PGY2 Oncology Pharmacy Resident Nebraska Medicine Omaha, Nebraska, United States
Poster Abstract: Paclitaxel is a chemotherapy agent that may be selected for the treatment of breast cancer in a variety of stages and treatment settings. Conventional paclitaxel has a boxed warning for severe hypersensitivity reactions, however, it has been reported that the majority (~95%) of paclitaxel hypersensitivity reactions occur during the first or second infusion. Corticosteroids have been shown to reduce the incidence of paclitaxel hypersensitivity reactions from 30% to 3%, but corticosteroids are not without side effects such as insomnia and hyperglycemia. Current practice at our institution is to prescribe home dexamethasone 20 mg to be given orally 12 hours and 6 hours prior to the administration of paclitaxel, however, some providers have elected to decrease or omit home dexamethasone prior to subsequent paclitaxel infusions due to the associated side effects.
This retrospective study at a large academic medical center analyzed the use of home dexamethasone prior to paclitaxel infusions. Patients were included if they were 19 years or older, had a diagnosis of breast cancer, had received at least 3 doses of paclitaxel as part of (neo)adjuvant therapy, and received a reduced or omitted dose of oral dexamethasone prior to paclitaxel infusions between January 1, 2015, to July 31, 2023. Patients were excluded if they received < 3 doses of paclitaxel, received albumin-bound paclitaxel, received a previous dose of paclitaxel prior to the current treatment regimen, had metastatic disease, or did not have their home dexamethasone dose decreased or omitted. The primary outcome was the incidence of grade 3/4 hypersensitivity reactions. Secondary outcomes included the incidence of corticosteroid-associated insomnia, hyperglycemia, and hospital admissions related to corticosteroid use, describing home dexamethasone prescribing practices, and identifying the cycle of paclitaxel where the most hypersensitivity reactions occurred. The data will be analyzed using descriptive statistics.
Results and conclusions are pending for this study.
References (must also be included in final poster): Breast Cancer Treatment (PDQ)- Heath Professional Version. Cancer.gov. https://www.cancer.gov/types/breast/hp/breast-treatment-pdq#_551_toc. Updated July 28, 2023. Accessed August 6, 2023.
Breast Cancer. NCCN.org. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Updated March 23, 2023. Accessed August 6, 2023.
Paclitaxel. In: AHFS DI Essentials: Bethesda, Maryland. American Society of Health-System Pharmacists; [updated 04/21/2023; accessed 08/06/2023].
Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641. doi:10.3747/co.21.1966
de Castro Baccarin AL, Irene MN, de Iracema Gomes Cubero D, et al. The feasibility of dexamethasone omission in weekly paclitaxel treatment for breast cancer patients. Support Care Cancer. 2019;27(3):927-931. doi:10.1007/s00520-018-4381-0
