Influence of dexamethasone dose on the control of chemotherapy-induced nausea and vomiting

Coleman, Robert E.; Twelves, C.; O'Reilly, SM; Rubens, Robert; Richards, M. A.; Harper, P.

doi:10.1016/0277-5379(91)90286-m

Cited by 8 publications

(4 citation statements)

References 3 publications

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“…The association was virtually absent in those receiving ondansetron combined with dexamethasone. This inverse relation between cortisol excretion and nausea severity is consistent with our previous study in patients receiving low emetogenic chemotherapy (Fredrikson et al, 1992 (Coleman et al, 1991). Our results mimic these findings indicating that subjects with sufficiently high endogenous cortisol levels gain little, if any, on exogenous corticosteroids as antiemetic medication.…”

Section: Discussionsupporting

confidence: 92%

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Hursti

Fredrikson²,

Steineck³

et al. 1993

Br J Cancer

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Summary Lower pre-chemotherapy night time cortisol excretion predicted more severe cisplatin induced nausea and vomiting in 42 ovarian cancer patients receiving ondansetron as a single antiemetic agent. Dexamethasone administration added to the antiemetic effect of ondansetron principally in patients who had low excretion of cortisol.Corticosteroids as single antiemetic agents have a well documented effect on mild to moderate chemotherapy induced emesis (Cassileth et al., 1983). During highly emetogenic chemotherapy, there is a synergistic antiemetic effect of corticosteroids and metoclopramide or 5-hydroxytryptamine (5-HT3) receptor antagonists (Kris et al., 1989;Smith et al., 1991). Recently we reported that nausea during chemotherapy with low emetic potential was inversely related to urinary cortisol excretion (Fredikson et al., 1992 Patients rated their nausea during the past 24 h at the morning of the first and second day after the cisplatin infusion by choosing one of four alternatives ranging from none to severe nausea. At the first morning patients also used a 100 mm visual analog scale (VAS) to report the severity of nausea. A zero score is anchored at the left end with 'no nausea at all' and a maximum score of 100 'worst possible nausea'. Emetic episodes (vomiting or retching) were recorded by patients during both days.In the statistical analyses patients responding with 'no' or 'mild' nausea were treated as one group and those responding 'moderate' or 'severe' nausea formed the other group. Regarding the emetic episodes, patients with complete or major response ( <2 emetic episodes) formed one group whereas minor response and failure (> 3 emetic episodes) formed the other group. A median split approach was used to form groups with relatively high and low cortisol excretion. Relative risk was used to describe the association between urinary cortisol levels and nausea and vomiting. Relative risk was calculated as the ratio between the proportions of patients with moderate or severe nausea, or > 3 emetic episodes in respective groups of interest. Calculation of 95% confidence intervals was performed as described by Greenland & Robins (1985). Student's t-test with one-tailed P-values was used to analyse VAS-ratings of nausea and the total number of emetic episodes. ResultsThe median used to form groups high and low in cortisol excretion was 23.2pmolmin-'. The high and low excretion group had a mean (standard error of the mean) of 38.7 (2.5) and 16.5 (0.9) pmol min-', respectively. The groups did not differ concerning the percentage of 1-vs 2-day chemotherapy course (chi2 = 0.12, P = 0.73). The mean cortisol excretion in patients receiving dexamethasone was 28.8 pmol min-' and in those receiving placebo 25.8 pmol min-' (t (40) = 0.68, P = 0.50). Evaluating the importance of age for the studied variables, patients were categorised by their median age (50 years). No significant association was found between patient's age, cortisol excretion, nausea intensity or emetic episodes (t (40)<1.12, chi2 (1)<0.54, ...

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Section: Discussionsupporting

confidence: 92%

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Hursti

Fredrikson²,

Steineck³

et al. 1993

Br J Cancer

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“…On the other hand, when the dose of the corticosteroid was increased and the dose divided, the steroid was as effective as a 5-HT 3 antagonist (Marschner et al, 1991;Italian Group for Antiemetic Research, 1995b). Only a few investigators have addressed the importance of dose and schedule of steroids (Chiara et al, 1987;Coleman et al, 1991;Gez et al, 1992;Havsteen and Kjaer, 1996) and the optimum dose and schedule is still unknown. The comparative data, however, suggest that the efficacy of steroids is optimized by divided doses.…”

Section: Discussionmentioning

confidence: 99%

Granisetron compared with prednisolone plus metopimazine as anti-emetic prophylaxis during multiple cycles of moderately emetogenic chemotherapy

Sigsgaard

Herrstedt

et al. 1999

Br J Cancer

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Summary This randomized, double-blind, double-dummy parallel study compared the anti-emetic efficacy and tolerability of the serotonin antagonist granisetron with prednisolone plus the dopamine D 2 antagonist metopimazine during nine cycles of moderately emetogenic chemotherapy. Chemotherapy naive women with stage I or II breast cancer scheduled to intravenous cyclophosphamide, fluorouracil and methotrexate or cyclophosphamide, epirubicin and fluorouracil every 3 weeks were included. Patients received a single intravenous dose of granisetron 3 mg or a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day. A total of 223 women were enrolled and 218 patients (97.8%) were evaluable for efficacy. Granisetron (n = 109) was superior to prednisolone plus metopimazine (n = 109) in the prophylaxis of acute nausea and vomiting during the first cycle of chemotherapy (P < 0.001) and prednisolone plus metopimazine was superior on days 2-5 (P = 0.002). Overall, granisetron was superior on days 1-5 (P = 0.009). The median number of cycles completed with granisetron was five (95% confidence interval 4-6) compared with two (95% confidence interval 2-2) for prednisolone plus metopimazine (P = 0.0019). Constipation and rash were reported more frequently with granisetron (P < 0.001 and P = 0.043 respectively) and palpitations more frequently with prednisolone plus metopimazine (P = 0.015). In conclusion, the number of cycles completed with granisetron was significantly higher than the number completed with prednisolone plus metopimazine, but the anti-emetic efficacy of both treatments declined during multiple cycles of moderately emetogenic chemotherapy.

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“…7 Lower doses of dexamethasone have been found to be as effective as higher doses in the control of non-cisplatin induced nausea and vomiting. 8 The mechanism of steroidinduced osteonecrosis remains obscure,3 as does the doseavascular necrosis relationship. However, it is prudent to use the lowest effective corticosteroid dose in an antiemetic regimen.…”

Section: Case Reportmentioning

confidence: 99%

Avascular Necrosis of Bone: The Hidden Risk of Glucocorticoids Used as Antiemetics in Cancer Chemotherapy

Virik

Karapetis

Droufakou

et al. 2001

Int J Clinical Practice

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SUMMARYThe role of antiemetics is invaluable in allowing cancer patients to complete otherwise potentially intolerable chemotherapy. Corticosteroids have an established place in the prevention and treatment of nausea and vomiting due to emetogenic cytotoxic agents. Avascular necrosis of bone is a recognised complication of glucocorticoid treatment – the risk of this increasing with higher doses and longer duration of use. This report details a case of bilateral avascular necrosis of the femoral heads in a patient receiving ‘standard’ doses of dexamethasone as part of the antiemetic regimen used in cisplatin‐based combination chemotherapy.

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Influence of dexamethasone dose on the control of chemotherapy-induced nausea and vomiting

Cited by 8 publications

References 3 publications

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids

Granisetron compared with prednisolone plus metopimazine as anti-emetic prophylaxis during multiple cycles of moderately emetogenic chemotherapy

Avascular Necrosis of Bone: The Hidden Risk of Glucocorticoids Used as Antiemetics in Cancer Chemotherapy

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