Cutting first-day dexamethasone dose not recommended for breast cancer patients on anthracycline

In breast cancer patients treated with anthracycline-containing regimens, reducing the first-day dose of dexamethasone (DEX) does not yield significant gastrointestinal benefit and is not recommended for nausea management, a recent study has found.

The researchers enrolled 126 patients who were divided into the reduced-dose (n=42) and control (n=84) groups. In the former, day 1 DEX dose was reduced to 6.6 mg, while controls were given the full 9.9-mg dose. The primary endpoint was complete response (CR) rate; secondary outcomes included the incidence and severity of anorexia, fatigue, vomiting, and nausea.

On day 1, controls achieved a 63.1-percent rate of CR, defined as the absence of emetic events, vomiting, and the need for rescue treatment. In comparison, the reduced-dose group showed a significantly lower CR of 38.1 percent (p<0.01).

However, in the delayed phase (days 2–7), CR rate between treatment arms were found to be statistically comparable.

A similar pattern was reported for nausea, which occurred at a significantly higher frequency in the reduced-dose group than in controls during the acute phase (61.9 percent vs 36.9 percent; p<0.01). Nausea incidence was comparable between groups during the delayed phase of observation (66.7 percent vs 59.5 percent, respectively) and overall (73.8 percent vs 61.9 percent, respectively).

Vomiting and anorexia also appeared to be more common in patients who received reduced doses of DEX, but the effect failed to reach statistical significance.

Multivariate analysis further confirmed that reducing DEX dose on day 1 significantly increased the likelihood of acute nausea (odds ratio, 2.74, 95 percent confidence interval, 1.17–6.43; p=0.02).