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Efficacy of one-day versus multiple-day dexamethasone for chemotherapy-induced nausea and vomiting in lung cancer patients receiving carboplatin-based chemotherapy: a propensity score–matched analysis

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Abstract

Purpose

Dexamethasone (DEX)-sparing strategies (one-day DEX) with palonosetron as doublet antiemetic prophylaxis have previously been studied. However, DEX-sparing regimens with 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and aprepitant (APR), as triplet antiemetic prophylaxis, have not been evaluated. This study aimed to evaluate the efficacy of a combination of 5-HT3RA, APR, and DEX on day 1 of carboplatin (CBDCA)-based chemotherapy in patients with lung cancer.

Methods

Data were pooled from a nationwide, multicenter, prospective observational study using propensity score–matched analysis to compare the incidence of chemotherapy-induced nausea and vomiting (CINV) between one- and multiple-day DEX regimens in combination with 5-HT3RA plus APR.

Results

Incidence of delayed nausea was significantly higher in the one-day than in the multiple-day DEX group. Incidence of nausea was also significantly higher in the one-day than in the multiple-day DEX group on days 3–5. Kaplan–Meier curves for nausea showed a significant difference between the two groups; however, there was no significant difference in the occurrence of vomiting or the Kaplan–Meier curves of time to vomiting.

Conclusion

To the best of our knowledge, this study is the first to evaluate the efficacy of a DEX-sparing regimen by comparing one- and multiple-day DEX combined with 5-HT3RA and APR concerning CINV incidence in lung cancer patients receiving CBDCA-based chemotherapy. Antiemetic regimens of one-day DEX result in poor control of delayed nausea; therefore, we recommend the application of the DEX-sparing strategy only after careful patient selection while considering the development of nausea.

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Data availability

The data that support the findings of this study are available from the study group. However, restrictions apply to the availability of these data, which were used under a license for the current study and are thus not publicly available. Data are, nevertheless, available from the authors upon reasonable request and with permission of the study group.

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Acknowledgements

We wish to thank Dr. Kazuo Tamura for providing support as the principal investigator of the nationwide, multicenter, observational study that collected the data used in this study. We also thank all of the participants of the aforementioned study and their families.

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Authors and Affiliations

  1. Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan

    Toshinobu Hayashi, Koichi Matsuo, Takafumi Nakano & Takashi Egawa

  2. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami Kogushi, Ube, 755-8505, Yamaguchi, Japan

    Mototsugu Shimokawa

  3. Center For Clinical Research, Yamaguchi University Hospital, 1-1-1 Minami Kogushi, Ube, Yamaguchi, 755-8505, Japan

    Fumitaka Mizuki

  4. Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1, Zokumyoin, Chikushino, Fukuoka, 818-0067, Japan

    Koichi Matsuo

  5. Department of Pharmacy, Kochi Medical School Hospital, 185-1 Kohasu, Oko town, Nankoku City, Kochi, 783-8505, Japan

    Kei Kawada

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  1. Toshinobu Hayashi
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Contributions

TH conceived the study concept. TH, MS, and FM conducted the claim data analysis. MS performed the statistical analyses. KM and FM provided technical support. TH, MS, KM, FM, KK, TN, and TE contributed to the interpretation of data and assisted in the preparation of the manuscript. TH and MS prepared the initial draft of the manuscript. TH, MS, FM, KM, KK, TN, and TE conducted the critical revision of the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Toshinobu Hayashi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Hayashi, T., Shimokawa, M., Mizuki, F. et al. Efficacy of one-day versus multiple-day dexamethasone for chemotherapy-induced nausea and vomiting in lung cancer patients receiving carboplatin-based chemotherapy: a propensity score–matched analysis. Support Care Cancer 29, 5029–5035 (2021). https://doi.org/10.1007/s00520-021-06061-8

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