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Tsang C, Robinson J, Wheatley-Price PF, Brule SY, Moore SM. The utility of H2 receptor antagonists in preventing infusion-related reactions to paclitaxel chemotherapy. Cancer 2023; 129:3815-3819. [PMID: 37665180 DOI: 10.1002/cncr.35006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Paclitaxel has a risk of infusion-related reactions (IRRs) and despite no prospective evidence, is often given with premedication including a corticosteroid, H1 antagonist, and H2 antagonist (H2RA). Backorders impacted the supply of intravenous H2RAs at our center, and it was removed as routine premedication. The authors compared the incidence of IRR in patients treated without H2RA to patients receiving standard H2RA premedication. METHODS The authors reviewed outpatients starting paclitaxel at the Ottawa Hospital from December 2019 to October 2021. Two cohorts were created: patients treated without H2RA premedication (intervention), and those receiving standard H2RA (control). Demographics, treatment, and IRR information were collected retrospectively. Primary end point was rate of grade ≥2 IRRs during first two doses of paclitaxel. RESULTS A total of 182 patients were treated without H2RA premedication, compared to 184 control patients treated during non-backorder periods. Baseline characteristics included: median age, 63 years; 86% female; and primary tumor 52% breast/24% gynecologic/10% gastric/esophageal/8% lung/6% other. There were no significant differences between cohorts in baseline characteristics. There was no difference in the rate of grade ≥2 IRR between cohorts; 12.1% (22 of 182; 95% confidence interval [CI], 7.7%-17.7%) for patients treated without H2RA, and 15.1% (28 of 185; 95% CI, 10.3%-21.1%) for control patients. The rate of grade ≥3 IRRs were also similar, 4.4% in intervention cohort versus 3.8% in control cohort. CONCLUSIONS The removal of H2RAs from premedication for paclitaxel did not result in an increased incidence of IRRs. The use of H2RAs in preventing IRRs to paclitaxel should be re-evaluated.
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Affiliation(s)
- Corey Tsang
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Pharmaceutical Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Robinson
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | | | - Sara M Moore
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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2
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Foreman E, Polwart C, Walker A, Chambers P. Histamine-2(H 2 ) Antagonists can be safely removed from standard Paclitaxel Pre-medication regimens. Br J Clin Pharmacol 2022; 88:4191-4198. [PMID: 35470452 PMCID: PMC9545865 DOI: 10.1111/bcp.15363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
Aims The aim of this study is to investigate the rates of hypersensitivity reactions (HSRs) in patients receiving paclitaxel chemotherapy, with and without a histamine‐2 (H2) antagonists. Method This prospective, multi‐centre, cohort study compared patients receiving paclitaxel treated with premedication regimens containing chlorphenamine, dexamethasone and an H2 antagonist vs patients treated without an H2 antagonist. Rates of HSRs were described and logistic multivariable regression was used to investigate any associations with H2 antagonist treatment, adjusting for confounding variables. Results A total of 1043 individuals were included in the study; of these, 638 (61%) patients received an H2 antagonist and 405 (49%) were not given an H2 antagonist. Incidence of HSR in the cohort treated with H2 antagonists was 11.31% (n = 70) vs 9.86% (n = 41) in the cohort without. There was no statistically significant difference between the rates of HSR observed in those receiving and not receiving an H2 antagonist (odds ratio 1.04, 95% CI 0.65, 1.66, P = .9). Conclusions Results presented within the study are consistent with other recently published evidence to suggest that H2 antagonists do not confer any advantage as part of premedication regimens in reducing the incidence of HSR in patients treated with paclitaxel.
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Affiliation(s)
| | | | | | - Pinkie Chambers
- UCL School of Pharmacy & University College London Hospitals NHS Foundation Trust, London, United Kingdom
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3
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Dubinsky S, Patel D, Wang X, Srikanthan A, Ng TL, Tsang C. Pre-medication protocols for the prevention of paclitaxel-induced infusion related reactions: a systematic review and meta-analysis. Support Care Cancer 2022; 30:5627-5644. [PMID: 35150312 DOI: 10.1007/s00520-022-06891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prophylaxis against infusion-related reactions (IRR) from paclitaxel with steroids and antihistamines is a standard of care due to high rates of IRR. This systematic review and meta-analysis aimed to comprehensively summarize the evidence behind various prophylaxis strategies. METHODS EMBASE, MEDLINE, PubMed, and the Cochrane Register of Controlled Trials were searched (1946 to May 14, 2021). The primary outcomes were Grade 3/4 IRR and any-grade IRR. Secondary outcomes included treatment delay or discontinuation and adverse events secondary to pre-medications. RESULTS Of the 1285 unique citations, 26 studies were selected: 11 studies for quantitative analysis and 15 studies for qualitative analysis. Studies included randomized controlled trials and observational studies (n = 25-281). There was a non-significant benefit in favour of oral steroids starting 12 h prior to paclitaxel administration versus intravenous steroids immediately prior to paclitaxel administration for grade 3/4 IRRs, with a risk difference (RD) of 2% [95%CI 0 to 5%], any-grade IRR with a RD of 4% [95%CI: -1% to 9%] and treatment discontinuation with a RD of 1% [95%CI -1% to 2%]. For de-escalation strategies, a point-estimate for any-grade IRR was 0.44% [95% CI, 0 to 0.02, p = 0.98] and for grade 3/4 IRR was 3.1% (95% CI, 0.02 to 0.07, p = 0.11). CONCLUSION Although studies have high risk of bias and risk, differences between steroid routes of administration were small, there was a non-significant trend in favour of oral steroids. De-escalation strategies after two previous successful paclitaxel infusions have an overall low incidence rate of severe IRR and warrant further prospective clinical trials. Insufficient evidence remains to recommend for or against other interventions for the prevention of paclitaxel IRR.
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Affiliation(s)
- Samuel Dubinsky
- Pharmacy Department, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
| | - Deep Patel
- Pharmacy Department, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
| | - Xiang Wang
- Pharmacy Department, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
| | - Amirrtha Srikanthan
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
- Department of Medical Oncology, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
| | - Terry L Ng
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
- Department of Medical Oncology, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
| | - Corey Tsang
- Pharmacy Department, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada.
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Lansinger OM, Biedermann S, He Z, Colevas AD. Do Steroids Matter? A Retrospective Review of Premedication for Taxane Chemotherapy and Hypersensitivity Reactions. J Clin Oncol 2021; 39:3583-3590. [PMID: 34357780 DOI: 10.1200/jco.21.01200] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Despite the widespread use of the taxanes paclitaxel and docetaxel for a variety of cancers and their well-known association with hypersensitivity reactions (HSRs), there is still significant variation in the prescribing practices of steroids for premedication. Premedication almost always includes dexamethasone, which can be associated with multiple adverse effects if taken for extended periods of time. This study reviews the pattern of steroid premedication in patients who received paclitaxel or docetaxel at Stanford Cancer Institute between January 2010 and June 2020. METHODS We used an electronic query of the electronic medical record followed up with a manual review of patient charts to ask whether we could find a correlation between steroid premedication dosing and the incidence or severity of HSRs with the first taxane dose. Variables considered included steroid dose and route, dose and type of taxane, clinical cancer group, sex, and race. RESULTS Five thousand two hundred seventeen patients were identified as having received paclitaxel or docetaxel, and 3,181 met criteria for our analysis. There were 264 (8.3%) HSRs. In adjusted multivariate analysis, we found no correlation of HSR rate or severity among any of the variables evaluated except gynecology oncology clinic patients, who had an increased risk (hazard ratio [HR] 1.34) of HSRs overall and high-grade HSRs (HR 2.34), and female patients, who had a higher rate of HSRs overall (HR 1.26), but not high-grade HSRs. CONCLUSION Neither dexamethasone dose nor route correlated with subsequent HSRs. Given the potential for adverse events from repeated high-dose steroids, our findings suggest that routine use of lower doses, such as a single 10 mg dose of dexamethasone, as premedication for taxanes to prevent HSRs is preferable to the current prescribing guidelines.
