Tapering Steroids Prior to Paclitaxel for Breast Cancer Does Not Increase Infusion Reactions

In patients receiving paclitaxel infusions for treatment of breast cancer, decreasing the at-home dosing of dexamethasone may help reduce the incidence of infusion reactions, according to a retrospective study presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024.

According to the study authors, “using steroids as a premedication [to paclitaxel] reduces the incidence of hypersensitivity reactions to around 1% to 3%.” Current prescribing information recommends dexamethasone 20 mg 12 hours and six hours prior to paclitaxel; however, “physicians may choose to taper home steroids after the second dose of paclitaxel and beyond,” the authors wrote. They sought to evaluate steroid tapering methods and incidence of infusion reaction among patients receiving paclitaxel for breast cancer at Nebraska Medical Center.

Ninety patients were included, and 306 paclitaxel infusions were assessed. Of these infusions, 283 were completed with a steroid reduction and 23 were completed with a steroid omission. Five infusion reactions occurred in the steroid reduction group (1.8%) and none occurred in the steroid omission group. Two of five reactions were grade I and three were grade II. Three patients who had an infusion reaction had a documented allergy to paclitaxel.

Of the total infusions, 118 (38.5%) were completed with a 12-hour and six-hour at-home dexamethasone dose prior to infusion, and 165 (54%) were completed with a six-hour dose. In the steroid reduction group, 90 steroid-related side effects occurred, including hyperglycemia (24.4%) and insomnia (15.6%). Four patients in the steroid omission group experienced side effects, including one patient with hyperglycemia (25%) and one patient with insomnia (25%).

“Decreasing home-dose dexamethasone resulted in a 1.6% overall incidence of infusion reactions, which is comparable with the reported 1% to 3% incidence of infusion reactions with standard dosing of premedication dexamethasone,” the authors summarized. They called on institutions to discuss standards for premedication dexamethasone prior to paclitaxel to assess the potential for decreasing home steroid exposure.

Reference

Kuhlers SL, Kathol E, Quach D, Krishnamurthy J, Marth K. Assessing outcomes of tapering 12-hr and 6-hr dexamethasone prior to paclitaxel infusions. Poster. Presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024; April 3-6, 2024; Tampa, Florida.