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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 128

Author response to: Reducing dexamethasone premedication with paclitaxel

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 Publication9-Sep-2019

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Room 304, Homi Bhabha Block, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_53_19

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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 2021 Feb 28];2:128. Available from: https://www.crstonline.com/text.asp?2019/2/1/128/266466

We thank Dr. Nirmal Raut for his thoughtful letter [1] regarding our study [2] and the accompanying editorial [3] 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%[4] to 17.9%;[5] 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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Raut NV. Reducing dexamethasone premedication with paclitaxel. Cancer Res Stat Treat 2019;2:126-7.  Back to cited text no. 1
  [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.  Back to cited text no. 2
  [Full text]  
Mailankody S. Modified dose dexamethasone premedication for paclitaxel use. Cancer Res Stat Treat 2018;1:116-7.  Back to cited text no. 3
  [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.  Back to cited text no. 4
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.  Back to cited text no. 5


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