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Affiliation(s)
| | | | - Zihuai He
- Stanford University School of Medicine, Stanford, CA
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5
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Cox JM, van Doorn L, Malmberg R, Oomen-de Hoop E, Bosch TM, van den Bemt PMLA, Boere IA, Jager A, Mathijssen RHJ, van Leeuwen RWF. The added value of H 2 antagonists in premedication regimens during paclitaxel treatment. Br J Cancer 2021; 124:1647-1652. [PMID: 33762718 PMCID: PMC8110571 DOI: 10.1038/s41416-021-01313-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Ranitidine, a histamine 2 blocker, is the standard of care to prevent hypersensitivity reactions (HSRs) caused by paclitaxel infusion. However, the added value of ranitidine in this premedication regimen is controversial. Therefore, we compared the incidence of HSRs during paclitaxel treatment between a standard regimen including ranitidine and a regimen without ranitidine. METHODS This prospective, pre-post interventional, non-inferiority study compared the standard premedication regimen (N = 183) with dexamethasone, clemastine and ranitidine with a premedication regimen without ranitidine (N = 183). The primary outcome was the incidence of HSR grade ≥3. Non-inferiority was determined by checking whether the upper bound of the two-sided 90% confidence interval (CI) for the difference in HSR rates excluded the +6% non-inferiority margin. RESULTS In both the pre-intervention (with ranitidine) and post-intervention (without ranitidine) group 183 patients were included. The incidence of HSR grade ≥3 was 4.4% (N = 8) in the pre-intervention group and 1.6% (N = 3) in the post-intervention group: difference -2.7% (90% CI: -6.2 to 0.1). CONCLUSIONS As the upper boundary of the 90% CI does not exceed the predefined non-inferiority margin of +6%, it can be concluded that a premedication regimen without ranitidine is non-inferior to a premedication regimen with ranitidine. CLINICAL TRIAL REGISTRATION www.trialregister.nl ; NL8173.
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Affiliation(s)
- Juul M. Cox
- grid.416213.30000 0004 0460 0556Department of Clinical Pharmacy and Maasstad Lab, Maasstad Hospital, Rotterdam, The Netherlands
| | - Leni van Doorn
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ruben Malmberg
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tessa M. Bosch
- grid.416213.30000 0004 0460 0556Department of Clinical Pharmacy and Maasstad Lab, Maasstad Hospital, Rotterdam, The Netherlands
| | - Patricia M. L. A. van den Bemt
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ingrid A. Boere
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Agnes Jager
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ron H. J. Mathijssen
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Roelof W. F. van Leeuwen
- grid.508717.c0000 0004 0637 3764Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
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Jung JW. Desensitization for hypersensitivity reactions related to chemotherapy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.3.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Lee JH, Moon M, Kim YC, Chung SJ, Oh J, Kang DY, Lee SY, Lee KH, Yun J, Kang HR. A One-Bag Rapid Desensitization Protocol for Paclitaxel Hypersensitivity: A Noninferior Alternative to a Multi-Bag Rapid Desensitization Protocol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:696-703. [PMID: 31678295 DOI: 10.1016/j.jaip.2019.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Desensitization is used to safely continue treatment with a culprit drug in patients with drug hypersensitivity. Currently, a multi-bag protocol is widely used for rapid desensitization, but performing the desensitization procedure is labor intensive as pharmacists and nurses need to prepare and administer diluted solutions. However, it has not been investigated whether dilution is essential for successful desensitization. OBJECTIVE To investigate the efficacy and safety of a nondilution, 1-bag protocol in comparison with a conventional multi-bag protocol for desensitization of patients with paclitaxel hypersensitivity. METHODS Patients who underwent paclitaxel desensitization between 2011 and 2018 were analyzed in this retrospective cohort study. The completion rate, time to completion, and occurrence and severity of breakthrough reaction (BTR) between a 1-bag protocol and a multi-bag protocol were compared. RESULTS A total of 211 desensitization procedures were performed, of which 207 procedures (98.1%) were completed successfully. The administration time was significantly shorter in the 1-bag protocol group compared with the conventional multi-bag protocol group (266.0 ± 149.3 minutes vs 484.2 ± 178.6 minutes, P < .05) without differences in the completion rate (97.6% vs 98.9%, P = .645), the incidence of BTR (16.1% vs 27.6%, P = .778), and the proportion of severe BTR (2.6% vs 5.7%, P = .134). CONCLUSIONS A nondilution, 1-bag protocol is noninferior to a multi-bag rapid desensitization protocol and can be a safe and effective option for paclitaxel desensitization.
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Affiliation(s)
- Jae-Ha Lee
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Mira Moon
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Young-Chan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jie Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jihyun Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Yoon Kang
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| | - James Yun
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Division of Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Hye-Ryun Kang
- Seoul National University Hospital Regional Pharmacovigilance Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
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8
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Raut N. Reducing dexamethasone premedication with paclitaxel. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_31_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maurice-Dror C, Perets R, Bar-Sela G. Glucocorticoids as an adjunct to oncologic treatment in solid malignancies - Not an innocent bystander. Crit Rev Oncol Hematol 2018; 126:37-44. [PMID: 29759565 DOI: 10.1016/j.critrevonc.2018.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/02/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Glucocorticoids are steroidal hormones which exert their action via genomic and non-genomic mechanisms. In the clinical setting, glucocorticoids are utilized for their anti-inflammatory, anti-allergenic and immunomodulatory effects and for their well-established, pro-apoptotic effects on hematological malignancies. In the treatment of solid tumors, glucocorticoids serve primarily for alleviation of tumor- and treatment-related symptoms and in most cases are not considered to have a direct effect on tumor growth and spread. However, significant pre-clinical data suggest that glucocorticoids have diverse effects on tumor progression, both pro- and anti- tumorigenic. In contrast, the clinical data regarding the pro- and anti-tumorigenic effects of glucocorticoids on solid tumors is scarce, and summarized in this review. The following review presents the suggested glucocorticoids mechanism of action and the effects of glucocorticoids on tumor cells, on the tumor microenvironment and on tumor response to cytotoxic therapy, in the pre-clinical and clinical settings.
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Affiliation(s)
| | - Ruth Perets
- Division of Oncology, Rambam Health Care Campus, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus, Israel; Technion-Israel Institute of Technology, Haifa, Israel.
