Researchers from the Ottawa Hospital Cancer Centre observed that a fixed-dose steroid replacement was superior to a physician-directed strategy prior to starting docetaxel. These findings were published in Supportive Care in Cancer.
In a clinical trial, 60 patients who missed a steroid premedication dose were randomized to receive 8 mg dexamethasone (n=30) or a physician-directed replacement (n=30) between 2016 and 2018. Patients were assessed for time to start docetaxel and adverse events.
Patients were aged mean 59.1 years and had cancers of the breast (70%), gastrointestinal tract (12%), prostate (12%), or lung (7%). Patients were prescribed docetaxel with cyclophosphamide (33%), docetaxel monotherapy (30%), 5-fluorouracil/epirubicin/cyclophosphamide prior to docetaxel (17%), or docetaxel-oxaliplatin-5-fluorouracil (12%). Patients were on their first (48%), second (22%), third (14%), fourth (10%), fifth (3%), or sixth (3%) chemotherapy cycle.
The physician-guided strategies included 8 mg (33%), 20 mg (17%), 12 mg (17%), 10 mg (13%), or 4 mg (3%) intravenous dexamethasone, 8 mg oral dexamethasone (10%), or no additional dexamethasone (7%).
Average time from randomization to docetaxel treatment was 21.2 (95% CI, 2.1-44.6; P =.033) minutes shorter among patients in the fixed-dose group (mean, 62.2±41.1 mins; median, 47.5 mins) compared with the physician-directed cohort (83.4±48.0 mins; median, 61 mins).
Rates of acute allergy, delayed allergic reaction, fluid retention, or skin rash were not significantly different between treatment groups.
This study was possibly biased by its open-label design.
The study authors concluded that 8 mg dexamethasone should be the standard care for patients who missed a steroid dose prior to starting chemotherapy.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Hsu T, Fergusson D, Stober C, et al; REaCT Investigators. A randomized clinical trial comparing physician-directed or fixed-dose steroid replacement strategies for incomplete dexamethasone dosing prior to docetaxel chemotherapy. Support Care Cancer. Published online October 5, 2020. doi:10.1007/s00520-020-05791-5