H. Koppler et al., Dose reduction of steroid premeditation for paclitaxel: No increase of hypersensitivity reactions, ONKOLOGIE, 24(3), 2001, pp. 283-285
Background: Premeditation with dexamethasone, ranitidine and clemastine is
mandatory for patients receiving paclitaxel to avoid hypersensitivity react
ions. The proposed dexamethasone dose is 20 mg orally 12 and 6 h prior to p
aclitaxel infusion. With this premeditation severe hypersensitivity reactio
ns are reduced to 1-2% of the treated patients. Besides this oral schedule
a single dose of dexamethasone, 40 mg given i.v., just prior to paclitaxel
has been shown to be equally effective. In an attempt to reduce steroid-ind
uced side effects, especially for patients receiving weekly paclitaxel prot
ocols, we reduced the dexamethasone dose. Patients and Methods: A total of
132 patients were treated on an outpatient basis with paclitaxel-containing
protocols. Paclitaxel was given in doses of 135-175 mg/m(2) once every 3 w
eeks in 76 patients and/or with 100 mg/m(2) weekly in 70 patients. Dexameth
asone premeditation was given in a single dose (40, 20, 10 mg) as an infusi
on directly before paclitaxel. Results: 0/46 patients receiving 40 mg dexam
ethasone premedication in 235 cycles and 0/48 patients receiving 20 mg dexa
methasone premeditation in 186 cycles experienced a severe hypersensitivity
reaction. 1/52 patients receiving 10 mg dexamethasone in 480 applications
developed a severe hypersensitivity reaction with bronchospasm, hypotension
and supraventricular tachycardia shortly after her first paclitaxel infusi
on started. Conclusion: No increase of severe hypersensitivity reactions is
seen when dexamethasone premeditation is reduced to doses of 20 or even 10
mg prior to paclitaxel infusion.