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10
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Maurer K, Michener C, Mahdi H, Rose PG. Universal tolerance of nab-paclitaxel for gynecologic malignancies in patients with prior taxane hypersensitivity reactions. J Gynecol Oncol 2018; 28:e38. [PMID: 28541630 PMCID: PMC5447141 DOI: 10.3802/jgo.2017.28.e38] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report on the incidence of nab-paclitaxel hypersensitivity reactions (HSRs) in patients with prior taxane HSR. METHODS From 2005 to 2015, all patients who received nab-paclitaxel for a gynecologic malignancy were identified. Chart abstraction included pathology, prior therapy, indication for nab-paclitaxel, dosing, response, toxicities including any HSR, and reason for discontinuation of nab-paclitaxel therapy. RESULTS We identified 37 patients with gynecologic malignancies with a history of paclitaxel HSR who received nab-paclitaxel. Six patients (16.2%) had a prior HSR to both paclitaxel and docetaxel while the other 31 patients had not received docetaxel. No patients experienced a HSR to nab-paclitaxel. Median number of cycles of nab-paclitaxel was 6 (range 2-20). Twelve patients received weekly dosing at 60 to 100 mg/m². The remainder of patients received 135 mg/m² (n=13), 175 mg/m² (n=9), or 225 mg/m² (n=3). Thirty four patients (91.9%) received nab-paclitaxel in combination with carboplatin (n=28, 75.7%), IP cisplatin (n=1, 2.7%), carboplatin and bevacizumab (n=3, 8.1%), or carboplatin and gemcitabine (n=2, 5.4%). Reasons for discontinuing nab-paclitaxel included completion of adjuvant therapy (n=16), progressive disease (n=18), toxicity (n=1), and death (n=1). There were no grade 4 complications identified during nab-paclitaxel administration. Grade 3 complications included: neutropenia (n=9), thrombocytopenia (n=4), anemia (n=1), and neurotoxicity (n=1). CONCLUSION Nab-paclitaxel is well-tolerated with no HSRs observed in this series of patients with prior taxane HSR. Given the important role of taxane therapy in nearly all gynecologic malignancies, administration of nab-paclitaxel should be considered prior to abandoning taxane therapy.
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Affiliation(s)
- Kathryn Maurer
- Division of Gynecologic Oncology, OB/GYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Chad Michener
- Division of Gynecologic Oncology, OB/GYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Haider Mahdi
- Division of Gynecologic Oncology, OB/GYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter G Rose
- Division of Gynecologic Oncology, OB/GYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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11
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Chen FC, Wang LH, Zheng XY, Zhang XM, Zhang J, Li LJ. Meta-analysis of the effects of oral and intravenous dexamethasone premedication in the prevention of paclitaxel-induced allergic reactions. Oncotarget 2017; 8:19236-19243. [PMID: 27911278 PMCID: PMC5386680 DOI: 10.18632/oncotarget.13705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/19/2016] [Indexed: 12/11/2022] Open
Abstract
Background Dexamethasone premedication is required to prevent paclitaxel-related hypersensitivity reactions (HSRs). Oral dexamethasone (PO-D) has been considered the standard premedication regimen. However, whether intravenous dexamethasone (IV-D) is feasible for preventing paclitaxel-related HSRs is still unclear. We conducted a meta-analysis to compare these two regimens. Methods We performed a systematic search in the PubMed, China National Knowledge Infrastructure, and Web of Science databases for relevant articles published before June 2016. Outcomes included HSRs and severe HSRs. Statistical analyses were performed using RevMan 5.2 software. Result Six studies comprising 1347 patients were included in the meta-analysis. The PO-D premedication regimen showed a significantly decreased incidence of severe HSRs compared with the IV-D regimen with an OR of 0.53 (95% CI 0.28-0.99, p = 0.05). However, there was no difference in the overall paclitaxel-related HSR rates between the two premedication regimens (OR 0.76, 95% CI 0.55-1.06, p = 0.11). Subgroup analyses according to study type and country of origin showed similar statistical results between the two premedication regimens. Conclusion Our meta-analysis showed that the PO-D premedication regimen is superior to the IV-D regimen in preventing paclitaxel-related HSRs. Additional randomized controlled trials are needed to confirm our findings.
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Affiliation(s)
- Fu-Chao Chen
- Department of Pharmacy, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, P.R. China
| | - Lin-Hai Wang
- Department of Pharmacy, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, P.R. China
| | - Xiao-Yu Zheng
- International School of Software, Wuhan University, Wuhan, Hubei, 430079, P.R. China
| | - Xiu-Min Zhang
- Department of Pharmacy, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, P.R. China
| | - Jun Zhang
- Department of Oncology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, P.R. China
| | - Lin-Jun Li
- Department of Oncology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, P.R. China
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12
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Abstract
Objective. To evaluate single-dose intravenous (IV) dexamethasone as a viable alternative to the standard two-dose oral protocol and as a method for the administration of corticosteroid prophylaxis in the prevention of paclitaxel-induced hypersensitivity reactions (HSR). Method. A retrospective analysis of pharmacy dispensing and medical records was undertaken to ascertain those patients who had received IV corticosteroid prophylaxis, details of therapy and incidence of HSR. A comprehensive literature review was also undertaken to determine the incidence of HSR to paclitaxel in patients receiving a similar IV dexamethasone premedication protocol. Results. Thirty-five patients received prophylactic dexamethasone 20 mg IV, given 30 minutes before paclitaxel infusion. Patients also received promethazine 25 mg IV and ranitidine 50 mg IV. No HSR were reported. A number of studies were identified in which IV corticosteroid prophylaxis was used, including retrospective analyses, a prospective report, clinical studies involving paclitaxel employing IV corticosteroids as part of the premedication regimen, and comparative retrospective studies. Only one study described IV corticosteroid therapy adversely. Conclusions. For the safe administration of paclitaxel, premedication with corticosteroids, and H1 and H2 receptor antagonists, is essential. The administration of IV dexamethasone 20 mg, given 30 minutes before paclitaxel infusion, is an appealing and practical alternative to the standard oral prophylactic regimen and offers benefits to patients in terms of compliance, convenience, ease of administration and flexibility.
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Affiliation(s)
- Peter Gilbar
- Pharmacy Department, Toowoomba Health Services, Toowoomba, Australia
| | - Alison Ridge
- Pharmacy Department, Toowoomba Health Services, Toowoomba, Australia
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13
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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. [PMID: 27098551 DOI: 10.1111/ajco.12495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
Abstract
AIM To compare the efficacies and side effects of intravenous and oral dexamethasone (IV-D and PO-D) for paclitaxel-associated hypersensitivity reaction (P-HSR) prophylaxis in patients with primary ovarian, fallopian tube and peritoneal carcinomas (POC/PFTC/PPC) receiving a first cycle of paclitaxel plus carboplatin (TC). METHODS In this double-blind randomized controlled trial, patients with POC/PFTC/PPC receiving a first cycle of TC were randomly allocated in a 1:1 ratio to either the IV-D or PO-D groups. Those were followed at 28 days. Primary outcomes were incidence of overall and severe P-HSRs. Secondary outcomes included incidence of dexamethasone-related side effects, other chemotherapy-related adverse events (AEs), and quality-of-life (QoL). RESULTS A total of 288 patients were enrolled from February to July 2015, of whom 281 were eligible for analysis, including 140 allocated to IV-D and 141 to PO-D. There was no significant difference in P-HSR rate between the IV-D and PO-D groups (17.9% vs. 19.1%, P = 0.780). Severe P-HSR occurred in one women in the IV-D group (0.7% vs. 0%, P = 0.498). There were no significant differences in other chemotherapy-related AEs and QoL scores. However, women in the PO-D had more side effects from short-term corticosteroid use than those in the IV-D group, especially acne (10.6% vs. 2.1%, P = 0.004). CONCLUSIONS IV-D and PO-D have similar efficacies for preventing P-HSR. However, short-term IV-D may be associated with fewer side effects than PO-D. IV-D is thus suggested for P-HSR prophylaxis in patients with POC/PFTC/PPC receiving a first cycle of TC.
