Paclitaxel hypersensitivity reaction rates in gynecologic and medical oncology patients following slow titration protocol: A quality improvement project.

BACKGROUND & OBJECTIVEA: To assess whether slow infusion of paclitaxel decreases hypersensitivity reaction (HSR) rates.

METHODS

This was a pre/post-intervention quality improvement study at a single academic-community hybrid institution. This study retrospectively reviewed patients receiving standard rate paclitaxel between 10/2023-10/2024, then implemented a paclitaxel slow infusion protocol (1 mL infusions at rates of 10 mL/h, 20 mL/h, and 30 mL/h, followed by standard rate of 167 mL/h) between 2/2025-8/2025. The primary outcome was HSR rate; secondary outcomes were HSR grade and paclitaxel rechallenge. Descriptive statistics, univariate and multivariate analyses were conducted.

RESULTS

A total of 460 patients (n = 320 pre- and n = 140 post-intervention) were analyzed, with 34% (n = 155) treated by a gynecologic oncologist and 66% (n = 305) by a medical oncologist. Sixty-nine percent of patients were female, and 79% of patients were receiving paclitaxel as part of a neoadjuvant or adjuvant chemotherapy regimen. Primary malignancies included lung (27%), breast (20%), ovary (17%), and uterus (17%). The paclitaxel HSR rate was 7% in the pre-intervention vs 10% in the post-intervention group (p = 0.042). HSR rates were significantly increased in medical oncology patients (4% vs 10%, p = 0.034), but not gynecologic oncology patients (12% vs 10%, p = 0.62). There was no difference in HSR grade (p = 0.12) or paclitaxel rechallenge (p = 0.31) between cohorts. In multivariate analysis, the post-intervention group had higher odds of HSR (OR = 1.72, 95% CI 1.001-2.96, p = 0.049) as did female patients (OR = 3.02, 95% CI 1.44-6.36, p = 0.004).

CONCLUSION

Slow infusion of paclitaxel resulted in significantly more HSRs among all comers. As a result, this institution has resumed standard paclitaxel administration.