Background and Objective: Taxane agents are associated with a high incidence of hypersensitivity reactions (HSRs) in patients with cancer. Inappropriate management of hypersensitivity reactions may lead to unnecessary cessation of first line taxane-based chemotherapies, or prolonged use of high dose corticosteroids. The aim of this study was to review the current management of taxane HSRs to inform the development of a standardised management protocol that could be further evaluated in clinical practice.
Methods: We performed a retrospective chart review of all patients who had a documented HSR to either cabazitaxel, docetaxel, NAB-paclitaxel, or paclitaxel in the outpatient oncology centre at Royal North Shore Hospital from 1st January 2018 to 31st December 2020. We reviewed the patient characteristics, clinical presentation, timing, and acute management of the initial HSR, as well as examining the outcomes after rechallenging.
Results: 50 out of 388 (13%) patients who had been administered a taxane agent were identified to have had an HSR. Paclitaxel was the most commonly associated agent (76%). 45 (90%) patients had a Grade 2 reaction, and 5 (10%) had a Grade 3/4 reaction. Treatment of the initial hypersensitivity reaction was heterogeneous and included varying combinations and doses of steroids, antihistamines, beta-agonists, intravenous fluids, and supplemental oxygen. Of the 47 patients rechallenged, 16 (34%) had a further HSR. Severe or recurrent hypersensitivity reactions led to a change in 10 (20%) patients’ chemotherapy regimens. No patients were considered for formal desensitisation.
Conclusion: Whilst most taxane HSR were successfully rechallenged, there remains substantial variability in the acute and subsequent management of patients. Implementation of a standardised management protocol may assist with reducing heterogeneity and improving subsequent rechallenges.