|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 126-127
Reducing dexamethasone premedication with paclitaxel
Nirmal Vivek Raut
Department of Medical Oncology, Bhaktivedanta Hospital and Research Institute, Thane, Maharashtra, India
|Date of Web Publication||9-Sep-2019|
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
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Raut NV. Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat 2019;2:126-7
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., 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%).,, 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., 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.,,, 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., 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.
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).
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? There is a notable increase in HSR in the 3 weekly schedules (7/8) similar to a study by Schwartz. 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.
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Conflicts of interest
There are no conflicts of interest.
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