A simplified premedication schedule for 1-hour paclitaxel administration

Many investigations have focused on an optimal dosing schedule for paclitaxel since its regulatory approval. Paclitaxel is generally administered at a dose of 175 mg/m2 IV over 3 hours or 135-175 mg/m2 IV over 24 hours, every 3 weeks. The purpose of this study was to simplify the administration of paclitaxel to make it suitable and practical in the outpatient setting. Using this rationale, the duration of administration was decreased to 1 hour, with a minimized premedication regimen. Fifty-two patients scheduled to receive paclitaxel-based chemotherapy were entered into the study. Tumor types included non-small cell lung cancer, small cell lung cancer, breast cancer, head and neck cancer, and ovarian cancer. Twelve patients received paclitaxel 175 mg/m2 IV, and the remaining 40 patients received paclitaxel 225 mg/m2 IV. Premedication consisted of IV dexamethasone 20 mg over 5-10 minutes, given 30-60 minutes before infusion of paclitaxel,followed by IV dimethindene maleate 4 mg and IV ranitidine 50 mg over 30 minutes. Paclitaxel always was administered before other chemotherapeutic agents. Hypersensitivity reactions were recorded in 4 patients (7.7%) and were not influenced by age, gender, disease, dose schedule, or number of cycles of therapy; no serious hypersensitivity reactions were observed. The present study supports the efficacy and safety of a short premedication schedule; with further study, this schedule might become a standard premedication protocol prior to paclitaxel administration.