Age (y) (mean ± SD) | 52.6 ± 9.8 (range 33-78) |
| Body weight (kg) (mean ± SD) | 58.8 ± 10.4 |
| Body mass index (kg/m2) (mean ± SD) | 24.5 ± 4.2 |
| Adjuvant/neoadjuvant chemotherapy regimen (number; %) | |
| Paclitaxel | 61 (70%) |
| Paclitaxel + Trastuzumab | 25 (30%) |
| Received paclitaxel cycle (number; %) | |
| 12 cycles | 73 (85%) |
| >6 cycles | 13 (15%) |
| Menopausal status | |
| Premenopausal | 21 (24%) |
| Postmenopausal | 65 (76%) |
| Underlying disease | |
| No allergy/asthma | 83 (97%) |
| Allergy/asthma | 3 (4%) |
| Pathology (number; %) | |
| Infiltrating ductal carcinoma | 81 (94%) |
| Noninfiltrating ductal carcinoma | 4 (5%) |
| Unknown | 1 (1%) |
| Infiltrating ductal carcinoma grading (number; %) | |
| Grade I | 3 (4%) |
| Grade II | 48 (56%) |
| Grade III | 29 (34%) |
| Unknown | 6 (7%) |
| Staging (number; %) | |
| Stage I | 3 (4%) |
| Stage II | 33 (38%) |
| Stage III | 50 (58%) |
| Physician preferences (number; %) | |
| Medical oncology clinic | 72 (84%) |
| Radiation oncology clinic | 13 (15%) |
| Surgical oncology clinic | 1 (1%) |
Patient characteristics based on incidence of hypersensitivity reaction (HSR) vs no HSR
| Patient characteristic | Total (n = 86) | No HSR (n = 80) | HSR (n = 6) | |
|---|---|---|---|---|
| Age (y; mean) | 52.62 | 53 | 46.50 | 0.12 |
| Body weight (kg; mean) | 58.77 | 59 | 55.97 | 0.49 |
| Body mass index (kg/m2; mean) | 24.46 | 25 | 23.46 | 0.54 |
| Body mass index | ||||
| <25 (kg/m2; mean) | 53 | 49 (61%) | 4 (67%) | |
| 25-30 (kg/m2; mean) | 23 | 21 (26%) | 2 (33%) | 0.87 |
| >30 (kg/m2; mean) | 10 | 10(13%) | 0 (0%) | >0.999 |
| Menopausal status | 0.15 | |||
| Premenopausal | 21 | 18 (22.5%) | 3 (50%) | |
| Postmenopausal | 65 | 62 (77.5%) | 3 (50%) | |
| Underlying disease | ||||
| No allergy/asthma | 83 | 77 (96%) | 6 (100%) | |
| Allergy/asthma | 3 | 3 (4%) | 0 (0%) | >0.999 |