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Affiliation(s)
- Marut Yanaranop
- Department of Obstetrics and Gynecology, Rajavithi Hospital.,College of Medicine, Rangsit University
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Efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: a multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving paclitaxel and carboplatin. Int J Clin Oncol 2015; 21:491-7. [DOI: 10.1007/s10147-015-0928-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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15
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de Lemos ML, Waignein S, de Haan M. Evidence-based practice in times of drug shortage. J Oncol Pharm Pract 2015; 22:566-70. [DOI: 10.1177/1078155215589980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Shortage of oncology drugs is a particularly complicated issue because there are usually limited therapeutic options. Moreover, oncology practice may employ medications for supportive indications which differ from their main usage. This means shortage of oncology drugs is not usually addressed by the major drug shortage guidelines. We have previously shown that, during a shortage crisis, it is possible to make a recommendation on the use of an expired drug supply based on a reasonable estimate of its safety and efficacy. Here, we would like to share further examples on how to deduce potential therapeutic alternatives based on pharmacokinetic and pharmacodynamic principles in the absence of direct clinical evidence in the literature.
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Affiliation(s)
- Mário L. de Lemos
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
| | - Sally Waignein
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
| | - Marie de Haan
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
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16
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Stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction. Support Care Cancer 2014; 23:2019-24. [PMID: 25519756 DOI: 10.1007/s00520-014-2556-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Paclitaxel-based chemotherapy continues to be an integral component of breast cancer treatment. Prolonged use of paclitaxel may result in repeated doses of premedications that can have unwanted side effects. Infusion hypersensitivity reactions occurring beyond the second dose of paclitaxel are infrequent and not well characterized. We previously published the results of a small, prospective pilot trial demonstrating the safety and feasibility of discontinuing premedications in patients who received the first two doses of paclitaxel-based chemotherapy without experiencing an infusion hypersensitivity reaction. In this study, we aimed to retrospectively characterize the incidence of rescue medication using this abbreviated premedication regimen in our institution following the publication of the pilot study. METHODS Patients with stages I-IV breast cancer who received paclitaxel from January 2011 through June 2013 were screened for eligibility. Patients who did not experience an infusion hypersensitivity reaction with their first or second dose of paclitaxel and discontinued paclitaxel premedication for subsequent doses were included in this analysis. The primary endpoint was to estimate the incidence of rescue medication use for the treatment of paclitaxel infusion hypersensitivity during doses three to six of paclitaxel in the study population. RESULTS In total, 449 patients received paclitaxel-based chemotherapy for the treatment of breast cancer during the interval time period. After receiving the first two doses of paclitaxel-based chemotherapy without experiencing an infusion hypersensitivity reaction, 234 breast cancer patients had their premedications discontinued for all remaining paclitaxel doses. These patients tolerated future paclitaxel doses without severe or life-threatening complications related to infusion hypersensitivity. The majority of patients did not have any symptoms of an infusion reaction, with only two of these patients requiring rescue medication to treat an infusion hypersensitivity reaction with subsequent paclitaxel doses (0.85; 95 % confidence interval (CI), 0.10-3.05 %). CONCLUSIONS Discontinuation of paclitaxel premedications in breast cancer patients who have not experienced an infusion hypersensitivity reaction with the first two doses of paclitaxel is not associated with increased rate of rescue medication use for infusion hypersensitivity.
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Gibson JM, Alzghari S, Ahn C, Trantham H, La-Beck NM. The role of pegylated liposomal doxorubicin in ovarian cancer: a meta-analysis of randomized clinical trials. Oncologist 2013; 18:1022-31. [PMID: 23881990 DOI: 10.1634/theoncologist.2013-0126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recent studies suggest that carboplatin with pegylated liposomal doxorubicin (C+PLD) is as efficacious as carboplatin with paclitaxel (C+P) and possibly is more tolerable for ovarian cancer therapy. Pegylated liposomal doxorubicin (PLD) may also be efficacious and tolerable as monotherapy in recurrent or platinum-resistant disease. We performed a meta-analysis of randomized trials in order to elucidate the role of PLD in ovarian cancer. METHODS We searched PubMed, Scopus, and ISI Web of Knowledge for studies comparing C+PLD with C+P and comparing PLD with another monotherapy. Summary hazard ratios (HRs) and relative risks with their corresponding 95% confidence intervals (CIs) were calculated using a fixed-effects model. RESULTS Three trials were included in the doublet regimen analysis, and five trials were included in the monotherapy regimen analysis. C+PLD provided superior progression-free survival (PFS) (HR, 0.87; 95% CI, 0.78-0.96) and similar overall survival (OS; HR, 0.95; 95% CI, 0.84-1.07) compared with C+P. There was no evidence of improved tolerability: C+PLD had more gastrointestinal toxicity, anemia, thrombocytopenia, cutaneous toxicity, and mucositis/stomatitis, although there was less neutropenia, neuropathy, and alopecia. PLD monotherapy had similar PFS (HR, 0.99; 95% CI, 0.89-1.11) and OS (HR, 0.99; 95% CI, 0.88-1.11) to other monotherapies, but it was more tolerable. There was less neutropenia, anemia, thrombocytopenia, and gastrointestinal toxicity, although cutaneous toxicity was increased. CONCLUSION C+PLD had better PFS and similar OS compared with C+P and had a very different toxicity profile. Therapy selection could be based on patient risks for side effects. PLD is as efficacious as other monotherapies and is more tolerable.
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Affiliation(s)
- Jean-Marie Gibson
- Department of Immunotherapeutics and Biotechnology, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas, USA
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18
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Ruggiero A, Triarico S, Trombatore G, Battista A, Dell’Acqua F, Rizzari C, Riccardi R. Incidence, clinical features and management of hypersensitivity reactions to chemotherapeutic drugs in children with cancer. Eur J Clin Pharmacol 2013; 69:1739-46. [PMID: 23765411 DOI: 10.1007/s00228-013-1546-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
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Scheele J, Diergarten K, Drevs J, Niazi FR. A phase I trial assessing the safety, tolerability, pharmacokinetic and pharmacodynamic characteristics of single-dose Auron Misheil therapy in healthy male subjects. J Clin Pharm Ther 2013; 38:3-11. [PMID: 23281770 DOI: 10.1111/j.1365-2710.2009.01087.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Auron Misheil therapy (AMT) is a combination of widely used pharmaceuticals and herbal components that has been used since the 1980s as a supportive therapy, mainly in end-stage cancer patients on a compassionate basis. This phase I study was conducted to assess the safety, tolerability, and pharmacokinetic (PK) and pharmacodynamic (PD) properties of AMT in a controlled trial environment. METHODS The study was conducted in a single rising dose, double-blind, placebo-controlled design. Three groups of eight healthy male volunteers received one of three doses of AMT (0·011, 0·033 or 0·066 mL AMT/kg body weight intramuscularly; n = 6 per group) or placebo (n = 2 per group). RESULTS AND DISCUSSION Auron Misheil therapy was shown to be well tolerated, revealing no severe or serious adverse events. There were no unexpected PK or PD results for any of the three components of AMT. CONCLUSIONS These data provide important PK, PD and safety data for AMT, and support further controlled clinical investigation in patients with different types of cancer as an option for supportive care.
