Department of Oncology, Imperial College Healthcare NHS Trust, London, UK.
Int J Gynecol Cancer. 2013 Sep;23(7):1318-25. doi: 10.1097/IGC.0b013e31829f1799.
Dexamethasone premedication is required with paclitaxel to prevent infusion-related hypersensitivity reactions (HSRs). Both oral dexamethasone (PO-D; 20 mg 12 and 6 hours before paclitaxel) and intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) regimens are used. The optimal premedication regimen and management of patients after HSR are unclear.
Data on HSRs in women receiving paclitaxel, 175 mg/m², every 3 weeks at Imperial College Healthcare Trust from May 2011 to February 2012 were obtained from the pharmacy database. During this period, dexamethasone premedication for paclitaxel was administered orally (PO-D; 20 mg 12 and 6 hours before paclitaxel) from May to August 2011, then changed to intravenous dexamethasone (IV-D; 20 mg 30 minutes before paclitaxel) for 3 months, and then reverted to PO-D from November 2011. There were 93 and 55 patients who received PO-D and IV-D before paclitaxel, respectively. Hypersensitivity reaction rates were pooled with those from published studies for analysis. Gynecologic oncology centers in the UK and Canada were surveyed regarding premedication and post-HSR management. A Markov Monte-Carlo simulation model compared costs and benefits of different strategies.
Hypersensitivity reaction rates with PO-D and IV-D were 5.4% (5/93) versus 14.5% (8/55) (P = 0.07) in Imperial College Healthcare Trust patients, and 6.8% (20/290) versus 14.1% (30/212) (P = 0.009) on pooled analysis with data from 2 additional studies (502 patients), respectively. However, IV-D is the most common premedication regimen used in the UK and Canada (48.5% and 34.2% of centers). Post-HSR paclitaxel on a desensitization protocol is a cost-effective alternative to discontinuing paclitaxel altogether.
Oral dexamethasone seems to be superior to IV-D in preventing HSRs. Post-HSR patients should be considered for desensitization.
为预防紫杉醇输注相关过敏反应（HSR），需预先给予地塞米松。目前有口服地塞米松（PO-D；紫杉醇前 12 小时和 6 小时各 20mg）和静脉用地塞米松（IV-D；紫杉醇前 30 分钟 20mg）两种方案。但目前尚不清楚哪种预处理方案最佳，以及 HSR 后患者的管理策略。
本研究通过检索 2011 年 5 月至 2012 年 2 月帝国理工学院医疗信托基金会（Imperial College Healthcare Trust）女性接受紫杉醇（175mg/m²，每 3 周 1 次）治疗的过敏反应数据，获取患者的药物数据库。在此期间，地塞米松预处理方案于 2011 年 5 月至 8 月期间采用 PO-D（紫杉醇前 12 小时和 6 小时各 20mg），3 个月后改为 IV-D（紫杉醇前 30 分钟 20mg），2011 年 11 月又恢复为 PO-D。分别有 93 例和 55 例患者接受了紫杉醇前的 PO-D 和 IV-D。通过合并发表研究中的数据进行分析，得出过敏反应发生率。对英国和加拿大的妇科肿瘤中心进行了地塞米松预处理和 HSR 后管理的调查。采用 Markov 蒙特卡罗模拟模型比较了不同策略的成本效益。
帝国理工学院医疗信托基金会患者中，PO-D 和 IV-D 的过敏反应发生率分别为 5.4%（5/93）和 14.5%（8/55）（P=0.07），合并另外 2 项研究（502 例患者）的数据后，分别为 6.8%（20/290）和 14.1%（30/212）（P=0.009）。然而，IV-D 是英国和加拿大最常用的预处理方案（48.5%和 34.2%的中心）。HSR 后，根据脱敏方案继续使用紫杉醇而非完全停止，是一种具有成本效益的替代方案。
口服地塞米松似乎比 IV-D 更能预防 HSR。HSR 后患者应考虑进行脱敏治疗。
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