Comparing the Rates of Hypersensitivity Reactions During First-Dose Taxane Infusions: Fixed-Rate Versus Stepwise...

Taxanes are associated with a higher incidence of immediate hypersensitivity reactions (HSRs) compared with other classes of chemotherapeutic agents, even with premedication. This study evaluates whether a titrated infusion protocol reduces the rate of first-dose HSRs to taxanes.

This was a retrospective cohort study conducted at a single-site hematology/oncology infusion center. The fixed-rate arm consisted of patients treated from January 2022 to July 2023 who received a fixed infusion rate for their first dose. The titration arm comprised patients treated from August 2023 to July 2024 who underwent a three-step titration protocol for their first dose. The primary end point was the rate of immediate HSRs during the first lifetime dose of docetaxel or paclitaxel. Secondary end points included HSR severity, HSRs during the first or second dose, and rate of treatment discontinuation because of HSRs.

Of 479 patients included (240 fixed-rate; 239 titration), HSRs occurred in 7.1% of the fixed-rate group and 11.3% of the titration group (odds ratio, 1.67 [95% CI, 0.89 to 3.15]; P = .1104). There were no differences in the severity of HSRs or in the rate of treatment discontinuation among both groups.

The use of a titrated infusion protocol for first lifetime dose taxanes did not significantly reduce the incidence or severity of immediate HSRs. These findings suggest that a titration protocol may not confer additional benefits over fixed-rate in this setting.