Evaluating paclitaxel hypersensitivity reaction rates with cetirizine premedication at a large academic cancer center

IntroductionPaclitaxel is associated with hypersensitivity reactions (HSRs) in up to 40% of patients, primarily during the first two lifetime infusions. Standard premedication with diphenhydramine, dexamethasone, and famotidine as recommended by the prescribing information reduces this risk to approximately 10%.¹ In July 2023, Dana-Farber Cancer Institute (DFCI) replaced diphenhydramine with cetirizine to minimize sedation and prolonged antihistamine effects.MethodsThis retrospective, IRB-exempt study evaluated HSR rates with cetirizine premedication in adults receiving their first lifetime paclitaxel dose between January 1 and July 31, 2024, using a DFCI paclitaxel titration protocol. Eligible patients received cetirizine, famotidine, and dexamethasone as premedication. The primary endpoint was the HSR rate during the first infusion and was compared to an 8.1% historical HSR rate with diphenhydramine using Fisher's exact test.ResultsAmong 150 patients, the HSR rate with cetirizine was 8.7%, showing no significant difference in HSR rate with diphenhydramine (8.1%, P = 1.00). HSRs were generally milder in the cetirizine group, with less epinephrine use (7.7% vs. 66.7%). Paclitaxel re-challenge was successful in 77% of cetirizine-pretreated patients, and only two patients required allergy referral.ConclusionData from this study suggests paclitaxel HSR rates with cetirizine premedication are not significantly different from HSR rates with diphenhydramine.