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LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 126-127

Reducing dexamethasone premedication with paclitaxel


Department of Medical Oncology, Bhaktivedanta Hospital and Research Institute, Thane, Maharashtra, India

Date of Web Publication9-Sep-2019

Correspondence Address:
Nirmal Vivek Raut
Department of Medical Oncology, Bhaktivedanta Hospital and Research Centre, Bhakti Vedanta Swami Marg, Sector 6, Sector 1, Shrishti Complex, Mira Road, Mira Bhayandar, Thane - 401 107, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_31_19

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How to cite this article:
Raut NV. Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat 2019;2:126-7

How to cite this URL:
Raut NV. Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat [serial online] 2019 [cited 2019 Sep 17];2:126-7. Available from: http://www.crstonline.com/text.asp?2019/2/1/126/266453



Dear Editor,

I have read the article entitled, “Hypersensitivity reactions to paclitaxel with a modified dexamethasone intravenous premedication regimen” by Noronha et al. in the Cancer Research, Statistics and Treatment (2018, Vol. 1, Issue 2, Pg. 78–83) and the accompanying editorial.[1],[2] I would like to congratulate the author for choosing this topic, as paclitaxel is one of the most commonly used chemotherapeutic agents, and especially in low-and-middle income countries, the usage of paclitaxel is higher compared to nab-paclitaxel.

The study by Noronha et al. shows that the modified premedication regimen using a single dose of intravenous (IV) dexamethasone (Dexa) 30–60 min before paclitaxel, omitting the oral doses, is a safe and convenient option. Looking at the prevalence of diabetes in the Southeast Asian population and increased incidence of malignancy in diabetics, this study has important implications.

With a low risk of hypersensitivity with the proposed regimen, the reduction in the steroid burden will translate into decreased glycemic excursions reducing the morbidity in these patients. Measurement of the blood sugars of patients would have helped quantify this benefit.

One would question the overall low incidence of hypersensitivity reactions (1.6%), which is significantly lesser compared to other studies in the literature (7%–17%).[3],[4],[5] Can this be attributed to under-reporting of lower grade reactions by the nursing staff, given the patient overload in tertiary care setup?

Of 310 patients, 54 (17.4%) in the study had received paclitaxel earlier. Probably, these are the patients in whom Dexa could be avoided completely.[6],[7] The author herself acknowledges this as an attractive option in this subgroup of patients considering no Hypersensitivity reaction (HSR) in the 20 patients in the study who received no Dexa.

Available literature shows conflicting results. Studies by Bookman et al., Markman et al., Gilbar and Ridge, and Yamada et al.[4],[5],[8],[9] show clearly show no increase in HSR, while Kwon et al. and O'Cathail et al. caution about higher incidence of HSR with the modified regimen.[10],[11] The current study results contradict the meta-analysis by Chen et al., which favor of the conventional oral regimen leading to lesser serious (Gr3/4) HSR, which are clinically more relevant.[12]

The study by Noronha et al. would have reduced this confusion if the study had a control arm with the conventional regimen. The study by O'Cathail et al. wisely randomized patients as per two different timelines (May–August: PO Dexa, September–November: IV Dexa).[11]

Considering only one HSR with 8 mg of IV Dexa as compared to six HSR with 20 mg, would the author recommend a dose of 8 mg can in all patients?[13] There is a notable increase in HSR in the 3 weekly schedules (7/8) similar to a study by Schwartz.[14] The process of randomization would have taken care of the heterogeneity in doses of Dexa (8 mg vs. 20 mg) and different schedules of paclitaxel (weekly vs. 3 weekly).

