|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 128
Author response to: Reducing dexamethasone premedication with paclitaxel
Vanita Noronha1, Deborah Enting2, Ravi Thippeswamy1, Amit Joshi1, Vijay Maruti Patil1, Kumar Prabhash1
1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, London, England, UK
|Date of Web Publication||9-Sep-2019|
Department of Medical Oncology, Tata Memorial Hospital, Room 304, Homi Bhabha Block, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Noronha V, Enting D, Thippeswamy R, Joshi A, Patil VM, Prabhash K. Author response to: Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat 2019;2:128
|How to cite this URL:|
Noronha V, Enting D, Thippeswamy R, Joshi A, Patil VM, Prabhash K. Author response to: Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Jan 19];2:128. Available from: http://www.crstonline.com/text.asp?2019/2/1/128/266466
We thank Dr. Nirmal Raut for his thoughtful letter  regarding our study  and the accompanying editorial  on the incidence of hypersensitivity reactions (HSRs) to a modified dexamethasone premedication regimen. Although we agree that measurement of the patients' blood sugars may have helped quantify the benefit of a lower overall steroid dose with the modified premedication regimen, our study design was observational, and we did not perform any additional testing beyond what is done in standard practice. Moreover, all patients in the study received the modified dexamethasone premedication regimen; thus, there would not have been a comparator, i.e., the blood sugar levels in patients who received conventional premedication regimens, and thus quantification of the benefit would not have been possible.
Dr. Raut questions the low incidence of HSR (1.6%) in our study. Certainly, underreporting may have occurred, given the large volume of patients at our center, which may have led to a lack of reporting of minor HSR that may have been felt to be of little clinical relevance. However, we would like to point out that the reported rates of HSR to paclitaxel vary widely in the literature, ranging from 2% to 17.9%; thus, certainly lower rates of HSR have been reported in earlier studies as well.
We appreciate the suggestion of the incorporation of a control arm; however, the aim of our study was to quantify the incidence of HSR that occurs in our patients with the modified premedication regimen that had already been widely adopted at our institution. Our study design was an observational prospective study.
Although there was only one HSR with the use of 8 mg intravenous (IV) dexamethasone compared to six reactions with the use of 20 mg, this cannot be extrapolated to making a recommendation for the universal use of 8 mg of IV dexamethasone premedication. The decision regarding the dose of dexamethasone was probably influenced by the perceived risk of HSR to the chemotherapy regimen, including the dose and schedule of paclitaxel being administered. In an observational study like ours, it would be impossible to eliminate the effect of such confounders and thus attributing cause-and-effect would be inappropriate.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Raut NV. Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat 2019;2:126-7. [Full text]
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. [Full text]
Mailankody S. Modified dose dexamethasone premedication for paclitaxel use. Cancer Res Stat Treat 2018;1:116-7. [Full text]
Moon C, Verschraegen CF, Bevers M, Freedman R, Kudelka AP, Kavanagh JJ, Use of docetaxel (Taxotere) in patients with paclitaxel (Taxol) hypersensitivity. Anticancer Drugs 2000;11:565-8.
Yanaranop M, Chaithongwongwatthana S. Intravenous versus oral dexamethasone for prophylaxis of paclitaxel-associated hypersensitivity reaction in patients with primary ovarian, fallopian tube and peritoneal cancer: A double-blind randomized controlled trial. Asia Pac J Clin Oncol 2016;12:289-99.