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Affiliation(s)
- J Scheele
- Auron Healthcare GmbH, Freiburg, Germany.
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Lee SY, Yang MS, Jung JW, Oh MJ, Park CH, Sohn SW, Kang HR, Cho YJ. Updates on desensitization for hypersensitivity reactions related to chemotherapy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi-Jung Oh
- Department of Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Han Park
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Seong-Wook Sohn
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Joo Cho
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Farnam K, Chang C, Teuber S, Gershwin ME. Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol 2012; 159:327-45. [PMID: 22832422 DOI: 10.1159/000339690] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/23/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. METHODS We performed a PubMed search using the terms 'drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions' and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. RESULTS Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current 'gold' standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a 'desensitization' protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. CONCLUSIONS Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.
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Affiliation(s)
- Kevin Farnam
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA 95616, USA
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22
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Yamada K, Tanabe H, Imai M, Jobo T, Kudo K, Fujiwara H, Nagata C, Furuya K, Suzuki M, Ochiai K, Tanaka T, Yasuda M. Feasibility study of paclitaxel plus carboplatin in patients with endometrial cancer: a Japan Kanto Tumor Board study (JKTB trial). J Obstet Gynaecol Res 2012; 39:311-6. [PMID: 22639962 DOI: 10.1111/j.1447-0756.2012.01890.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The optimal chemotherapy regimen for patients with endometrial cancer has not been established. We assessed the feasibility of paclitaxel plus carboplatin (TC) for postoperative chemotherapy in patients with endometrial cancer. MATERIAL AND METHODS Patients with newly diagnosed endometrial cancer received TC (paclitaxel 180 mg/m(2) , carboplatin AUC6 mg/mL/min) every three weeks. Treatment was continued until disease progression or completion of six cycles. Toxicities were evaluated every cycle according to NCI-CTCAE version 3.0. RESULTS Sixty patients were registered from December 2005 through November 2006. Forty-four of 60 (73.3%) cases completed all of the planned six cycles. Grades 3 and 4 hematologic toxicities were observed as follows: leukopenia (61.7%), neutropenia (95.0%), anemia (21.7%), and thrombocytopenia (5.0%). There were six patients who dropped out from the protocol by neutropenia. Grade 3 non-hematologic toxicities were observed as follows: nausea (3.3%), vomiting (1.7%), neuropathy (5.0%), myalgia (6.7%) and constipation (1.7%). No grade 4 non-hematologic toxicity was observed. CONCLUSION This TC regimen is feasible for endometrial cancer patients.
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Affiliation(s)
- Kyosuke Yamada
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Minato-ku Azabu-juban Manami Women's Clinic, Minato-ku, Tokyo, Japan.
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Kim MY, Kang SY, Lee SY, Yang MS, Kim MH, Song WJ, Kim SH, Kim YJ, Lee KW, Cho SH, Min KU, Lee JS, Kim JH, Chang YS. Hypersensitivity Reactions to Oxaliplatin: Clinical Features and Risk Factors in Koreans. Asian Pac J Cancer Prev 2012; 13:1209-15. [DOI: 10.7314/apjcp.2012.13.4.1209] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Berger MJ, Dunlea LJ, Rettig AE, Lustberg MB, Phillips GS, Shapiro CL. Feasibility of stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction. Support Care Cancer 2011; 20:1991-7. [PMID: 22089428 PMCID: PMC3411299 DOI: 10.1007/s00520-011-1303-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/25/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Paclitaxel-based chemotherapy continues to be an integral component in the treatment of many solid tumors. Prolonged use of paclitaxel may result in repeated doses of premedications and potential unwanted side effects. Infusion hypersensitivity reactions occurring beyond the second dose are infrequent and not well characterized. We hypothesized that patients whose paclitaxel premedications were discontinued after two doses were unlikely to experience infusion hypersensitivity reactions with subsequent paclitaxel doses. METHODS Patients receiving paclitaxel-based chemotherapy who did not experience an infusion hypersensitivity reaction with their first or second dose had their paclitaxel premedications discontinued. The primary endpoint was to estimate the incidence of rescue medication for the treatment of paclitaxel infusion hypersensitivity during doses 3 to 6 for patients whose paclitaxel premedications had been discontinued. RESULTS After receiving the first two doses of paclitaxel-based chemotherapy without experiencing an infusion hypersensitivity reaction (any grade), 55 breast cancer patients had their premedications discontinued for all remaining paclitaxel doses. None of these patients required rescue medication to treat an infusion hypersensitivity reaction with subsequent doses. CONCLUSIONS In patients who have not experienced an infusion hypersensitivity reaction with the first two doses of paclitaxel, discontinuation of paclitaxel premedications may be considered an option without an increased risk of infusion hypersensitivity requiring rescue medication.
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Affiliation(s)
- Michael J Berger
- Pharmacy Department, The James Comprehensive Breast Center, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University, Columbus, OH 43212, USA.
