Effect of palonosetron and dexamethasone administration on the prevention of gastrointestinal symptoms in hepatic arterial chemoembolization with epirubicin

Abstract

There are several studies on premedication to prevent postembolization syndromes which occurs after transcatheter arterial chemoembolization (TACE), but the medication to be used is still not established. This study aimed to examine the effect of palonosetron and dexamethasone on the prevention of gastrointestinal symptoms induced by TACE. MethodsPatients with hepatocellular carcinoma who were treated with TACE with epirubicin were retrospectively evaluated.The complete response rate of antiemetic drugs and incidence and severity of gastrointestinal symptoms were compared between the antiemetic group (AE group), which includes 51 patients prophylactically administered with palonosetron 0.75 mg and dexamethasone 9.9 mg intravenously before TACE on day 1 and dexamethasone 6.6 mg intravenously on days 2 and 3, and control group with 101 patients without antiemetic premedication. ResultsComplete response rate in the entire evaluation period was significantly higher in the AE group compared to that in the control group. In the acute phase, the incidence and severity of nausea, vomiting, and anorexia significantly decreased in the AE group, but only anorexia improved in the delay phase. Additionally, postembolization syndromes, such as abdominal pain and fever, were significantly attenuated in the AE group; however, constipation worsened in this group. ConclusionsPremedication of palonosetron and dexamethasone significantly prevents the incidence and reduces the severity of gastrointestinal symptoms especially in the acute phase. Further studies will be needed to determine the most recommended 5-HT 3 antagonist or dosage of dexamethasone in establishing the optimal antiemetic regimen.

Efficacy and safety analysis of dexamethasone-lipiodol emulsion in prevention of post-embolization syndrome after TACE: a retrospective analysis

“…In recent years, some clinical trials have also confirmed the utility and safety of dexamethasone in preventing the adverse effects of TACE [ 31 – 33 ]. Ogasawara et al [ 34 ] found that the dexamethasone regimen was more effective than the control regimen at preventing TACE-induced fever, anorexia, and nausea/vomiting in patients with HCC.…”

Dexamethasone prevents TACE-induced adverse events

“…Several retrospective and prospective clinical trials have confirmed the function of dexamethasone in reducing TACE-induced adverse events. [ 15 , 22 ] Targeting the glucocorticoid receptor dexamethasone plays an important role in inflammatory and immune responses through the genetic effects of inhibiting the expression of inflammatory mediators and inducing the apoptosis of immunocytes. Furthermore, the membrane-stabilizing action of dexamethasone has been recognized for a long time.…”

“…[ 13 ] In recent years, some clinical trials have also been conducted to verify the practicability and safety of dexamethasone in preventing TACE-induced adverse events. [ 14 , 15 ] To date, no comprehensive meta-evidence supports the benefits of dexamethasone for patients undergoing TACE. Therefore, we performed the current meta-analysis to provide quantitative evidence-based suggestions for the clinical utilization of dexamethasone to prevent PES induced by TACE.…”

Oncologic Interventions: Periprocedural Medications

“…Similar to chemoembolization, administration of the steroid dexamethasone may help reduce symptoms associated with PES. 21 One of the known delayed complications of radioembolization is REILD. First described by Sangro et al in 2008, 22 this syndrome presents clinically with jaundice and ascites, and in severe cases can be life-threatening.…”

“…Similar to chemoembolization, administration of the steroid dexamethasone may help reduce symptoms associated with PES. 21…”