The administration of paclitaxel without prophylaxis for the prevention of hypersensitivity reactions: is this a rationale and safe therapeutic strategy?

摘要: Paclitaxel is currently one of the most widely employed antineoplastic agents in oncologist's armamentarium. A unique toxicity this agent development hypersensitivity reactions, which occur as many 6 ± 10% patient's receiving drug (Weiss et al. 1990). During initial clinical paclitaxel, concern for incidence and severity reactions led to decision that all patients would be treated with a three regimen designed prevent these 1990; McGuire 1989). This program included use dexamethasone, taken night before morning chemotherapy, along histamine-1 histamine-2 receptor antagonists delivered intravenously approximately 30 min prior paclitaxel administration. All given were also required receive 24-h infusion, but subsequently reported randomized trial (Eisenhauer 1994), results experience, have revealed shorter infusion schedules can an acceptable reactions. statement assumes continue prophylactic program, regardless schedule utilized. The need employ prophylaxis paclitaxel-associated if very long treatment (e. g., $96 h) are administered has recently been questioned (Wilson 1994; Georgiadis 1997; Younes 1996; Seidman 1996). major rationale suggestion data gathered from small phase 1 ±2 trials longer ($96 where appeared lower than observed regimens (#24 Spriggs Tondini 1992). Is reasonable strategy based on knowledge drug-induced well actual data? Can approach considered safe? Several points made addressing important issue. First, serious paclitaxel-induced actually quite low (53% patients) 1996), failure observe or more episodes 2 involving 15± cannot interpreted indicate such do not occur, even strongly suggest schedules. Second, theoretical perspective, it difficult understand why extending duration 24 96 hours should significantly reduce It well-established usually develop within first few minutes initiation often delivery only milligrams into systemic circulation 1989; Essayan Peereboom 1993). Therefore, minimal slowing rate entry eliminate risk reaction, administered? signs, symptoms, course aclassico those caused by release histamine other vasoactive substances (type 1) In cases severe penicillin allergy, iodinated radiographic contrast material, reaction bee stings) desensitization successfully subsequent However, situaThe Journal Cancer Research Clinical Oncology occasionally publishes Editorials Guest editorials current controversial problems experimental oncology. These papers reflect personal opinions authors. Readers send any comments directly authors