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Kidera Y, Satoh T, Ueda S, Okamoto W, Okamoto I, Fumita S, Yonesaka K, Hayashi H, Makimura C, Okamoto K, Kiyota H, Tsurutani J, Miyazaki M, Yoshinaga M, Fujiwara K, Yamazoe Y, Moriyama K, Tsubaki M, Chiba Y, Nishida S, Nakagawa K. High-dose dexamethasone plus antihistamine prevents colorectal cancer patients treated with modified FOLFOX6 from hypersensitivity reactions induced by oxaliplatin. Int J Clin Oncol 2011; 16:244-9. [DOI: 10.1007/s10147-010-0170-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Muto S, Kouyama Y, Yokoyama Y, Okuno H, Ishii T, Masaka T, Matsuzawa Y, Kawashima T, Shirai K. Development of an Enzyme-Linked Immunosorbent Assay System to Determine the Presence of Antibodies Specific for Taxane Structures. Biol Pharm Bull 2011; 34:562-6. [DOI: 10.1248/bpb.34.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Satoshi Muto
- Department of Disease Analysis, Faculty of Pharmaceutical Sciences, Toho University
| | - Yuichi Kouyama
- Department of Disease Analysis, Faculty of Pharmaceutical Sciences, Toho University
| | - Yuusaku Yokoyama
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Toho University
| | - Hiroaki Okuno
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Toho University
| | - Toshihiro Ishii
- Department of Pharmacy, Toho University Sakura Medical Center
| | - Toru Masaka
- Department of Pharmacy, Toho University Sakura Medical Center
| | - Yasuo Matsuzawa
- Department of Respiratory Medicine, Toho University Sakura Medical Center
| | - Tatsuo Kawashima
- Department of Respiratory Medicine, Toho University Sakura Medical Center
| | - Koji Shirai
- The Center of Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center
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Maemondo M, Masuda N, Sekine I, Kubota K, Segawa Y, Shibuya M, Imamura F, Katakami N, Hida T, Takeo S. A phase II study of palonosetron combined with dexamethasone to prevent nausea and vomiting induced by highly emetogenic chemotherapy. Ann Oncol 2009; 20:1860-6. [PMID: 19561037 DOI: 10.1093/annonc/mdp195] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This is a randomized, double-blind, dose-ranging study in patients receiving highly emetogenic chemotherapy (HEC) to evaluate the safety, efficacy, and pharmacokinetics of palonosetron, in combination with dexamethasone. MATERIALS AND METHODS We randomized 233 patients to receive palonosetron as a single i.v. bolus dose of 0.075, 0.25, or 0.75 mg before administration of HEC. Dexamethasone (12-16 mg i.v. on day 1, 8 mg i.v. on day 2, and 4-8 mg i.v. on day 3) was administered for prophylactic antiemesis. Pharmacokinetics of palonosetron was analyzed in 24 patients. RESULTS In this study, all patients were given > or =50 mg/m(2) cisplatin, which was considered to be HEC. No significant differences in complete response (CR: no emesis and no rescue medication) rates were found in the first 24 h between the 0.075-, 0.25-, and 0.75-mg groups (77.6%, 81.8%, and 79.5%, respectively). In the 120-h period of overall observation, CR rates increased in a dose-dependent manner. In the 0.75-mg group, we observed a significantly longer time to treatment failure than in the 0.075-mg group (median time >120 versus 82.0 h, P = 0.038). Palonosetron was tolerated well and did not show any dose-related increase in adverse effects. CONCLUSIONS Palonosetron at doses of 0.25 and 0.75 mg was shown to be effective in preventing chemotherapy-induced nausea and vomiting with high CR rates of patients treated with HEC in Japan. All tested doses of palonosetron were tolerated well.
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Affiliation(s)
- M Maemondo
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan.
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Diagnosis and management of hypersensitivity reactions related to common cancer chemotherapy agents. Ann Allergy Asthma Immunol 2009; 102:179-87; quiz 187-9, 222. [DOI: 10.1016/s1081-1206(10)60078-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wright A, Sittig DF. Automated development of order sets and corollary orders by data mining in an ambulatory computerized physician order entry system. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2007:819-23. [PMID: 17238455 PMCID: PMC1839652 DOI: pmid/17238455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Clinical decision support is essential for achieving the maximum value from electronic medical records. Content for decision support systems is usually developed manually, and developing good content is difficult. In this paper, we propose an alternate method to develop decision support content automatically through data mining of past ordering behaviors. We present two data mining methods from computer science: frequent itemset mining, which we use to learn order sets, and association rule mining, which we use to learn corollary orders. We successfully applied these techniques to a database of 156,756 orders from an ambulatory computerized physician order entry system. This analysis yielded a large pool of clinically relevant decision support content. Compared to manual development, these methods are more efficient, account more fully for local preferences and practice variations, and yield content more readily integrated into clinical systems.
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Affiliation(s)
- Adam Wright
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
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Lümmen G, Jäger T, Sommer F, Ebert T, Schmitz-Draeger B. [Nutrition, lifestyle, physical activity, and supportive care during chemotherapeutic treatment]. Urologe A 2007; 45:555-8, 560-5. [PMID: 16607518 DOI: 10.1007/s00120-006-1037-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With improvements in cancer survival rates, more patients with cancer are living longer and the influence of nutrition, lifestyle, physical activity as well as supportive care during and after chemotherapy is of increasing interest. In several malignancies smoking cessation increases cancer survival. Similar effects are expected by healthy nutrition. Regular physical activity of cancer patients reduces drug interactions of chemotherapy, decreases the number of comorbid conditions, and helps patients maintain independence as long as possible. For supportive care during chemotherapy the 5-HT3 receptor antagonists are more effective for the prevention of chemotherapy-induced nausea and vomiting. There are several colony-stimulating factors (e.g. GCSF, erythropoietin) for hematopoietic recovery post-chemotherapy. Altogether supportive care of chemotherapy reduces toxicity and increases efficacy.
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Affiliation(s)
- G Lümmen
- Klinik für Urologie und Kinderurologie, St.-Agnes-Hospital, Barloer Weg 125, 46397, Bocholt.
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Abstract
PURPOSE OF REVIEW Hypersensitivity reactions (HSRs) to chemotherapy agents have limited their use for fear of inducing severe reactions or death. Alternative regimens may be limited by tumor sensitivity and the need to provide first-line therapy. Rapid desensitizations allow patients to be treated with medications to which they have presented a HSR. The purpose of this review is to highlight the indications and recent developments in chemotherapy rapid desensitization protocols. RECENT FINDINGS Intravenous and oral rapid desensitization protocols are available for taxenes, platinums, doxorubicin, monoclonal antibodies and others. Candidate patients present mild to severe type I hypersensitivity, mast cell/IgE-dependent reactions, as seen with platinums. Anaphylactoid reactions, such as those with taxenes, can be treated with the same protocols. Repeat desensitizations in outpatient settings are well tolerated and allow patients to remain in clinical studies/trials. Breakthrough symptoms during desensitizations are less severe than the initial reaction and no deaths have been reported. Cancer remissions are similar to those for nondesensitized patients. SUMMARY The use of rapid desensitization protocols for cancer patients with HSRs to chemotherapy depends on their demonstrated tolerability and efficacy in selected populations. Education of nurses, pharmacists, and oncology and allergy specialists is needed to improve their universal application as standard of care.
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Yahata H, Saito M, Sendo T, Itoh Y, Uchida M, Hirakawa T, Nakano H, Oishi R. Prophylactic effect of pemirolast, an antiallergic agent, against hypersensitivity reactions to paclitaxel in patients with ovarian cancer. Int J Cancer 2006; 118:2636-8. [PMID: 16353140 DOI: 10.1002/ijc.21680] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We have previously shown that sensory nerve peptides contribute to the pathogenesis of pulmonary hypersensitivity reactions (HSRs) to paclitaxel in rats. Moreover, pemirolast, an antiallergic agent, reverses the HSRs to paclitaxel, although the mechanism is considered to result from the blockade of paclitaxel-induced release of sensory peptides, rather than the inhibition of histamine release. In the present study, we investigated the preventive effect of pemirolast against acute HSRs in a total of 84 patients who undertook postoperative paclitaxel plus carboplatin chemotherapy every 4 weeks for ovarian cancer. Patients were assigned to receive oral lactose (placebo) or pemirolast (10 mg), 2 hr before paclitaxel infusion. All patients received conventional premedication, including oral diphenhydramine, intravenous ranitidine and intravenous dexamethasone, 30 min before paclitaxel infusion. The HSRs that led to the discontinuance of paclitaxel infusion (grade>or=2) occurred in 5 of 42 patients in placebo group, whereas none of pemirolast-treated 42 patients showed any signs of HSRs. Plasma histamine concentrations were not changed after paclitaxel infusion in either group. Our present findings suggest that pemirolast is potentially useful for prophylaxis of paclitaxel-induced HSRs. In this respect, the use of pemirolast as premedication is expected to be beneficial to the safety management in patients who undergo chemotherapy containing paclitaxel.
