The Evaluation of Paclitaxel Hypersensitivity Reactions (Hsrs) Following the Discontinuation of Prophylactic Pre-Medications

Abstract

Background: Paclitaxel administration is associated with a variable rate of hypersensitivity reactions (HSRs). Such reactions are infrequent beyond the second dose. Pre-medications comprising of corticosteroids and anti-histamines are administered to reduce the risk of HSRs, but are associated with adverse effects and a longer visit time. It is unclear if pre-medications are needed beyond the second dose. Objectives: Pre-medications were discontinued for all patients receiving paclitaxel-based regimens beyond the second dose. We sought to evaluate this practice change and hypothesize that this policy is unlikely to result in an increased rate of HSRs. Methods: A retrospective chart review was performed over a four-month period to review the incidence of HSRs. Adult patients were included if they received paclitaxel-based chemotherapy and did not have an HSR during the first two doses. Surveys were administered to patients receiving weekly paclitaxel to evaluate patient preference. Time required to administer pre-medications was also estimated. Results: Of 187 patients who met the inclusion criteria, 77 patients received weekly paclitaxel, seven patients received dose-dense paclitaxel every two weeks and 103 patients received paclitaxel every three weeks. Two of 111 patients receiving paclitaxel + platinum (1.80%) and two of 76 patients receiving paclitaxel +/- trastuzumab (2.63%) had nonsevere HSRs. An average of 90 minutes of chair time per patient (per clinic visit), was saved by omitting pre-medications. Of 52 surveys, 23 (44%) were returned and 20 patients (86.9%) preferred treatment without pre-medications compared to their first two doses with pre-medications. Conclusion: In patients receiving paclitaxel + platinum regimens or paclitaxel +/- trastuzumab, the discontinuation of pre-medications is a safe and feasible option if a patient has not experienced a HSR during the first or second dose of paclitaxel. Omission of pre-medications has substantial time saving implications for chemotherapy chair time.