Role of dexamethasone dosage in combination with 5-HT3 antagonists for prophylaxis of acute chemotherapy-induced nausea and vomiting

Abstract

Dexamethasone (20 mg) or its equivalent in combination with 5-HT 3 antagonists appears to be the gold-standard dose for antiemetic prophylaxis. Additional to concerns about the use of corticosteroids with respect to enhanced tumour growth or impaired killing of the tumour cells, there is evidence that high-dosage dexamethasone impairs the control of delayed nausea and emesis, whereas lower doses appear more beneficial. To come closer to the most adequate dose, we started a prospective, single-blind, randomized trial investigating additional dosage of 8 or 20 mg dexamethasone to tropisetron (Navoban), a 5-HT 3 receptor antagonist, in cis -platinum-containing chemotherapy. After an interim analysis of 121 courses of chemotherapy in 69 patients, we have been unable to detect major differences between both treatment alternatives. High-dose dexamethasone (20 mg) had no advantage over medium-dose dexamethasone with respect to objective and subjective parameters of acute and delayed nausea and vomiting. In relation to concerns about the use of corticosteroids in non-haematological cancer chemotherapy, we suggest that 8 mg or its equivalent should be used in combination with 5-HT 3 antagonists until further research proves otherwise. © 1999 Cancer Research Campaign

Gastroparesis secondary to a demyelinating disease: a case series

“…The demyelinating disease could have affected the vagal nerve nuclei in these patients, which explains their GI complaints. Though, corticosteroids can help nausea and vomiting especially when associated with chemotherapy, they do not improve gastric emptying [3,4]. The role for corticosteroids in MS is to treat of acute symptomatic relapses of MS [5,6].…”

Glucocorticoid administration in antiemetic therapy

“…Glucocorticoids are used widely in medicine, ranging from the treatment of inflammatory disorders (e.g., rheumatoid arthritis, asthma, dermatitis) and autoimmune processes (e.g., Crohn disease, idiopathic thrombocytopenia) to prophylactic treatment to achieve better maturation of fetal lungs in preterm neonates. In oncology, glucocorticoid treatment has also proved beneficial in several situations, including the following: 1) reduction of operative morbidity1; 2) improved effectiveness of antiemetic drugs (e.g., benzamides, 5‐HT3 antagonists)2–5; 3) substitution in cases of treatment with the early aromatase inhibitor aminogluthimid6; 4) reduction of tissue edema in cases of brain metastases and cranial radiotherapy, as well as prevention of radiation‐induced emesis7–9; 5) treatment of leukemia, lymphomas, and hormone‐resistant advanced prostate carcinoma10–12; 6) prevention of the side effects of cancer drugs, for example, allergic reactions related to taxanes and pulmonary toxicity syndrome with 1,3‐bis (2‐chlorothyl)‐1‐nitosourea13, 14; and 7) improvement in the quality of life of patients with terminal cancer 15, 16…”