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Affiliation(s)
- Hideaki Yahata
- Department of Obstetrics and Gynecology Medicine, Kyushu University Graduate School of Medical Sciences, and Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
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Henry A, Charpiat B, Perol M, Vial T, de Saint Hilaire PJ, Descotes J. Paclitaxel Hypersensitivity Reactions. Cancer J 2006; 12:237-45. [PMID: 16803683 DOI: 10.1097/00130404-200605000-00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Several studies have suggested the usefulness of a test dose of paclitaxel to reduce the incidence of hypersensitivity reactions and the resulting cost of drug wastage. The aim of this study was to assess the utility of implementing such a test dose. METHOD We retrospectively reviewed the medical charts of patients who had received one or two courses of single-agent paclitaxel or a combination chemotherapy regimen to calculate hypersensitivity reaction incidence and the cost of drug wastage. Thereafter, a paclitaxel test-dose program was routinely implemented during the first and second cycles of paclitaxel treatment for all patients. Hypersensitivity reaction incidence and drug wastage cost were again assessed. RESULTS Before the routine use of a test dose, 162 patients received one or two paclitaxel infusions alone or in combination therapy from January 1, 1997 to February 28, 2003. Ten (6.2%) patients experienced a hypersensitivity reaction; one of them was severe. After implementation of the test-dose program, 130 patients received 244 test doses (12 mg paclitaxel/10 mL normal saline) with an intensified premedication regimen at the first and second cycles of chemotherapy from June 28, 2003 to March 2, 2005. Three patients (2.3%) experienced a minor hypersensitivity reaction, one immediately after the test dose and two during infusion of the full dose despite a well-tolerated test dose. Thus, the negative predictive value of the test dose was 98.4%. The overall incidence of hypersensitivity reactions experienced during the first or second cycle of paclitaxel chemotherapy decreased about 63% compared with the incidence before implementation of the test dose (P < 0.20). The test-dose program resulted in a 29% increase in the cost of chemotherapy (approximately 6100 dollars for 130 patients). CONCLUSION To our knowledge, this is the largest study ever reported to test the potential cost-saving benefit of the implementation of a paclitaxel test-dose program to prevent hypersensitivity reactions. The results suggest that the routine use of a test dose is not a cost-effective measure.
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Affiliation(s)
- Agnes Henry
- Pharmacy Department, Croix-Rousse Hospital, Lyon, France.
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Harries M, Ellis P, Harper P. Nanoparticle Albumin–Bound Paclitaxel for Metastatic Breast Cancer. J Clin Oncol 2005; 23:7768-71. [PMID: 16204007 DOI: 10.1200/jco.2005.08.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Braverman AS, Rao S, Salvatti ME, Adamson B, McManus M, Pierre S. Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration. Chemotherapy 2005; 51:116-9. [PMID: 15886470 DOI: 10.1159/000085618] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Accepted: 11/19/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Taxanes cause hypersensitivity reactions, averted by premedication with H1 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.
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Affiliation(s)
- Albert S Braverman
- Downstate College of Medicine, State University of New York, New York, NY 11203-2098, USA.
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Sendo T, Itoh Y, Goromaru T, Hirakawa T, Ishida M, Nakano H, Oishi R. Role of substance P in hypersensitivity reactions induced by paclitaxel, an anticancer agent. Peptides 2004; 25:1205-8. [PMID: 15245881 DOI: 10.1016/j.peptides.2004.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 04/08/2004] [Accepted: 04/13/2004] [Indexed: 11/15/2022]
Abstract
The role of substance P in adverse pulmonary reactions induced by an anticancer agent paclitaxel was investigated in rats and humans who undertook post-operative chemotherapy for ovarian cancer. In rats, paclitaxel caused a marked plasma extravasation and edema in lungs with a concomitant decrease in arterial partial oxygen pressure, which were reversed by an NK1 antagonist LY303870. Substance P level in rat plasma and bronchoalveolar lavage fluid increased after paclitaxel injection. In 13 patients, plasma level of substance P but not histamine significantly (P < 0.05) increased during paclitaxel infusion. Therefore, substance P rather than histamine may be involved in paclitaxel hypersensitivity.
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Affiliation(s)
- Toshiaki Sendo
- Department of Hospital Pharmacy, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Itoh Y, Sendo T, Hirakawa T, Takasaki S, Goromaru T, Nakano H, Oishi R. Pemirolast potently attenuates paclitaxel hypersensitivity reactions through inhibition of the release of sensory neuropeptides in rats. Neuropharmacology 2004; 46:888-94. [PMID: 15033348 DOI: 10.1016/j.neuropharm.2003.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Revised: 11/07/2003] [Accepted: 11/14/2003] [Indexed: 11/24/2022]
Abstract
The effects of anti-allergic agents on the hypersensitivity reactions to paclitaxel, an anti-cancer agent, were examined in rats. Intravenous injection of paclitaxel (15 mg/kg) caused a marked extravasation of plasma protein in lungs and a transient decrease in arterial partial oxygen pressure (PaO(2)). The paclitaxel-induced protein extravasation was inhibited by low doses (0.1-1 mg/kg) of pemirolast or high doses (30-100 mg/kg) of cromoglycate. However, ketotifen was not effective. The decrease in PaO(2) induced by paclitaxel was also significantly reversed by pemirolast. On the other hand, the paclitaxel-induced plasma extravasation was not attenuated by a histamine H(1) blocker diphenhydramine or an H(2) blocker famotidine, but was significantly reduced by a neurokinin NK(1) antagonist LY303870 (0.5 mg/kg) and an NK(2) antagonist SR48968 (1 mg/kg). The concentrations of proteins and sensory peptides such as substance P, neurokinin A and calcitonin gene-related peptide but not histamine in the rat bronchoalveolar lavage fluid were elevated by paclitaxel injection. Both cromoglycate and pemirolast reduced the paclitaxel-induced rise in proteins and sensory peptides. Therefore, we demonstrated for the first time that sensory nerve peptides are involved in paclitaxel hypersensitivity and that an anti-allergic agent pemirolast attenuates the paclitaxel response by inhibiting the release of sensory nerve peptides.
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Affiliation(s)
- Yoshinori Itoh
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Kloover JS, den Bakker MA, Gelderblom H, van Meerbeeck JP. Fatal outcome of a hypersensitivity reaction to paclitaxel: a critical review of premedication regimens. Br J Cancer 2004; 90:304-5. [PMID: 14974481 PMCID: PMC2409560 DOI: 10.1038/sj.bjc.6601303] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hypersensitivity reactions (HSRs) to paclitaxel are frequently encountered in patients receiving this antitumour drug. Administration of histamine H1- and H2-receptor antagonists and corticosteroids has been shown to reduce significantly the risk of developing an HSR in patients receiving taxanes. In this case report, we describe the fatal outcome of an HSR in a patient receiving paclitaxel despite short-course premedication. The level of evidence supporting the short-course i.v. premedication schedule is challenged, as it is not compatible with the pharmacokinetic properties of dexamethasone.
