Sasada Shinji, Hirashima Tomonori, Nakamura Yukiko, Takimoto Takayuki, Furukawa Mitsugi, Kobayashi Masashi, Nitta Takashi, Matsui Kaoru, Kawase Ichiro
Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino 3-7-1, Habikino, Osaka, 583-8588, Japan.
Int J Clin Oncol. 2007 Aug;12(4):274-8. doi: 10.1007/s10147-007-0675-9. Epub 2007 Aug 20.
Paclitaxel often causes severe hypersensitivity reactions (HSRs) rapidly after infusion, even in patients given prophylactic therapy. The purpose of this study was to analyze the incidence of paclitaxel-related HSRs in patients with non-small cell lung cancer (NSCLC) retrospectively, and to assess the feasibility of a modified premedication protocol.
One hundred and seven patients who were pretreated with either a conventional premedication regimen (two doses of dexamethasone) or a short premedication regimen (single dose of dexamethasone with oral diphenhydramine and intravenous ranitidine), prior to paclitaxel infusion were retrospectively analyzed. A modified premedication regimen, consisting of 12.5 ml of Rescalmin (intravenous diphenhydramine 50 mg and calcium bromide 437.5 mg), intravenous ranitidine 100 mg, and intravenous dexamethasone 20 mg, was given 30 min prior to paclitaxel, with oral dexamethasone 8 mg given on the night before the paclitaxel. Patients received paclitaxel intravenously at 175 mg/m(2) over 3 h, followed by carboplatin, AUC 5, over 1 h on day 1 every 3 weeks.
In the conventional premedication group, 21 patients had HSRs (32.3%); in 1 of these patients the HSR was considered to be severe (1.5%). In the short premedication group, 19 patients had HSRs (45.2%); in 6 of these patients the HSRs were considered to be severe (14.3%). The incidence of severe HSRs was significantly higher in the short premedication group than in the conventional premedication group (P = 0.027). In the modified premedication protocol study, HSR events were recorded in 14 patients (63.6%); 14 showed flushing, 2 had skin rash, and 1 had tachycardia. No severe HSRs were seen.
The incidence of HSRs in the short premedication group tended to be higher than that in the conventional premedication group. The modified premedication protocol was found to be feasible for preventing paclitaxel-related HSR, but case accumulation is needed.
紫杉醇即使在接受预防性治疗的患者中，也常于输注后迅速引发严重的过敏反应（HSR）。本研究旨在回顾性分析非小细胞肺癌（NSCLC）患者中紫杉醇相关HSR的发生率，并评估改良预处理方案的可行性。
回顾性分析107例在紫杉醇输注前接受传统预处理方案（两剂地塞米松）或简短预处理方案（单剂地塞米松联合口服苯海拉明和静脉注射雷尼替丁）的患者。改良预处理方案包括在紫杉醇输注前30分钟给予12.5 ml 瑞司氯铵（静脉注射苯海拉明50 mg和溴化钙437.5 mg）、静脉注射雷尼替丁100 mg和静脉注射地塞米松20 mg，在紫杉醇输注前一晚口服地塞米松8 mg。患者每3周于第1天静脉输注紫杉醇175 mg/m²，持续3小时，随后静脉输注卡铂，AUC为5，持续1小时。
在传统预处理组中，21例患者发生HSR（32.3%）；其中1例患者的HSR被认为是严重的（1.5%）。在简短预处理组中，19例患者发生HSR（45.2%）；其中6例患者的HSR被认为是严重的（14.3%）。简短预处理组中严重HSR的发生率显著高于传统预处理组（P = 0.027）。在改良预处理方案研究中，14例患者记录到HSR事件（63.6%）；14例出现潮红，2例出现皮疹，1例出现心动过速。未观察到严重HSR。
简短预处理组中HSR的发生率倾向于高于传统预处理组。发现改良预处理方案对于预防紫杉醇相关HSR是可行的，但需要积累病例。
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