Study Investigates Rates of Paclitaxel Hypersensitivity Reactions in a Community Hospital System

A study of patients receiving treatment with paclitaxel in an academic community hospital system found low rates of treatment-related hypersensitivity reactions (HSRs). These findings were presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024.

The investigators performed a retrospective chart review for 200 inpatients and outpatients within the Memorial Healthcare System. The primary outcome was the incidence of paclitaxel HSRs. The secondary outcome was time to HSRs. Other outcomes analyzed were rates of paclitaxel re-challenge and rates of switching therapies.

The most common malignancy was of the breast (56.0%), followed by gynecologic (26.0%), lung (10.5%), and other (8.0%). Only 16.5% of patients completed titration per Memorial Health System protocol (begin infusion at a 50% rate for 15 minutes, then proceed to increase to full rate if no reaction occurs).

Ten (5%) patients experienced an HSR, of whom 60% were anaphylactic. Seventy percent of HSRs occurred within 15 minutes of infusion. Five patients who had an HSR had a therapy switch: 4 to nab-paclitaxel and 1 to a longer infusion time.

“Dose ranges of premedications fell below recommended doses within the package insert,” the authors noted. Additionally, the “majority of premedications were given outside the recommended administration time range, questioning appropriate use based on the dosage form and half-life of premedications.”

Overall, the incidence of HSRs fell below rates published in the literature (31%-45%), despite the low percentage of titration per health system protocol. “Potential improvements to the standardization of paclitaxel administration protocol include removing titration instructions and acetaminophen for prophylaxis in paclitaxel protocols,” the authors noted.

Reference

Kim MJ, Osmon E, Rodriguez M, Graibe-Martinez D. Incidence of paclitaxel hypersensitivity reactions at an academic community hospital system. Poster. Presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024; April 3-6, 2024; Tampa, Florida.