Dexamethasone premedication for prophylaxis of taxane toxicities: can the doses be reduced when paclitaxel or docetaxel are given weekly?

PURPOSE

To evaluate the clinical literature supporting reduced doses of dexamethasone to prevent taxane hypersensitivity reactions (HSRs), and edema/skin toxicities in respect to docetaxel, when taxanes are given weekly, as opposed to every 3 weeks.

DATA SOURCE

Clinical literature of human-controlled clinical trials, accessed through MEDLINE and meeting abstract databases (from 1990 to 2010).

DATA EXTRACTION

The retrieved literature was reviewed to include all human clinical trials that recorded adverse effect information with weekly taxanes utilizing reduced-dose or tapering dexamethasone schemas, either prospectively or retrospectively.

DATA SYNTHESIS

Prophylaxis for paclitaxel-related HSRs generally includes one or more 20 mg doses of dexamethasone, with histamine-1 and -2 receptor antagonists prior to infusion of paclitaxel. Prophylaxis for docetaxel-related HSRs generally includes dexamethasone beginning 1 day before docetaxel, and continuing twice daily for a total of 3 days. These schedules were designed for taxanes given every 3 weeks, but may lead to steroid-related adverse effects when given weekly with weekly taxane administration. Treatment strategies designed to reduce corticosteroid exposure in patients receiving weekly taxanes have been investigated.

CONCLUSIONS

Several predication strategies utilizing reduced doses of dexamethasone with weekly taxanes appear to be feasible and safe, and can be considered for patients experiencing, or at high risk for steroid-induced side effects. However, the optimal schedule is not yet determined; larger prospective clinical trials are needed.