Objective
Paclitaxel-induced peripheral neuropathy (PIPN) and hypersensitivity reactions (HSRs) often lead to dose reductions or treatment cessation, compromising treatment efficacy and quality of life. This study aimed to review the incidence and management of PIPN and HSRs and compare the findings with published evidence,1,2,3,4,5 and review associated dose reductions and treatment cessations.
Sample and Setting
A retrospective observational study was conducted on oncology patients receiving paclitaxel chemotherapy from 2020-2024 at a single metropolitan private hospital in Sydney.
Procedure
Data from pharmacy documents, Odyssey eMR™, and InterSystems TrakCare® were extracted and analysed using Microsoft Excel.
Results
A total of 176 patients received paclitaxel. The median age was 54.5 years, and majority were female (87.50%). Breast cancer was the most prevalent diagnosis (81.25%), followed by oesophageal cancer and lung cancer (both 5.68%). Most patients (97.48%) were in the non-metastatic stage. On average, patients received 8.18 doses of paclitaxel. PIPN affected 67.61% of patients, with a mean onset of 30.40 days after treatment initiation. HSRs occurred in 17.05% of patients, on average after 1.32 paclitaxel doses. HSRs were managed by temporary infusion interruption, clinical review, and if needed, corticosteroids and/or H2 antagonists were administered. Infusions were rechallenged at a reduced infusion rate. Of temporarily interrupted infusions, 88.99% were rechallenged successfully. PIPN management involved dose reduction and treatment cessation. These approaches were consistent with published clinical guidelines. Dose reductions occurred in 58.52% of patients, with 42.72% attributed to PIPN and 1.94% to HSRs. Treatment cessation occurred in 49.43% of patients, with 40.23% due to PIPN and 1.15% due to HSRs.
Conclusion and Clinical Implications
PIPN and HSRs significantly contribute to paclitaxel dose reductions and early discontinuation. The incidence and management strategies observed in this study align with published literature, highlighting the importance of proactive adverse events management for improved treatment adherence and patient outcomes.