ABSTRACT
Premedication with dexamethasone, H1 and H2 receptor antagonists given intravenously prior to paclitaxel are highly successful in preventing life-threatening hypersensitivity reactions. We conducted a prospective study to assess the availability and safety of the administration of promethazine and dexamethasone per os in the premedication of paclitaxel hypersensitivity reactions. Of 180 eligible cancer patients, 100 patients received paclitaxel weekly and 80 patients, every 3 weeks. Patients received premedication with promethazine 25 mg per os, dexamethasone 2-20 mg per os and cimetidine 300 mg intravenously. One hundred patients in the weekly group received 940 cycles of paclitaxel. Hypersensitivity reactions occurred in one (1%) patient. There were no hypersensitivity reactions in 99% of patients. Eighty patients in the 3 weekly group received 464 cycles of paclitaxel. Hypersensitivity reactions occurred in (3) 4% of patients while 96% of patients had no hypersensitivity reactions. Two of these three patients had no further hypersensitivity reactions after receiving premedication intravenously. In the two groups 40 min/cycle reduction in treatment duration was observed. In conclusion, this study shows that drugs used for premedication prior to paclitaxel can be given orally. This strategy is feasible, gives excellent results in reducing hypersensitivity reactions and shortens the time of treatment for patients and treating staff.
Subject(s)
Anti-Allergic Agents/therapeutic use , Drug Hypersensitivity/prevention & control , Paclitaxel/adverse effects , Premedication/methods , Administration, Oral , Adult , Aged , Aged, 80 and over , Anti-Allergic Agents/administration & dosage , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/adverse effects , Cimetidine/administration & dosage , Cimetidine/therapeutic use , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Female , Humans , Male , Middle Aged , Neoplasms/drug therapy , Paclitaxel/administration & dosage , Promethazine/administration & dosage , Promethazine/therapeutic use , Prospective StudiesABSTRACT
BACKGROUND: Classic Kaposi's sarcoma is a rare tumor with an indolent behavior. Local therapy is not applicable in disseminated cutaneous disease. Patients with advanced disease are usually treated with systemic chemotherapy. OBJECTIVES: To assess the effectiveness and toxicity of single-agent vinblastine in the treatment of disseminated and recurrent Kaposi's sarcoma. METHODS: Ten patients with wide cutaneous spread of classic Kaposi's sarcoma were treated with single-agent vinblastine, 6 mg/m2 intravenously once every 2 weeks. Vinblastine was continued for 2 months after achieving a maximal response. RESULTS: The male:female ratio was 2.3:1, and median age 64 years (range 50-79 years). The median number of involved nodules in the skin was 34. The overall response rate was 90%, 5 with complete response (50%) and 4 with partial response (40%). Complete responders had a longer duration of response than partial responders: 41.2 vs. 14.8 months. The median survival of all patients was 33 months. Side effects were minimal and tolerable. CONCLUSIONS: Vinblastine is very effective in the treatment of extensive classic 'Kaposi's sarcoma, and results in a high response rate, long survival and disease-free survival with tolerable toxicity.