Journal of Oncology Pharmacy Practice - January 2022 - 99

Masood et al.
99
Different scientists studied dexamethasone as premedication
prior to docetaxel infusion.1,8 The manufacturer
reported the patient compliance of IV
dexamethasone is higher than the rate of orally dexamethasone
as premedication regimen because it provides
less patient discomfort but cost were not
concerned. Investigators analyzed data from 206
patients undergoing weekly docetaxel. Out of those,
109 patients received dexamethasone 10mg intravenously
and 4mg orally every 12 hours for 4 doses,
beginning 1 hour before docetaxel administration,
and 97 received dexamethasone 10mg intravenously 1
hour prior to chemotherapy administration.9 It showed
no significant differences in the incidence of hypersensitivity.
However, researchers found that patients who
received low-dose dexamethasone experienced significantly
fewer infections.9 These findings suggest that a
low-dose dexamethasone premedication may be as
effective at preventing docetaxel hypersensitivity while
reducing infection complications10,11 but in our findings,
there is no increase or decrease in the incidence
of hypersensitivity reaction and the patients who
received orally dexamethasone experienced no infection
or reaction while patients who received intravenous
dexamethasone experienced no hypersensitivity
reaction as well11
so these findings suggest that a
single dose of IV dexamethasone premedication may
be effective not only avoiding the hypersensitivity reaction
but also effective for good patient compliance as
compared for taking three days oral premedication
prior to docetaxel administration.
Dexamethasone as a single agent, weekly docetaxel
has shown activity in advanced lung cancer, metastatic
breast cancer, and prostate cancer. Most of the
common adverse effects associated with weekly
dosing schedule such as fatigue, excessive tearing, nail
changes, and alopecia are cumulative toxicities and are
related both to the weekly dose administered and to the
total cumulative docetaxel dose.12 While in the present
study, higher number of tri-weekly docetaxel schedule
has shown in breast cancer and prostate cancer with
common adverse effects associated with tri-weekly
dosing schedule13,14 such as hair loss, shortness of
breath, vomiting, muscle pain, neutropenia, febrile
neutropenia, anaemia, thrombocytopenia. Majority of
these side effects can be minimized by making minor
changes in the docetaxel dosing schedule.12
Pemetrexed is an anti-folate antimetabolite agent
that is used as a single agent or in combination with
cisplatin for the treatment with locally advanced or
metastatic non-small cell lung cancer.15 Various type
of hypersensitivity reactions have been shown in different
studies but cutaneous adverse reactions are the
common side effects of pemetrexed antimetabolite
agent which includes alopecia, rash, pustulosis,
urticarial vasculitis, toxic epidermal necrolysis, eyelid
edema and scleroderma like reactions.14 These cutaneous
reactions have been shown in patients while taking
three days premedication oral dexamethasone 4mg
twice daily and no patient reported above skin reaction
by taking premedication with a single dose of dexamethasone
prior to pemetrexed administration.14 So a
single dose of 20mg intravenous dexamethasone premedication
on the same day of treatment to avoid
patient compliance and reduce the risk of hypersensitivity
reaction (HSRs).16
Intravenous dexamethasone has greatly been used
for systemic administration when oral therapy is not
suitable or desirable in certain conditions. In palliative
care, intravenous dexamethasone may be administered
to treat symptoms such as fatigue, anorexia, refractory
nausea and vomiting or adjuvant analgesia and symptomatic
treatment of cord compression or raised intracranial
pressure as compared to the oral route which is
not more feasible.17 Intravenous dexamethasone
improves patient compliance and to a certain degree,
the patient's quality of life as compared to oral dexamethasone
in which patient sometime forget to take
their medication properly. Intravenous dexamethasone
minimize the risk of hypersensitivity reactions as compared
to oral dexamethasone. This can improve patient
compliance and to a certain degree, the patient's quality
of life but there is one disadvantage, the cost of
intravenous dexamethasone is higher than the cost of
oral dexamethasone.
Nevertheless, there are few limitations of the study
as well. Firstly, there may be any undiagnosed parameter
like delayed adverse drug reaction. Secondly, the
delayed ADRs include insomnia, epigastric discomfort,
agitation, increased appetite may also be not noticed
during study period. Thirdly, the cost of drug is varied
from brand to brand. The IV dexamethasone is acceptable
for hypersensitivity reactions without looking at
effects of fluid retention and nausea/vomiting may be
premature. Lastly, patient compliance may vary in
both oral and intravenous route.18,19 Therefore, there
is need to do more research on this topic in future as
well.
Conclusion
No hypersensitivity reaction had been found either in
oral or intravenous dexamethasone prior to docetaxel
administration by using patient data from Hospital
Information System (HIS). However, intravenous
dexamethasone not only improve patient compliance
but also reduce the risk of hypersensitivity reactions
but the cost of intravenous dexamethasone is higher
than the cost of oral dexamethasone. In conclusion,
Journal of Oncology Pharmacy Practice - January 2022

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