Abstract
Aprepitant (Apr) is an effective antiemetic agent for chemotherapy-induced nausea and vomiting (CINV). Current CINV guidelines recommend the antiemetic combination of a 5-HT3 receptor antagonist, Apr, and dexamethasone (Dex) for highly emetogenic chemotherapies. Apr inhibits CYP3A4 dose-dependently. Since Dex is metabolized by CYP3A4, the combined use of Apr and Dex inhibits Dex metabolism. CINV guidelines therefore recommend dose-reduction of Dex when Apr and Dex are used together. However, there is some controversy over whether or not Dex should be reduced when administered as an antitumor agent for lymphoid malignancies. We retrospectively compared the antitumor effect of Dex-containing chemotherapy in which Dex is administered at the usual dose without Apr (group A) or administered at a half-dose in combination with Apr (group B). We analyzed 62 consecutive patients with refractory or relapsed CD20 + B cell lymphoma who received R-DHAP therapy in our hospital, including 29 and 33 cases in groups A and B, respectively. The response rate at the end of the first course of R-DHAP was 62.1% and 54.5%, respectively (P = 0.61). As another endpoint to evaluate the effect of Dex, group B tended to show greater suppression of the lymphocyte count (P = 0.05). Therefore, decreasing the dose of Dex by half appeared to be reasonable when combined with Apr.
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Abbreviations
- CINV:
-
Chemotherapy-induced nausea and vomiting
- Apr:
-
Aprepitant
- Dex:
-
Dexamethasone
- CTCAE:
-
Common Terminology Criteria for Adverse Events
- FL:
-
Follicular lymphoma
- DLBCL:
-
Diffuse large B cell lymphoma
- AUC:
-
Area under the concentration vs. time curve
- SSRIs/SNRIs:
-
Selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Kaoru Hatano. The first draft of the manuscript was written by Kaoru Hatano and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This research study was conducted retrospectively from data obtained for clinical purposes. The methodology for this study was approved by the Clinical Research Ethics Review Board of Jichi Medical University Hospital (Ethics approval number: ClinicalA20-086). Informed consent was obtained from all individual participants included in the study.
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Hatano, K., Fujiwara, Si., Umino, K. et al. Clinical interaction between dexamethasone and aprepitant in chemotherapy for lymphoma. Ann Hematol 101, 1211–1216 (2022). https://doi.org/10.1007/s00277-022-04832-9
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DOI: https://doi.org/10.1007/s00277-022-04832-9