Pre-medication protocols for the prevention of paclitaxel-induced infusion related reactions: a systematic review and meta-analysis

Dubinsky, Samuel; Patel, Deep; Wang, Xiang; Srikanthan, Amirrtha; Ng, Terry L.; Tsang, Corey

doi:10.1007/s00520-022-06891-0

Cited by 6 publications

(2 citation statements)

References 38 publications

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“…The three-step titration protocol used in this study significantly reduced the rate of HSRs, resulting in fewer treatment delays and a higher completion rate of prescribed, taxane-based courses of treatment. Consistent with previous studies indicating a higher risk for HSR with initial exposures, 6 we observed that 93% of reactions occurred with the first lifetime dose, warranting heightened caution with initial doses. Although the difference in reaction severity between groups did not reach statistical significance, clinical relevance was recognized in fewer needs for epinephrine, desensitization, and treatment plan modifications in titrated patients.…”

Section: Discussionsupporting

confidence: 91%

“…4 Reactions usually develop within the first few minutes of infusion, 5 during first and second lifetime exposures at reported rates from 10% to 41%. 6 Although the majority are mild to moderate, 7 anaphylaxis occurs in a small percentage of patients. 4,8,9 Reactions typically resolve with interruption of the drug, administration of fluids, and rescue medications if indicated.…”

Section: Introductionmentioning

confidence: 99%

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A Three-Step Taxane Titration Protocol Decreases Hypersensitivity Reactions During First and Second Exposures

Lynch

Menon

Mazzola

et al. 2023

JCO Oncology Practice

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INTRODUCTION Patients receiving taxanes are at risk for developing hypersensitivity reactions (HSRs) primarily during first and second lifetime exposures. Immediate HSRs require emergency care and can interfere with the continuation of preferred treatment. Although different approaches to slow titration have been used successfully for desensitization after HSR occurrence, there are no standardized recommendations for taxane titration to prevent HSRs. PURPOSE To determine if a gradual, three-step infusion rate titration decreases the rate and severity of immediate HSRs during first and second lifetime exposures to paclitaxel and docetaxel. METHODS We used a prospective, interventional design with historical comparisons to evaluate a sample of 222 first and second lifetime exposure paclitaxel and docetaxel infusions. The intervention was a three-step infusion rate titration provided at the initiation of first and second lifetime exposures. Ninety-nine titrated infusions were compared with 123 historical records of nontitrated infusions. RESULTS Compared with the nontitrated group (n = 123), the titrated group (n = 99) had significantly less HSRs (19% v 7%; P = .017). No significant difference in HSR severity was found between groups ( P = 1.00). However, four nontitrated patients received epinephrine, and one required transfer to the emergency department (ED) because of reaction severity. In contrast, no titrated patients received epinephrine or required transfer to the ED. In the nontitrated group, seven patients did not complete their infusions versus one patient in the titrated group. CONCLUSION A standardized, three-step infusion rate titration prevented HSR occurrence. Significant issues affecting practice feasibility and sustainability were addressed.

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Section: Discussionsupporting

confidence: 91%