Nakayama, Y., Ito, Y., Tanabe, M., & Takahashi, S. (2016). Omission of dexamethasone from antiemetic treatment for highly emetogenic chemotherapy in breast cancer patients with hepatitis B infection or diabetes mellitus. The Journal of Community and Supportive Oncology, 14, 210–214. 

To examine the effects of a dexamethasone-sparing antiemetic regimen for women receiving highly emetogenic chemotherapy (HEC)

Data were obtained from medical records for women treated with anthracycline and cyclophosphamide regimens who were given antiemetic regimens not containing dexamethasone. Complete control (CC) and complete response (CR) rates were calculated and compared to reported rates. Varied medications were used for rescue, including aprepitant.

• N = 97   
• MEAN AGE = 57.6 years
• FEMALES: 100%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had breast cancer and were receiving HEC regimens.
• OTHER KEY SAMPLE CHARACTERISTICS: Dexamethasone was not used because of a Hepatitis B or diabetes mellitus diagnosis. Most were chemotherapy naive.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

• Retrospective

• Patients completed questionnaires of when seen in the clinic for time and chemotherapy-induced nausea and vomiting (CINV) events during treatment.
• CR was defined as no vomiting and no use of rescue medication.
• CC was defined as no vomiting, no use of rescue, and no more than mild nausea.

Patients received one of three regimens: granisetron only, aprepitant and granisetron, or aprepitant and palonosetron. In the acute phase, the CR rates ranged from 44.8%–76.9% with the highest CR rates in aprepitant-containing regimens. The CC rates ranged from 31%–46.2%. In the delayed phase, the CR rates ranged from 44.8%–74.4%, again, with the highest rates in aprepitant-containing regimens. The CC rates in the delayed phase ranged from 27.6%–51.7%. Comparisons showed that the CR and CC rates were about 20% higher with the dexamethasone-containing regimens.

Dexamethasone-sparing regimens were less effective than standard triple drug antiemetics for CINV prophylaxis in patients receiving HEC. The best antiemetic control in dexamethasone-sparing regimens in this study was seen with the use of aprepitant.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Specific timing and questionnaire information for CINV measure not well described

Some patients may require dexamethasone-sparing antiemetic regimens while on chemotherapy because of other chronic health conditions. The findings suggest that steroid-sparing regimens are less effective for CINV control in patients receiving HEC. Further research is needed to determine the most effective alternatives to triple drug antiemetics in these cases.