Preliminary experience with a modified premedication protocol that included intravenous diphenhydramine and calcium bromide for the prophylaxis of paclitaxel-related hypersensitivity reactions |
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Authors: | Shinji Sasada Tomonori Hirashima Yukiko Nakamura Takayuki Takimoto Mitsugi Furukawa Masashi Kobayashi Takashi Nitta Kaoru Matsui Ichiro Kawase |
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Institution: | (1) Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino 3-7-1, Habikino, Osaka 583-8588, Japan;(2) Department of Thoracic Oncology, Shizuoka Cancer Center Hospital, Naga-izumi, Japan;(3) Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan |
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Abstract: | Background Paclitaxel often causes severe hypersensitivity reactions (HSRs) rapidly after infusion, even in patients given prophylactic
therapy. The purpose of this study was to analyze the incidence of paclitaxel-related HSRs in patients with non-small cell
lung cancer (NSCLC) retrospectively, and to assess the feasibility of a modified premedication protocol.
Methods One hundred and seven patients who were pretreated with either a conventional premedication regimen (two doses of dexamethasone)
or a short premedication regimen (single dose of dexamethasone with oral diphenhydramine and intravenous ranitidine), prior
to paclitaxel infusion were retrospectively analyzed. A modified premedication regimen, consisting of 12.5 ml of Rescalmin
(intravenous diphenhydramine 50 mg and calcium bromide 437.5 mg), intravenous ranitidine 100 mg, and intravenous dexamethasone
20 mg, was given 30 min prior to paclitaxel, with oral dexamethasone 8 mg given on the night before the paclitaxel. Patients
received paclitaxel intravenously at 175 mg/m2 over 3 h, followed by carboplatin, AUC 5, over 1 h on day 1 every 3 weeks.
Results In the conventional premedication group, 21 patients had HSRs (32.3%); in 1 of these patients the HSR was considered to be
severe (1.5%). In the short premedication group, 19 patients had HSRs (45.2%); in 6 of these patients the HSRs were considered
to be severe (14.3%). The incidence of severe HSRs was significantly higher in the short premedication group than in the conventional
premedication group (P = 0.027). In the modified premedication protocol study, HSR events were recorded in 14 patients (63.6%); 14 showed flushing,
2 had skin rash, and 1 had tachycardia. No severe HSRs were seen.
Conclusions The incidence of HSRs in the short premedication group tended to be higher than that in the conventional premedication group.
The modified premedication protocol was found to be feasible for preventing paclitaxel-related HSR, but case accumulation
is needed. |
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Keywords: | Paclitaxel Premedication Hypersensitivity reactions Prophylaxis Diphenhydramine |
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