Glucocorticoid administration in antiemetic therapy: is it safe?

Although glucocorticoids are often used in cancer therapy, in particular to enhance the effectiveness of antiemetic therapy, they have been associated with impaired tumor apoptosis and an increased frequency of metastases in some reports. The current study aimed to determine whether glucocorticoid treatment had an adverse effect on outcomes in patients with ovarian carcinoma.

Records of patients with ovarian carcinoma who were scheduled to receive at least six courses of systemic chemotherapy were reviewed. Patients were grouped into those who had or had not received corticosteroid medication as a part of general antiemetic prophylaxis before chemotherapy, and details of hematologic parameters during treatment and disease recurrence-free and overall survival were recorded.

Altogether, 245 patients with ovarian carcinoma had received chemotherapy. Of these, 62 had been given concurrent glucocorticoid treatment and 183 had not. The two patient groups were well balanced with respect to disease stage and other prognostic factors. Kaplan-Meier analyses showed no significant differences in survival between the groups. Patients who received glucocorticoid treatment had significantly higher leukocyte values in the days immediately after chemotherapy, higher nadir leukocyte values, and higher counts before subsequent courses of chemotherapy (P < 0.01; Levene test, t test) compared with patients who did not receive glucocorticoid treatment. As a result, the initial treatment targets were achieved significantly more often in the glucocorticoid group (P = 0.007; chi-square test).

There was no evidence that glucocorticoid treatment had a negative effect on outcomes in these patients. Glucocorticoids may exert protective effects on the bone marrow.