在每周至每两周一次的紫杉醇长期给药期间逐渐减少并停用糖皮质激素预防性用药。
Tapering and discontinuation of glucocorticoid prophylaxis during prolonged weekly to biweekly paclitaxel administration.
作者信息
Braverman Albert S, Rao Sujatha, Salvatti Mary Ellen, Adamson Barbara, McManus Margaret, Pierre Shirley
机构信息
Downstate College of Medicine, State University of New York, New York, NY 11203-2098, USA.
出版信息
Chemotherapy. 2005 May;51(2-3):116-9. doi: 10.1159/000085618. Epub 2005 May 9.
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.
背景
紫杉烷类会引起超敏反应，可通过使用H1阻滞剂和高剂量糖皮质激素（GC）进行预处理来避免。每周延长紫杉烷给药可能会导致GC毒性。
目的
确定在高剂量GC预处理后对初始紫杉醇（PTX）输注无超敏反应的患者在后续不进行GC预防的情况下能否耐受延长的PTX治疗。
患者和方法
在122例乳腺癌患者中，115例对初始PTX治疗无超敏反应，地塞米松（DXM）剂量从20mg开始，每周递减2.0mg，接受9个或更多疗程的患者DXM剂量减至0。在4个PTX疗程后，苯海拉明改为口服而非静脉给药。
结果
在使用2.0 - 5.0mg DXM后进行了143次PTX给药，未使用DXM时进行了357次给药。共有46例患者在未使用DXM的情况下接受了1 - 40个PTX疗程。这115例患者均未发生超敏反应。
结论
在高剂量及逐渐减量的GC预处理后，对首次PTX输注无反应的患者在后续PTX治疗中可能不需要GC预防。
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