Omission of dexamethasone from antiemetic treatment for highly emetogenic chemotherapy in breast cancer patients with hepatitis B infection or diabetes mellitus.
BACKGROUND
Chemotherapy with anthracycline- and cyclophosphamide-containing regimens are classified as highly emetogenic. Combinatory treatments of aprepitant (Apr), palonosetron (Pal), or granisetron (Gra) with dexamethasone are recommended as antiemetic treatments for such emetogenic chemotherapy. We retrospectively examined whether omission of dexamethasone is tolerable for patients with hepatitis B virus (HBV) and diabetes mellitus (DM), for whom it is recommended not receive dexamethasone.


METHODS
During August 2009 and September 2007, we reviewed the medical records of patients with breast cancer who were HBV carriers or had been diagnosed with DM. 97 patients were treated with anthracycline- and cyclophosphamide- containing regimens with omission of dexamethasone in antiemetic treatment because of their HBV or DM status.


RESULTS
Results The number of patients treated with Gra only, Apr and Gra, Apr and Pal, were 29, 29, and 39, respectively. Complete response (CR) in the acute phase (0-<24 hours after chemotherapy) or delayed phase (24-120 hours after chemotherapy) for Gra only, Apr-Gra, and Apr-Pal was 44.8% and 44.8%, 72.4% and 72.4%, and 76.9% and 74.4%, respectively. Complete control (CC) in the acute or delayed phase in each regimen for Gra only, Apr-Gra, and Apr-Pal was 31.0% and 27.6%, 48.2% and 51.7%, and 46.2% and 46.2%, respectively. Apr-Gra or Apr-Pal tended to be superior to Gra only in CR and CC in both the acute and delayed phases. HBV reactivation or aggravation of DM control was not observed in any of the 3 therapy options. CR and CC were about 20% higher for the dexamethasone-containing regimen than for the non-dexamethasone regimen in both the acute and delayed phases.


CONCLUSIONS
Omission of dexamethasone in antiemetic treatment is tolerable when anthracycline- and cyclophosphamide-containing chemotherapy is administered to patients with breast cancer who have comorbidities of being HBV carriers or of DM.
Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. nakayama01077@gmail.com.
Yoshie
Y
Nakayama
Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Yoshinori
Y
Ito
Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Masahiko
M
Tanabe
Medical Oncology, Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Shunji
S
Takahashi
CINV; HBV carrier; anthracycline; breast cancer; diabetes mellitus