Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

H2-antagonists for prevention of taxane infusion reactions: are these required? (#214)

Kimberley-Ann Kerr 1 2 3 , Huda Binte Ryaz Patel 4 , Angela Shum 5 , Kirsty Tait 1 2 5 , Chen-Yao Hung 1 2 , Christopher Hocking 1 4
  1. Lyell McEwin Hospital, Greenwith, SA, Australia
  2. SA Pharmacy, Adelaide
  3. Digital Health SA, Adelaide
  4. University of Adelaide, Adelaide
  5. University of South Australia, Adelaide

Aim

Taxane-based chemotherapy is used in the treatment of multiple malignancies. Due to the high risk of hypersensitivity reactions product information for paclitaxel and cabazitaxel recommends the use of an antihistamine, corticosteroid and H2-antagonist pre-treatment.

In September 2019, ranitidine became unavailable due to possible contamination. Prior to routine availability of alternate H2-antagonists our unit administered taxane chemotherapy without H2-antagonists.  This practice has continued for weekly paclitaxel and cabazitaxel protocols.

This project aimed to determine if the rate or severity of taxane infusion reactions changed following removal of ranitidine as a standard pre-medication in our cancer centre from September 2019.

Method

A retrospective audit of case notes was conducted of all patients who received weekly paclitaxel or 3-weekly cabazitaxel for one year preceding unavailability of ranitidine (August 2018 to August 2019) and one year post unavailability (October 2019 to October 2020). Case notes were reviewed for the first three cycles of all patients who received weekly paclitaxel (as ranitidine is typically ceased post cycle 3) and all cycles for patients who received cabazitaxel.

Results

To date, 175 patients have been reviewed, receiving a total of 541 infusions (79 patients receiving 234 infusions with ranitidine, and 96 patients receiving 307 infusions without ranitidine). Current analysis indicates no difference in infusion reactions, with 10 infusion reactions experienced (4.3% of infusions) amongst those receiving ranitidine compared with 7 infusion reactions (2.3% of infusions)  amongst those without ranitidine, p=0.2. No patient experienced multiple reactions. All patients who experienced an infusion reaction received paclitaxel. Data collection is ongoing and expected to be completed by end of August 2022.

Conclusion

We observed no increase in the rate of infusion reactions with weekly paclitaxel and 3-weekly cabazitaxel despite cessation of routine H2-antagonists administration.  Our audit suggests patients may be able to safely receive these treatments without routine H2-antagonist.