Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy

Vardy, Janette; Chiew, Kimberly S.; Galica, Jacqueline; Pond, Gregory R.; Tannock, I. F.

doi:10.1038/sj.bjc.6603048

Cited by 218 publications

(104 citation statements)

References 31 publications

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“…In a study by Vardy et al [22], patients receiving DEX for prevention of delayed CINV reported the following adverse events in the week following chemotherapy: moderate-to-severe insomnia (45%), indigestion and/or epigastric discomfort (27%), agitation (27%), increased appetite (19%), weight gain (16%) and acne (15%). As a result, there has been interest in minimizing the DEX dose and frequency, especially in patients who experience these DEX-related side effects.…”

Section: Antiemeticsmentioning

confidence: 99%

Neuropharmacology and Management of Chemotherapy-Induced Nausea and Vomiting in Patients with Breast Cancer

et al. 2014

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Advances in our understanding of the pathophysiology of chemotherapy-induced nausea and vomiting (CINV), the identification of patient risk factors, and the development of new antiemetics have led to significant improvements in CINV prevention. With the correct use of antiemetic drugs, CINV can be prevented in the majority of patients. Extensive clinical data have been considered in the development of antiemetic treatment recommendations by reliable institutions such as the Multinational Association of Supportive Care in Cancer, the European Society of Medical Oncology and the American Society for Clinical Oncology. These guidelines are intended to enable physicians to incorporate the latest clinical research into their daily practice, considering CINV prevention as part of an optimal patient-centered approach to cancer management. Yet despite the availability of these guidelines, there is emerging evidence that implementation of treatment recommendations is suboptimal. Recently, guideline committees gave special consideration to patient-related risk factors (young, females) contributing to the emetogenic potential for patients receiving anthracycline and cyclophosphamide-based chemotherapy. As women with breast cancer represent a particularly challenging population regarding emesis control, it is especially important that treatment recommendations are followed. This review focuses on the content of the current antiemetic guidelines, addressing the importance of how these are intended to be implemented in routine clinical practice.

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Section: Antiemeticsmentioning

confidence: 99%

Neuropharmacology and Management of Chemotherapy-Induced Nausea and Vomiting in Patients with Breast Cancer

et al. 2014

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“…[11–13] Weight gain during treatment is thought to be in-part due to increased appetite from the corticosteroids used for chemotherapy-induced nausea and vomiting prophylaxis, while long-term weight increases in some instances may be due to chemotherapy-related hormonal changes. [14,15]…”

Section: Introductionmentioning

confidence: 99%

Short- and Long-term weight changes among United States veterans with diffuse large B-cell lymphoma treated with CHOP chemotherapy

O’Brian¹,

Luo

Ganti

et al. 2015

Leukemia & Lymphoma

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Identifying weight changes associated with treatment of diffuse large B-cell lymphoma (DLBCL) has the potential to improve the long-term health of survivors. A retrospective cohort of United States veterans with a new diagnosis of DLBCL between October 1, 1998 and September 30, 2008, with follow-up until April 23, 2013, was assembled. Weight changes were evaluated before, during, and after treatment in 1,935 DLBCL patients who received cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab (CHOP+/− R). Seventy-nine percent of patients were obese or overweight 1 year prior to treatment. During the 12 months leading up to treatment, 57% of the cohort lost weight. Among patients surviving 24 months after treatment initiation, weight increased an average of 2.9kg above weight at treatment completion. The weight change trends observed in these DLBCL patients suggest that weight management strategies may be an important part of long-term survivorship planning after conclusion of treatment.

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“…However, we believe our results do demonstrate the utility of PALO in the delayed setting, as no corticosteroids were used. While the use of corticosteroids in the delayed setting has been shown to decrease the risk of nausea from chemotherapy, they have also been shown, even when used for short durations, to result in intolerable side effects such as insomnia, indigestion/epigastric discomfort, agitation and acne in the week following chemotherapy [9,11,17]. With the addition of PALO, we were able to improve control of CINV without the use of dexamethasone.…”

Section: Discussionmentioning

confidence: 97%

Antiemetic Control with Palonosetron in Patients with Gastrointestinal Cancer Receiving a Fluoropyrimidine-Based Regimen in Addition to Either Irinotecan or Oxaliplatin: A Retrospective Study

et al. 2012

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Background: For moderately emetogenic chemotherapy, palonosetron (PALO) is reported to provide complete control of chemotherapy-induced nausea and vomiting (CINV) in 69% of patients. Prior to August 2009, our gastrointestinal (GI) cancer patients receiving the moderately emetogenic compounds oxaliplatin or irinotecan plus a fluoropyrimidine regimen received ondansetron and dexamethasone orally on day 1 of chemotherapy for CINV prevention. Beginning in August of 2009, ondansetron was replaced by PALO 0.25 mg (intravenous push). Methods: This is a single-institution retrospective study of GI cancer patients who received oxaliplatin or irinotecan plus a fluoropyrimidine. Failure of an antiemetic regimen was defined as grade ≥1 vomiting or grade ≥2 nausea (Common Terminology Criteria for Adverse Events, version 3) on days 1 through 5 following chemotherapy. Patients were divided for analysis into pre-PALO and post-PALO cohorts. Fisher’s exact test compared cohort differences. Results: A total of 305 patients were included in the study, with 157 patients in the pre-PALO cohort and 148 in the post-PALO cohort. For all patients, the risk of antiemetic failure was reduced from 50.3% [95% confidence interval (CI) 42.2–58.4%] to 28.4% (95% CI 21.3–36.4%) with PALO. This reduction in the relative risk of antiemetic failure was observed in all subgroups. Conclusion: The addition of PALO may provide increased control of CINV for the moderately emetogenic regimens of oxaliplatin or irinotecan plus a fluoropyrimidine in GI cancer patients.

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Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy

Cited by 218 publications

References 31 publications

Neuropharmacology and Management of Chemotherapy-Induced Nausea and Vomiting in Patients with Breast Cancer

Neuropharmacology and Management of Chemotherapy-Induced Nausea and Vomiting in Patients with Breast Cancer

Short- and Long-term weight changes among United States veterans with diffuse large B-cell lymphoma treated with CHOP chemotherapy

Antiemetic Control with Palonosetron in Patients with Gastrointestinal Cancer Receiving a Fluoropyrimidine-Based Regimen in Addition to Either Irinotecan or Oxaliplatin: A Retrospective Study

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