Journal Article

TAXANE TITRATION: TAILORED FOR BETTER OUTCOMES

Dorkewitz, Bridget, Budig-Rubbelke, Jennifer, Pabst, Kelly, Letton, Cathryn, Price, Terri

2025

Overview

Significance & Background: The Dana Farber Cancer Institute (DFCI), Boston, MA, conducted a project to evaluate the benefits of taxane titration to reduce hypersensitivity reactions (HSRs). They concluded that the patient group with titrated taxanes had significantly less taxane related HSRs than the non-titrated patient group. Outpatient Infusion Quality Team (OIQT) decided to implement our own quality project and attempt to replicate their project outcomes. Taxanes are at greatest risk of causing HSRs during the first and second lifetime exposures. HSRs need immediate care and can interfere with the continuation of preferred treatment. Currently, our infusion nurses use different approaches of slow titration to prevent HSR. In preparation for this project, a literature review was conducted and identified no published standardized recommendations for taxane titrations to prevent HSRs. DFCI came to the same conclusion and stated they used a desensitization protocol developed by their allergy team. We trialed the DFCI protocol to standardize our administration guidelines for all taxanes given in infusion. Purpose: The goal was to determine if a standardized gradual infusion rate titration would decrease the incidence and severity of immediate HRSs during the first two exposures to taxanes. Interventions: Education was created by the OIQT and presented to the infusion nurses at a staff meeting. The charge nurses and preceptors served as resources for any questions encountered throughout implementation. Any HSRs to taxanes were documented in the medical record and occurrence report (OR) system so the OIQT could track outcome data. Results: A key objective addressed by the DFCI project was to \"prime\" the administration tubing with medication, so the titration volume was drug, not saline. It was hypothesized that desensitization would be more reliable if the taxane was delivered from the initiation of the infusion via slow titration. We contacted the IV tubing manufacturer to verify recommended prime volumes. A three-month baseline review of ORs revealed four documented HSRs with the first and/or second taxane cycles. The OIQT chose to match the same timeframe for the quality project. Outcome data identified zero HSRs to taxanes when using the standardized titration method. Discussion: The project demonstrated similar outcomes to our peers, utilizing a standardized titration protocol results in a decrease in HSRs during first and second exposures to taxanes.

• Publisher: Oncology Nursing Society
• Subject: Nurses