H2 receptor antagonists (H2RAs) may not prevent infusion-related reactions (IRRs) to paclitaxel, according to research published in Cancer.

Due to supply issues, a hospital in Canada was forced to remove H2RAs as part of routine premedication in patients receiving paclitaxel. Subsequent evaluation showed no increase in IRRs after this change.

The researchers evaluated outpatients starting paclitaxel from December 2019 to October 2021 at the Ottawa Hospital Cancer Centre in Ontario. The patients had a variety of cancers, including breast (52%), gynecologic (24%), gastric/esophageal (10%), lung (8%), and other cancers (6%).

Patients were grouped according to H2RA treatment, with 184 patients who received standard H2RA premedication and 182 who did not. All patients received premedication with intravenous corticosteroids and oral or intravenous diphenhydramine.

There was no significant difference in the rate of grade 2 or higher IRRs between the groups. Grade 2 or higher IRRs occurred in 12.1% of patients treated without H2RAs and 15.1% of patients treated with H2RAs. The rate of grade 3 or higher IRRs was 4.4% and 3.8%, respectively.

There were no significant differences in the outcomes of IRRs between the groups. The proportion of patients who were able to complete their paclitaxel infusion was 68% in patients who received H2RAs and 59% in those who did not. A change of treatment was required for 21% of patients who received H2RAs and 36% of those who did not.

The remaining patients with IRRs continued paclitaxel with a repeat reaction (2 patients who received H2RAs and 1 who did not) or had an unknown outcome (1 who received an H2RA).

“Despite the longstanding history and frequency of paclitaxel use in oncology, there is very little evidence to support the empiric premedication regimen for IRR,” the researchers wrote. “Our study makes a significant contribution to the scarce literature regarding the utility of H2 receptor antagonists in this setting and demonstrates findings that are consistent with other reports. Based on the increasing evidence that H2RAs do not offer additional benefits for preventing IRR, their inclusion as a standard‐of‐practice for paclitaxel IRR prevention warrants revaluation.”

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


Tsang C, Robinson J, Wheatley-Price PF, Brule SY, Moore SM. The utility of H2 receptor antagonists in preventing infusion-related reactions to paclitaxel chemotherapy. Cancer. Published online September 4, 2023. doi:10.1002/cncr.35006

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