Low-dose dexamethasone is just as effective as high-dose dexamethasone for preventing hypersensitivity reactions (HSRs) to taxane chemotherapy, according to a retrospective study published in the Journal of Clinical Oncology.

The study results did not show any correlation between the rate of HSRs and the dose of dexamethasone or the route of dexamethasone administration.

“Given the potential for adverse events from repeated high-dose steroids, our findings suggest that routine use of lower doses, such as a single 10 mg dose of dexamethasone, as premedication for taxanes to prevent HSRs is preferable to the current prescribing guidelines,” the researchers wrote.

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For this study, the researchers retrospectively reviewed the pattern of premedication in patients who received paclitaxel or docetaxel at a single center between January 2010 and June 2020.

The team used an electronic query of the electronic medical records along with a manual review of patient charts to determine if there was a correlation between dexamethasone premedication dosing and the incidence or severity of HSRs with the first taxane dose.

The researchers’ final analysis included 3181 adult patients who received paclitaxel and/or docetaxel during the period studied. In all, there were 264 (8.3%) HSRs in this group.

In an adjusted multivariate analysis, there was no significant difference in the risk of HSRs among patients receiving high-dose dexamethasone and those receiving low-dose dexamethasone.

Among the different variables analyzed, only gynecologic cancers and female sex were significantly associated with the risk of HSRs in the adjusted analysis.

Female patients had a higher risk of HSR (hazard ratio [HR], 1.26; 95% CI, 1.09-1.46; P =.0014) than did male patients (HR, 0.59; 95% CI, 0.42-0.82; P =.0014).

When compared with all cancer patients, patients with gynecologic cancers had a higher risk of having an HSR (HR, 1.34; 95% CI, 1.01-1.79; P =.0444).

Additionally, patients with gynecologic malignancies were more likely to have high-grade reactions than all other cancer groups (HR, 2.34; 95% CI, 1.14-4.79; P =.0200). However, there was no correlation between patient sex and the risk of grade 3-4 HSRs.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lansinger OM, Biedermann S, He Z, et al. Do steroids matter? A retrospective review of premedication for taxane chemotherapy and hypersensitivity reactions. J Clin Oncol. Published online August 06, 2021. doi: 10.1200/JCO.21.01200