The following article features coverage from ONS Bridge 2020. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

 

A literature review on whether oral or intravenous (IV) dexamethasone premedication is optimal for hypersensitivity prophylaxis in the setting of paclitaxel administration resulted in a recommendation of no changes to standard practices. These findings were presented on the Oncology Nursing Society (ONS) Bridge, a virtual conference.

Mild to severe infusion-related hypersensitivity reactions, such as facial flushing, urticaria, shortness of breath, angioedema, and anaphylaxis, are common in patients treated with paclitaxel.


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Hence, premedication with dexamethasone is considered the standard-of-care for the prevention of paclitaxel-related hypersensitivity reactions. However, questions remain regarding the preferred route of administration: oral dexamethasone administered 12 and 6 hours prior to administration of paclitaxel vs premedication with intravenous (IV) dexamethasone.

Following concerns raised by the infusion staff at the Carle Foundation Hospital and Physician Group in Urbana, Illinois, a literature review was conducted by Sarah Glenn, MSN, OCN, for the purpose of assessing the risk of paclitaxel-related hypersensitivity in patients with cancer receiving oral vs IV dexamethasone premedication.

A key finding of this literature review was that most of the articles on this topic were published between 2001 and 2004, and primarily represented prospective reviews or case controlled studies conducted at multiple institutions. Furthermore, there was no consensus across these studies regarding the preferred route of administration of dexamethasone prophylaxis in the setting of paclitaxel administration.

“Given the ambivalence regarding the superior route of administration, no practice change is indicated at this time,” stated Ms Glenn.

She added that “new research is needed to answer the concerns of nurses and patients related to [hypersensitivity reactions],” and that “larger randomized [controlled] studies would be beneficial to address those concerns and validate the appropriate use and type of premedication for both safety and convenience.”

Reference

Glenn S. Dexamethasone use to prevent paclitaxel hypersensitivity reactions. Presented at: ONS Bridge; September 8-17, 2020. Accessed September 14, 2020. https://ons.confex.com/ons/2020/qi/eposter.cgi?eposterid=595