Effective desensitization protocol to paclitaxel following hypersensitivity reaction

The objective of this paper is to describe our experience with a desensitiz ation protocol to paclitaxel using the original paclitaxel solution in pati ents following severe hypersensitivity reactions. A retrospective review of 75 consecutive patients with ovarian cancer who received intravenous pacli taxel-based chemotherapy between January 1996 and May 1998 at the Gynecolog ic Oncology Unit at Meir Hospital-Sapir Medical Center, Kfar-Saba, Israel. All patients who developed a hypersensitivity reaction to paclitaxel were t reated with a desensitization protocol. The protocol included serial 10-fol d dilutions (up to 1:100,000) of the actual paclitaxel infusate, delivered in successive volumes of 1, 2, 4, and 8 mi. These escalating doses of pacli taxel were given intravenously at 15-min intervals for each dilution. Follo wing administration of the last diluted dose, the patient received a 1-ml d ose of the undiluted solution. If no side effects were recorded, the rest o f the actual dose was delivered at a 3-h infusion rate. Vital signs were mo nitored and recorded throughout the course of treatment. Six patients with a previous paclitaxel-associated hypersensitivity reaction were successfull y treated with the desensitization protocol. In conclusion, we demonstrate that the desensitization protocol is feasible and safe without compromising cytotoxic activity. Our results show that th is strategy is a reasonable choice in this clinical setting and potentially avoids paclitaxel-based regimen interruption.