title: A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study.
abstract: BACKGROUND
  In a previous pilot study, adrenal suppression was found to be common after antiemetic dexamethasone therapy in cancer patients. The objective of this large prospective multicenter study was to confirm the incidence and factors associated with secondary adrenal suppression related to antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.
  
  
  METHODS
  Chemotherapy-naïve patients who were scheduled to receive at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Patients with a suppressed adrenal response before chemotherapy or those administered corticosteroids within 6 months of enrollment in the study were excluded.
  
  
  RESULTS
  Between October 2010 and August 2014, 481 patients receiving chemotherapy underwent the rapid adrenocorticotropic hormone (ACTH) stimulation test to assess eligibility; 350 of these patients were included in the final analysis. Fifty-six patients (16.0%) showed a suppressed adrenal response in the rapid ACTH stimulation test at 3 or 6 months after the start of the first chemotherapy. The incidence of adrenal suppression was affected by age, performance status, stage, and use of megestrol acetate in univariate analysis. Multivariate analysis revealed that secondary adrenal suppression associated with antiemetic dexamethasone therapy was significantly associated with megestrol acetate treatment (odds ratio: 3.06; 95% confidence interval: 1.60 to 5.86; p < .001).
  
  
  CONCLUSIONS
  This large prospective study indicates that approximately 15% of cancer patients receiving chemotherapy with a normal adrenal response show suppressed adrenal responses after antiemetic dexamethasone therapy. This result was particularly significant for patients cotreated with megestrol acetate.
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
authors.forename: Ji Chan
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Sang Byung
authors.initials: SB
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
authors.forename: Samyoung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
authors.forename: Hwan Jung
authors.initials: HJ
authors.lastname: Yun
authors.affiliation: Department of Internal Medicine, Chonnam National University Hwansun Hospital, Hwasun-Gun, Republic of Korea.
authors.forename: Woo Kyun
authors.initials: WK
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Chonnam National University Hwansun Hospital, Hwasun-Gun, Republic of Korea.
authors.forename: Hyun-Jeong
authors.initials: HJ
authors.lastname: Shim
authors.affiliation: Department of Internal Medicine, Chonnam National University Hwansun Hospital, Hwasun-Gun, Republic of Korea.
authors.forename: Jun-Eul
authors.initials: JE
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Chonnam National University Hwansun Hospital, Hwasun-Gun, Republic of Korea.
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea.
authors.forename: Moo-Rim
authors.initials: MR
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea.
authors.forename: Hyeok
authors.initials: H
authors.lastname: Shim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Jihyun
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Moon Ki
authors.initials: MK
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Seung Taik
authors.initials: ST
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea kihyeonglee7030@hanmail.net.
authors.forename: Ki Hyeong
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D019290:Megestrol Acetate / Q000008:administration & dosage; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000932:Antiemetics; D003907:Dexamethasone; D011239:Prednisolone; D019290:Megestrol Acetate; D006854:Hydrocortisone
keywords: Adrenal; Antiemetic; Cancer; Dexamethasone; Suppression