Efficacy and safety of dexamethasone sparing for the prevention of nausea and vomiting associated with moderately emetogenic chemotherapy: a systematic review and meta-analysis of Clinical Practice Guidelines for Antiemesis 2023 from Japan Society of Clinical Oncology

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发表日期：

2024年10月17日

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Kazuhisa Nakashima,
Ayako Yokomizo,
Michiyasu Murakami,
Kenji Okita,
Makoto Wada,
Keiko Iino,
Tatsuo Akechi,
Hirotoshi Iihara,
Chiyo K. Imamura,
Ayako Okuyama,
Keiko Ozawa,
Yong-il Kim,
Hidenori Sasaki,
Eriko Satomi,
Masayuki Takeda,
Ryuhei Tanaka,
Takako Eguchi Nakajima,
Naoki Nakamura,
Junichi Nishimura,
Mayumi Noda,
Kazumi Hayashi,
Takahiro Higashi,
Narikazu Boku,
Koji Matsumoto,
Yoko Matsumoto,
Nobuyuki Yamamoto,
Kenjiro Aogi,
Masakazu Abe

摘要

Background

Palonosetron, a second-generation 5-HT₃ receptor antagonist (5-HT₃RA), is more effective than first-generation 5-HT₃RA. Several studies have investigated whether dexamethasone (DEX), when combined with palonosetron as a 5-HT₃RA, can be spared in the delayed phase after moderately emetogenic chemotherapy (MEC). In this systematic review, we aimed to determine which between 1- and 3-day DEX administration, when combined with palonosetron, is more useful in patients receiving MEC.

Methods

The PubMed, Cochrane Library, and Ichushi-Web databases were searched for relevant studies published between 1990 and 2020. We included studies that compared the efficacy of 1- and 3-day DEX administration in preventing nausea and vomiting associated with MEC. Outcomes were “prevention of vomiting (complete response rate and no vomiting rate),” “prevention of nausea” (complete control rate, total control rate, no nausea rate, and no clinically significant nausea rate)” in the delayed phase, “prevention of blood glucose level elevation,” and “prevention of osteoporosis.”

Results

Eight studies were included in this systematic review. The no vomiting rate was significantly higher in the 3-day DEX group than in the 1-day DEX group. However, the other efficacy items did not significantly differ between the two groups. Meanwhile, insufficient evidence was obtained for “prevention of blood glucose level elevation” and “prevention of osteoporosis.”

Conclusions

No significant differences in most antiemetic effects were found between 1- and 3-day DEX administration. Thus, DEX administration could be shortened from 3 days to 1 day when used in combination with palonosetron.