Presenting Author: Garrett Rompelman, PharmD, BCOP, Dana-Farber Cancer Institute, Boston, MA
Co-Authors: Vlashyn, Olga, PharmD, MS, Mazzola, Emanuele, PhD, Lynch, Donna-Marie, FNP, Menon, Susanne, CNP, Alvarez, Michele, MSN, RN BMT-CN, and Jabaley, Terri, PhD, RN, OCN, Dana-Farber Cancer Institute, Boston, MA
BACKGROUND: Patients exposed to paclitaxel and docetaxel (taxanes) have an increased rate of hypersensitivity reaction (HSR), especially during the first and second exposures (21% to upward of 41%). Most symptoms are mild that involve skin reactions, to more severe, including anaphylaxis and death. Taxane administration varies in practice settings, including the rate of infusion during titration and priming intravenous lines with drug versus diluent because of a lack of supporting evidence in the literature.
OBJECTIVES: To determine the impact of titrating taxanes on HSR incidence rates and severity in patients receiving first or second taxane doses, and to identify if there is a difference between HSR incidence rates and severity in the first 2 exposures when priming the taxane lines with drug compared with priming with diluent.
METHODS: A total of 99 taxane patient infusions (first and second doses) were titrated using lines primed with drug and were prospectively monitored and compared for HSR incidence and severity with a retrospective cohort of taxane infusions (n=123) without titration. A follow-up monitoring of 999 taxanes with a modified titrated rate and lines primed with diluent were then compared with the original cohort (n=99, titrated infusions using lines primed with drug) and (n=123, nontitrated infusions) to evaluate the differences in HSR rate and severity.
RESULTS: There was a significant decrease (P<.001; 6% vs 18.7%) in the incidence rates of HSRs when titrating taxanes using a line primed with drug compared with taxane patients exposed without titration. In addition, there was no significant difference (P=.659) between HSR rates and severity when taxane patients were titrated with lines primed with diluent compared with lines primed with drug.
CONCLUSION: These comparisons showed a significant reduction in HSRs when patients received a slow rate of infusion during the initial exposures to taxanes. There was no statistical difference between priming with diluent versus with drug when both groups were titrated, proving a slower rate of administration is crucial. In both analyses, there was no significant difference in severity based on the grade of reaction; however, the use of epinephrine and the incidence of hospitalizations and treatment interruptions were reduced in the titration arms.
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- Docetaxel injection, for intravenous use [prescribing information]. Hospira; May 2023. https://labeling.pfizer.com/showlabeling.aspx?format=PDF&id=4411
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