Prolonged dexamethasone cuts delayed nausea after chemo

Joseph A. Roscoe, Ph.D., of the University of Rochester in New York, and colleagues conducted a randomized, double-blind study of the effectiveness of several treatment regimens for the prevention of DN: palonosetron plus dexamethasone followed by prochlorperazine; granisetron plus dexamethasone followed by prochlorperazine; aprepitant plus palonosetron plus dexamethasone followed by aprepitant plus dexamethasone; or palonosetron plus dexamethasone followed by prochlorperazine plus dexamethasone.

The researchers observed no difference between the effects of palonosetron and granisetron on DN when given with dexamethasone on day one followed by prochlorperazine on days two and three. Also, aprepitant was no more effective at reducing DN than prochlorperazine. Some benefit was achieved, however, by adding dexamethasone to prochlorperazine on days two and three.

"Over half of the patients studied experienced DN, and control afforded by all of the antiemetic regimens examined was inadequate. The finding that a second-generation 5-hydroxytryptamine receptor antagonist (5-HT RA), palonosetron, showed no greater efficacy in controlling DN than a first-generation 5-HT RA was disappointing," the authors write. "We were similarly disappointed that aprepitant provided no significant benefit over prochlorperazine in controlling DN. More effective regimens for controlling DN are needed and should include the addition of prolonged dexamethasone."

Two authors disclosed financial ties to the pharmaceutical industry.

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Journal reference: Journal of Clinical Oncology

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