Reducing the Incidence of Taxane-Associated Hypersensitivity: Examining Chemotherapy Titration Rates in the Outpatient Infusion Center

Docetaxel, an antineoplastic drug effective in treating a variety of malignancies,including breast, ovarian, cervical, and lung cancers, causes high rates (41%) of hypersensitivityreactions during a first or subsequent exposures. Current evidence supports using a multi-steprate titration for docetaxel to reduce hypersensitivity reactions. This evidence, along with anobserved rise in docetaxel-related hypersensitivity reactions, led the oncology pharmacy team atthe University of North Carolina Outpatient Infusion Center to adopt a multi-step rate titrationmethod for docetaxel in March 2024. Using the Centers for Disease Control Program EvaluationFramework, a program evaluation was conducted of the multistep titration. This evaluationidentified several gaps in knowledge, education, resources, and training related to the protocol.A comprehensive chart review was performed on each individual patient encounter andidentified a reactivity rate of 7.6% during the implementation period, compared with the priorreported reactivity rate of 23%. Recommendations including the use of infusion pump multi-steptitration functionality, medication barcoding with titration support, implementation of astandardized workflow, enhancing staff education, and providing accessible resources fortitration were presented to help limit titration deviations. This program evaluation aimed toaddress practice gaps, improve the titration process for other malignancy groups, and guidefuture practice changes to promote interprofessional collaboration.