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Affiliation(s)
- J S Kloover
- Department of Pulmonology, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
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Itoh Y, Sendo T, Hirakawa T, Goromaru T, Takasaki S, Yahata H, Nakano H, Oishi R. Role of sensory nerve peptides rather than mast cell histamine in paclitaxel hypersensitivity. Am J Respir Crit Care Med 2003; 169:113-9. [PMID: 14563655 DOI: 10.1164/rccm.200307-901oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Paclitaxel is one of the most extensively used anticancer agents, however, its use is often limited by severe hypersensitivity reactions, including respiratory distress, bronchospasm, and hypotension, which can occur despite premedication with dexamethasone and histamine H1 and H2 antagonists. The present study was designed to determine the mechanisms of paclitaxel hypersensitivity. In rats, paclitaxel (15 mg/kg, intravenously) caused a marked increase in pulmonary vascular permeability and edema. PaO2 decreased, whereas PaCO2 increased, transiently after paclitaxel injection. The paclitaxel-induced pulmonary vascular hyperpermeability was blocked by dexamethasone but not by histamine H1 or H2 antagonists. Paclitaxel increased the vascular permeability in lungs of mast cell-deficient rats Ws/Ws(-/-) to almost the similar extent as that elicited in wild-type rats. On the other hand, the paclitaxel-induced pulmonary vascular hyperpermeability was reversed by sensory denervation with capsaicin or pretreatment with LY303870 and SR48968, NK1 and NK2 antagonists, respectively. Consistent with these findings, a marked elevation of sensory neuropeptides such as substance P, neurokinin A, and calcitonin gene-related peptide was observed in rat bronchoalveolar lavage fluid after paclitaxel injection. These findings suggest that sensory nerves rather than mast cells are implicated in the etiology of paclitaxel hypersensitivity.
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Affiliation(s)
- Yoshinori Itoh
- Department of Hospital Pharmacy, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- Rita Wickham
- Palliative Care and Pain Medicine Service, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.
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Kwon JS, Elit L, Finn M, Hirte H, Mazurka J, Moens F, Trim K. A comparison of two prophylactic regimens for hypersensitivity reactions to paclitaxel. Gynecol Oncol 2002; 84:420-5. [PMID: 11855881 DOI: 10.1006/gyno.2001.6546] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the rates of hypersensitivity reactions to paclitaxel with the conventional prophylactic regimen of two doses of oral corticosteroids and a modified regimen of a single dose of intravenous corticosteroid. METHODS This was a retrospective historical cohort study assessing the rates of hypersensitivity reactions in patients receiving paclitaxel for ovarian or primary peritoneal carcinoma at the Hamilton Regional Cancer Centre from 1996 to 2000. Until 1998, all patients received the conventional prophylactic regimen consisting of two doses of oral dexamethasone (20 mg), 12 and 6 h prior to paclitaxel. From 1998 to the present, patients received a single dose of intravenous dexamethasone (20 mg), 30 min prior to paclitaxel. All patients also received an H(1) and H(2) blocker intravenously prior to paclitaxel administration. The analysis was corrected for potential covariates such as dose of paclitaxel and rate of infusion. The primary outcome measure was the rate of hypersensitivity reactions as defined by the National Cancer Institute of Canada-Clinical Trials Group. The Yates-corrected chi(2) test was used to compare the rates of these reactions, and a logistic regression analysis was used to determine whether any of the covariates were significant factors in these reactions. RESULTS One hundred seven patients received the conventional corticosteroid prophylaxis prior to paclitaxel, and 110 received the single-dose intravenous corticosteroid prophylaxis. Of the 107 patients in the conventional prophylaxis group, 8 had a hypersensitivity reaction (7.5%), and only 1 of these was severe (0.9%). In contrast, of the 110 patients in the single-dose IV corticosteroid group, 19 had a hypersensitivity reaction (17.3%), and 8 of these were severe (7.3%). The difference in hypersensitivity reaction rates was significant (chi(2), P = 0.047). In the logistic regression analysis, the only significant factor related to hypersensitivity reactions was the type of prophylactic steroid regimen. CONCLUSIONS In this series, the single-dose intravenous corticosteroid prophylactic regimen appeared to be associated with a higher rate of hypersensitivity reactions to paclitaxel than the conventional two-dose oral corticosteroid regimen.
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Affiliation(s)
- Janice S Kwon
- Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, M5S 1A1, Canada
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Abstract
OBJECTIVE To evaluate clinical literature supporting the prophylactic use of single-dose intravenous dexamethasone to prevent hypersensitivity reactions (HSRs) to paclitaxel infusion. DATA SOURCES Clinical literature accessed through MEDLINE (from 1986 to 2000). DATA SYNTHESIS Prophylaxis for paclitaxel-related HSRs generally includes repeated dexamethasone doses beginning 12 hours before paclitaxel, and administration of diphenhydramine plus a histamine2-receptor antagonist 30 minutes before infusion of paclitaxel. Singe-dose intravenous dexamethasone administered with ancillary medications 30 minutes before infusion of paclitaxel has been used to prevent regimen-related HSRs. CONCLUSIONS Single-dose intravenous dexamethasone can be used in combination with appropriate ancillary medications to prevent paclitaxel-related HSRs.
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Affiliation(s)
- P E Kintzel
- Department of Pharmacy, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
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Generali J, Cada DJ. Famotidine: Prevention of Paclitaxel Hypersensitivity Reactions. Hosp Pharm 2001. [DOI: 10.1177/001857870103600711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
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Affiliation(s)
- Joyce Generali
- Drug Information Center, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160
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Rohl J, Kushner D, Markman M. Chronic administration of single-agent paclitaxel in gynecologic malignancies. Gynecol Oncol 2001; 81:201-5. [PMID: 11330950 DOI: 10.1006/gyno.2001.6142] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are currently limited published data available on the safety and feasibility of the prolonged administration of paclitaxel. The goal of this study was to review the cumulative toxicity associated with the continuous long-term administration of this agent to women with gynecologic cancers. METHODS Eleven patients with gynecologic malignancies of varying histologic subtypes who received >15 consecutive courses of paclitaxel were identified in a retrospective review of individuals treated between 1994 and 1999 in the Gynecologic Oncology Program of the Cleveland Clinic Taussig Cancer Center. The analysis excluded paclitaxel delivered as a component of an initial chemotherapy regimen for the cancer. Paclitaxel was administered at doses ranging from 80 to 175 mg/m(2) every 3-4 weeks as a 3-h infusion. RESULTS In general, the patients included in this report were heavily pretreated and were continued on therapy either as a result of documentation of an objective response or with evidence of stabilization of disease (e.g., physical examination, radiographic evaluation, CA-125 antigen level) and the maintenance of a satisfactory quality of life. In the 11 patients, the median duration of therapy was 20 cycles (range: 16-36 cycles). Alopecia was observed in all patients. A single patient experienced grade 3 anemia and grade 4 neutropenia. Of note, there was 1 case of grade 2 and no cases of grade 3 peripheral neuropathy in this population. CONCLUSION Prolonged delivery of paclitaxel for >15 consecutive cycles can be safely administered to carefully selected patients with persistent or recurrent advanced gynecologic cancers.
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Affiliation(s)
- J Rohl
- Department of Gynecology & Obstetrics, Cleveland Clinic Foundation and Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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