Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration

Background: Taxanes cause hypersensitivity reactions, averted by premedication with H-1 blockers and high glucocorticoid ( GC) doses. Prolonged weekly taxane administration may lead to GC toxicity. Purpose: To determine whether patients not hypersensitive to initial paclitaxel (PTX) infusion after high-dose GC premedication will tolerate subsequent, prolonged PTX treatment without GC prophylaxis. Patients and Methods: In 115/122 breast cancer patients not hypersensitive to initial PTX treatment, 20 mg dexamethasone (DXM) doses were tapered by 2.0 mg/week, reaching 0 in those receiving 9 or more courses. After 4 PTX courses, diphenhydramine was administered orally, rather than intravenously. Results: PTX was administered 143 times after 2.0 - 5.0 mg of DXM and 357 times without DXM. A total of 46 patients received 1 - 40 PTX courses without DXM. None of these 115 patients experienced hypersensitivity reactions. Conclusion: Patients unreactive to their first PTX infusions, after high-dose and tapering GC premedication, may not require GC prophylaxis for subsequent PTX therapy. Copyright (C) 2005 S. Karger AG, Basel.