Tsukuda, M., Ishitoya, J., Mikami, Y., Matsuda, H., Katori, H., Horiuchi, C., … Toth, G. (2009). Antiemetic effects of granisetron and dexamethasone combination therapy during cisplatin-containing chemotherapy for head and neck cancer: Dexamethasone dosage verification trial. International Journal of Clinical Oncology, 14, 337–343.doi: 10.1007%2Fs10147-008-0874-z
To determine the optimal dose of dexamethasone in combination with granisetron for chemotherapy-induced nausea and vomiting (CINV) control with cisplatin-containing chemotherapy
Patients were randomized to either receive 8 mg dexamethasone before chemotherapy and 24, 48, and 72 hours after chemotherapy during cycle 1, and 16 mg dexamethasone at the same time periods with cycle 2 of chemotherapy (8 mg antecedent group), or dosing of dexamethasone in the opposite sequence. All patients also received 3 mg granisetron with each dexamethasone administration. Physicians had discretion to provide addition treatment in cases of extreme nausea or vomiting. Symptoms were evaluated daily for 5 days.
The study was conducted at a single site in Japan.
All patients were in active treatment.
This was a randomized crossover trial.
Overall efficacy rates ranged from 47.2% on day 5 to 88.9% on day 1. No differences were found at any time point between groups.
No difference was found in antiemetic effect between 8 mg and 16 mg dexamethasone dosing.
The study suggests that lower dosages of dexamethasone may be as effective as higher doses for CINV management. Further research in this area is needed. Lower dosing may help to reduce potential side effects of steroids.