In conclusion, I agree that the modified IV Dexa regimen is a safe and effective premedication option before paclitaxel; however, the rates of HSR are way higher than reported in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Noronha V, Enting D, Thippeswamy R, Joshi A, Patil VM, Prabhash K. Hypersensitivity reactions to paclitaxel with a modified dexamethasone intravenous premedication regimen. Cancer Res Stat Treat 2018;1:78-83.  Back to cited text no. 1
  [Full text]  
2.
Mailankody S. Modified dose dexamethasone premedication for paclitaxel use. Cancer Res Stat Treat 2018;1:116-7.  Back to cited text no. 2
  [Full text]  
3.
Picard M, Castells MC. Re-visiting hypersensitivity reactions to taxanes: A comprehensive review. Clin Rev Allergy Immunol 2015;49:177-91.  Back to cited text no. 3
    
4.
Gilbar P, Ridge A. Dexamethasone prophylaxis for paclitaxel hypersensitivity. J Oncol Pharm Pract 2002;8:81-7.  Back to cited text no. 4
    
5.
Yamada Y, Shirao K, Ohtsu A, Boku N, Hyodo I, Saitoh H, et al. Phase II trial of paclitaxel by three-hour infusion for advanced gastric cancer with short premedication for prophylaxis against paclitaxel-associated hypersensitivity reactions. Ann Oncol 2001;12:1133-7.  Back to cited text no. 5
    
6.
de Castro Baccarin AL, Irene MN, de Iracema Gomes Cubero D, Luz AS, Castro SN, Sordi R, et al. The feasibility of dexamethasone omission in weekly paclitaxel treatment for breast cancer patients. Support Care Cancer 2019;27:927-31.  Back to cited text no. 6
    
7.
Parinyanitikul N, Tanpipattanakul W, Poovorawan N, Rattananupong T, Laoitthi P, Sithidetphaiboon P, et al. Incidence of infusion hypersensitivity reaction after withholding dexamethasone premedication in early breast cancer patients not experiencing two previous cycles of infusion hypersensitivity reaction for weekly paclitaxel chemotherapy. Support Care Cancer 2018;26:2471-7.  Back to cited text no. 7
    
8.
Bookman MA, Kloth DD, Kover PE, Smolinski S, Ozols RF. Intravenous prophylaxis for paclitaxel-related hypersensitivity reactions. Semin Oncol 1997;24:S19-13-15.  Back to cited text no. 8
    
9.
Markman M, Kennedy A, Webster K, Peterson G, Kulp B, Belinson J, et al. An effective and more convenient drug regimen for prophylaxis against paclitaxel-associated hypersensitivity reactions. J Cancer Res Clin Oncol 1999;125:427-9.  Back to cited text no. 9
    
10.
Kwon JS, Elit L, Finn M, Hirte H, Mazurka J, Moens F, et al. A comparison of two prophylactic regimens for hypersensitivity reactions to paclitaxel. Gynecol Oncol 2002;84:420-5.  Back to cited text no. 10
    
11.
O'Cathail SM, Shaboodien R, Mahmoud S, Carty K, O'Sullivan P, Blagden S, et al. Intravenous versus oral dexamethasone premedication in preventing paclitaxel infusion hypersensitivity reactions in gynecological malignancies. Int J Gynecol Cancer 2013;23:1318-25.  Back to cited text no. 11
    
12.
Chen FC, Wang LH, Zheng XY, Zhang XM, Zhang J, Li LJ. Meta-analysis of the effects of oral and intravenous dexamethasone premedication in the prevention of paclitaxel-induced allergic reactions. Oncotarget 2017;8:19236-43. doi:10.18632/oncotarget.13705.  Back to cited text no. 12
    
13.
Köppler H, Heymanns J, Weide R. Dose reduction of steroid premedication for paclitaxel: No increase of hypersensitivity reactions. Onkologie 2001;24:283-5.  Back to cited text no. 13
    
14.
Schwartz JR. Dexamethasone premedication for prophylaxis of taxane toxicities: Can the doses be reduced when paclitaxel or docetaxel are given weekly? J Oncol Pharm Pract 2012;18:250-6.  Back to cited text no. 14
    



This article has been cited by
1 Author response to: Reducing dexamethasone premedication with paclitaxel
Vanita Noronha,Deborah Enting,Ravi Thippeswamy,Amit Joshi,VijayMaruti Patil,Kumar Prabhash
Cancer Research, Statistics, and Treatment. 2019; 2(1): 128
[Pubmed] | [DOI]



 

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