title: Pemetrexed-Induced Rash May Be Prevented by Supplementary Corticosteroids.
abstract: Pemetrexed, a chemotherapeutic drug, is highly active in non-small cell lung cancer and malignant pleural mesothelioma. Unfortunately, rashes are more commonly associated with pemetrexed than other chemotherapies, and it is recommended that patients receive corticosteroids (8 mg/d of dexamethasone) for 3 d, including the day of pemetrexed administration (day 1). However, the efficacy of corticosteroids in this context has not been fully verified. In this retrospective study, we evaluated the medical records of 78 patients who received pemetrexed between April 2009 and March 2014, to confirm whether supplementary corticosteroids prevented rash development. The incidence of rash was lower in the 47 patients who received supplementary corticosteroids (after day 1) compared with the incidence among the 31 patients who did not receive supplementary corticosteroids (19.1% vs. 38.7%). The average cutoff dosage of supplementary corticosteroids on day 2 and day 3 was 1.5 mg/d of dexamethasone, as calculated using the receiver operating characteristic curve, and the odds ratio was 0.33 (95% confidence interval: 0.12-0.94). Administration of ≥1.5 mg of corticosteroids on day 2 and day 3 significantly reduced the severity of the rash compared to no supplementary treatment (grades 2/3, 13.3% vs. 33.3%, p<0.05). However, increasing the dose of corticosteroids had no additional effect on rash development. These results suggest that ≥1.5 mg of supplementary dexamethasone on day 2 and day 3 (in addition to day 1) may be necessary for preventing pemetrexed-induced rash, but high doses of dexamethasone (e.g., 8 mg/d) are unnecessary.
authors.affiliation: Department of Pharmacy, Tokushima University Hospital.
authors.forename: Takumi
authors.initials: T
authors.lastname: Sakurada
authors.forename: Soji
authors.initials: S
authors.lastname: Kakiuchi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Tajima
authors.forename: Yuya
authors.initials: Y
authors.lastname: Horinouchi
authors.forename: Ken
authors.initials: K
authors.lastname: Konaka
authors.forename: Naoto
authors.initials: N
authors.lastname: Okada
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nishisako
authors.forename: Toshimi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Teraoka
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kawazoe
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nishioka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishizawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D019540:Area Under Curve; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005076:Exanthema / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D016017:Odds Ratio; D000068437:Pemetrexed / Q000009:adverse effects* / Q000627:therapeutic use; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D000068437:Pemetrexed; D003907:Dexamethasone