1542P - Efficacy and safety of a single dose of dexamethasone pre docetaxel treatment: The Auckland experience

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Supportive Care
Presenter Elaine Rogers
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors E.S. Rogers1, E. Witton1, J. Stewart2, D. Porter1
  • 1Medical Oncology, Regional Cancer and Blood Service, 1014 - Auckland/NZ
  • 2Faculty Of Medical And Health Sciences, The University of Auckland, Auckland/NZ

Abstract

Aim

Auckland City Hospital implemented a change to single intravenous (IV) pre-medication (pre-med) 20mg dose of dexamethasone pre-docetaxel treatment, because of patient (pt) reports of un-wanted side effects of insomnia, reflux-oesophagitis, weight gain with multi-dose regimens, and treatment delays to missed oral pre-med doses of dexamethasone. The new pre-med regimen was based on data by Choudham, J Oncol Pharm Practice, 2011.

Methods

An audit tool was developed and data were collected prospectively to identify the impact of symptoms and overall safety in pts receiving this regimen. All pts received outpatient treatment at 3 week intervals. 610 cycles of docetaxel were administered to 160 pts with breast, lung, prostate, head & neck cancer who received the following regimens; FEC-D, TC, TH, TCH, Docetaxel, Docetaxel/Carboplatin±trastuzumab, and TPF. Demographics; 126 female and 34 male, median age 53 years (range 28-78). 134 pts commenced treatment with single pre-med dose of dexamethasone (SD). Multi-day (MD) group comprised various IV/PO dexamethasone regimens ranging from day -1 to day 4 (n = 26). The MD group included prostate pts who received IV 20mg dexamethasone plus prednisone 5mg PO BD continuously. Oedema at/before cycle 3 in SD and MD groups were compared.

Results

Infusion hypersensitivity reactions (HSR) occurred in 17 cycles (3%) and in 13 patients (8%). 1 pt experienced a severe reaction, leading to treatment discontinuation. Docetaxel was successfully re-administrated after corticosteroids and anti-histamine in all 16 mild/moderate HSR. No HSR occurred after cycle 4. Only 1 pt experienced a weight gain of >10%.

Oedema Cycle 3 Nausea & vomiting Cycle 1 Hand/foot syndrome (HFS) Cycle 1
SD 11% 32% 29%
MD 12% 35% 11%

Conclusions

Single dose dexamethasone is an acceptable first-line pre-med for docetaxel, with the option of adding in additional doses as required. Rates of oedema, N&V and weight gain were comparable to MD regimens. Infusion HSR rate is low and acceptable. Anecdotally it results in less insomnia and reflux-oesophagitis, though a formal comparison would be required to demonstrate this conclusively with validated tools. HFS appears to be more common.

Disclosure

All authors have declared no conflicts of interest.