RISK OF SEVERE ACUTE HYPERSENSITIVITY REACTIONS AFTER RAPID PACLITAXEL INFUSION OF LESS-THAN 1-H DURATION

On the basis of the safety of the 1-h paclitaxel infusion schedule in prior studies we attempted to evaluate the feasibility of a shorter in fusion schedule ( < 1-h), given the general lack of published data or of attempts at applying this strategy. Before receiving paclitaxel, al l patients were premedicated with promethazine, dexamethasone, and ran itidine, they were then given paclitaxel at a dose of 175 mg/m(2) dilu ted in 150 mi normal saline. Four patients were evaluated, two with br east cancer, one with ovarian carcinoma, and one with non-small-cell l ung cancer. All had received at least two prior cycles of paclitaxel a nd had never exhibited any hypersensitivity reaction. In all four pati ents, adverse signs and symptoms were observed at 5-15 min after the s tart of paclitaxel administration. These included generalized erythema (three patients), angioedema tall patients), sinus tachycardia (all p atients), dyspnea tall patients), and increased sweating tall patients ). One patient experienced acute diarrhea. Significant changes in vita l signs were recorded in all patients, but there was no dysrhythmia or syncope. Thereafter, drug infusion was interrupted and supportive mea sures were initiated with dimethidene maleate, ranitidine, and methylp rednisolone. In ail patients, symptoms resolved over the next 15-30 mi n, and paclitaxel was reinstituted at the standard 1-h rate with no fu rther sequelae. Paclitaxel administration in < 1 h did not prove to be safe in the current pilot experience and, therefore, cannot be recomm ended.