Aim
Markman’s desensitisation protocol allows successful retreatment of patients who have significant paclitaxel hypersensitivity reactions (PHR)1. We assessed the rates of PHR using a modified Markman’s protocol in patients with gynaecological malignancies receiving paclitaxel. By introducing this protocol, we aimed to reduce the risk and severity of PHR and save time.
Methods
We evaluated all patients receiving paclitaxel before (December 2018 to September 2019) and after (October 2019 to July 2020) the implementation of a modified Markman’s protocol. The pre-implementation group received paclitaxel infused with a gradual titration rate from 60ml/hr to 180ml/hr. The post-implementation group received paclitaxel infused via 3 fixed-dose infusion bags (Bag 1: paclitaxel 2mg in 100ml saline over 30 minutes, Bag 2: paclitaxel 10mg in 100ml saline over 30 minutes, Bag 3: remainder of paclitaxel dose in 500ml saline over 3 hours) in the first 2 cycles. Rates of PHR were compared. The cost was also compared.
Results
A total of 426 paclitaxel infusions were administered to 78 patients. Median age was 64 years (range 34-81), and most had ovarian cancer (49%, n=38/78). The rate of PHR was 8% (n=16/195) versus 9% (n=20/231) before and after implementation (p=0.87). Most PHR occurred within the first 30 minutes in both groups (pre- vs post- implementation, 88% [n=14/16] vs 75% [n=15/20]; p=0.45), and were Grade 2 in severity (pre- vs post-implementation, 81% [n=13/16] vs 75% [n=15/20]; p=0.37). There was one Grade 3 PHR in pre-implementation group. All patients were successfully rechallenged in the post-implementation group compared to 81% (n=13/16) in pre-implementation group (p=0.43). The modified Markman’s protocol cost at least $100/cycle more for the first two cycles than the pre-implementation protocol.
Conclusion
The modified Markman's desensitisation protocol as a prophylaxis measure did not reduce the PHR rate although all patients were successfully rechallenged.