Single premedication dose of dexamethasone 20 mg IV before docetaxel administration

Background: The administration of docetaxel requires the use of dexamethasone for the prevention of hypersensitivity reactions (HSRs) and fluid retention reactions (FRRs). The manufacturer recommends dexamethasone for 3 days starting the day before docetaxel. This regimen has the potential for nonadherence so the utility of a single dexamethasone dose would be welcomed. Objective: To ascertain the incidence of HSRs and FRRs after receiving a single dose of intravenous dexamethasone before docetaxel administration. Design: Retrospective chart review. Setting: Data set from an oncology clinic affiliated with a large, tertiary, academic, teaching hospital. Patients: Ninety patients (median age 59 years, range 40-92 years) with cancer (primarily breast cancer, nonsmall cell lung cancer and head/neck cancer) who received docetaxel. Measurements and Results: Patients with heart failure, renal failure, chronic edema, current steroid use and/or prostate cancer were excluded from the study. Seven patients (7.8%) experienced a HSR requiring a treatment intervention (fluid bolus, oxygen, steroid, and/or diphenhydramine). Eleven patients (12.2%) had documented fluid retention. The mean docetaxel dose at the onset of fluid retention was 247.2 ± 134.5 mg/m ². Limitations: This single center evaluation with a small sample size had the potential for incomplete collection of the adverse events from the medical records due its retrospective nature. Conclusion: Hypersensitivity reactions and FRRs occurred in 7.8% and 12.2% of patients, respectively. This is lower than the rates reported by the manufacturer with the oral premedication regimen.