A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

Han, Hye‐Suk; Shim, Young Kwang; Kim, Jeong Eun; Jeon, Hae Myung; Lim, Sung Cil; Oh, Tae Jung; Lee, Ki Hyeong; Kim, Seung Taik

doi:10.1007/s00520-011-1248-z

Cited by 20 publications

(11 citation statements)

References 29 publications

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“…The incidence of adrenal suppression occurring in cancer patients receiving systemic chemotherapy with antiemetic dexamethasone therapy was expected to be approximately 35% (p 5 .35) based on a pilot study [13]. The number of patients required can be assessed using the following formula with 95% confidence interval and 5% sampling error: n $ (2 3 Z 12a/2 √p(1 2 p) / (2 3 samplingerror) 5(2 31.96 √0.35(120.35))/ (2 30.05) [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous pilot study, we assessed the incidence of adrenal suppression related to antiemetic dexamethasone therapy in cancer patients [13]. Adrenal suppression after antiemetic dexamethasone therapy was demonstrated biochemically in 45 of 103 patients (43.7%) and was more common in patients receiving megestrol acetate concomitantly.…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence of secondary adrenal suppression associated with the repeated use of dexamethasone for the prevention of CINV has not been reported. We conducted a pilot study to assess the incidence of adrenal suppression in 103 patients receiving chemotherapy with dexamethasone as an antiemetic; it was found that adrenal suppression is common (43.7%) after antiemetic dexamethasone therapy [13]. We designed a larger prospective multicenter study to confirm the incidence of and factors associated with secondary adrenal suppression related to antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Han

Park

et al. 2015

The Oncologist

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Background. In a previous pilot study, adrenal suppression was found to be common after antiemetic dexamethasone therapy in cancer patients.The objective of this large prospective multicenter study was to confirm the incidence and factors associated with secondary adrenal suppression related to antiemetic dexamethasone therapy in cancer patients receiving chemotherapy. Methods. Chemotherapy-naïve patients who were scheduled to receive at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Patients with a suppressed adrenal response before chemotherapy or those administered corticosteroids within 6 months of enrollment in the study were excluded. Results. Between October 2010 and August 2014, 481 patients receiving chemotherapy underwent the rapid adrenocorticotropic hormone (ACTH) stimulation test to assess eligibility; 350 of these patients were included in the final analysis. Fifty-six

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Han

Park

et al. 2015

The Oncologist

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“…Suppression of HPA axis function with adrenocortical insufficiency is a common side effect of glucocorticoid treatment but it is somewhat unpredictable [9,10,11]. There are no obvious correlations between the total dose of oral glucocorticoid or the duration of treatment and adrenocortical insufficiency [12].…”

Section: Discussionmentioning

confidence: 99%

Methylprednisolone Pulse Treatment of Graves' Ophthalmopathy Is Not Associated with Secondary Adrenocortical Insufficiency

2015

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Objective: Graves' ophthalmopathy (GO) is an inflammatory disease in the orbital region. The first-line medical treatment is glucocorticoids. An important potential side effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal (HPA) axis with impairment of endogenous cortisol production, implicating symptoms of adrenocortical insufficiency, especially in the period after cessation of therapy with possible risks in cases of intercurrent illness. The aim of this study was to evaluate HPA axis function before and after methylprednisolone pulse treatment of GO. Study Design: HPA axis function was evaluated by measurements of plasma ACTH and an ACTH stimulation test with plasma cortisol measurements at 0 and 30 min after an intravenous bolus of synthetic ACTH (Synacthen® 250 µg). This was done in 12 patients with GO before and at cessation of methylprednisolone pulse treatment (500 mg i.v. per week for 6 weeks followed by 250 mg i.v. per week for an additional 6 weeks). Results: All patients included fulfilled the criteria of intact HPA axis function before and at cessation of methylprednisolone pulse treatment. Data are given as medians (with ranges). Before glucocorticoid treatment basal plasma cortisol was 290 nM (196-579) and 786 nM (612-1,050) after ACTH stimulation. At cessation of therapy the corresponding values were 309 nM (88-718) and 852 nM (524-1,011), respectively. Thus, all patients passed a 30-min stimulated plasma cortisol of 500 nM. Before treatment plasma ACTH was 4.2 pmol/l (4-16) and at cessation of therapy the corresponding value was 4.8 pmol/l (2-9; p = 0.27). Conclusion: Transient suppression of the HPA axis with secondary adrenocortical insufficiency does not seem to be a common phenomenon after intravenous methylprednisolone pulse therapy for GO. Therefore, routine precautions are not necessary. However, our results do not exclude that transient secondary adrenocortical insufficiency might occur occasionally.

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“…In addition, cytotoxic chemotherapeutics are typically considered to be immunosuppressive (17,18). Moreover, chemotherapy-induced nausea is often treated with high dose corticoids, which also induce an unwarranted immunosuppressive side effects (19).…”

Section: Discussionmentioning

confidence: 99%

Capsaicin induces immunogenic cell death in human osteosarcoma cells

Jin

Wang

et al. 2016

Experimental and Therapeutic Medicine

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Nano-Pulse Stimulation (NPS) is a non-thermal pulsed electric field modality that has been shown to have cancer therapeutic effects. Here we applied NPS treatment to the human pap-illomavirus type 16 (HPV 16)-transformed C3.43 mouse tumor cell model and showed that it is effective at eliminating primary tumors through the induction of immunogenic cell death while subsequently increasing the number of tumor-infiltrating lymphocytes within the tumor microenvironment. In vitro NPS treatment of C3.43 cells resulted in a doubling of activated caspase 3/7 along with the translocation of phosphatidylserine (PS) to the outer leaflet of the plasma membrane, indicating programmed cell death activity. Tumor-bearing mice receiving standard NPS treatment showed an initial decrease in tumor volume followed by clearing of tumors in most mice, and a significant increase in overall survival. Intra-tumor analysis of mice that were unable to clear tumors showed an inverse correlation between the number of tumor infiltrating lymphocytes and the size of the tumor. Approximately half of the mice that cleared established tumors were protected against tumor re-challenge on the opposite flank. Selective depletion of CD8 + T cells eliminated this protection, suggesting that NPS treatment induces an adaptive immune response generating CD8 + T cells that recognize tumor antigen (s) associated with the C3.43 tumor model. This method may be utilized in the future to not only ablate primary tumors, but also to induce an anti-tumor response driven by effector CD8 + T cells capable of protecting individuals from disease recurrence.

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A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

Abstract: We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.

Cited by 20 publications

References 29 publications

A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Methylprednisolone Pulse Treatment of Graves' Ophthalmopathy Is Not Associated with Secondary Adrenocortical Insufficiency

Capsaicin induces immunogenic cell death in human osteosarcoma cells

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