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Validation of Steroid-Sparing Therapy in Patients Receiving Oxaliplatin-based Chemotherapy: A before-and-after
Yoshihiro Yamamoto1, Norio Watanabe2, Aoi Goshima1
1Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan.
Background And Objective:
Although steroids are useful antiemetics, various moderate-to-severe chemotherapy-induced adverse events are observed. Although steroid-sparing antiemetic therapy is beneficial for moderate emetic risk, studies on only oxaliplatin-based regimen have not been fully evaluated. Therefore, this prospective observational study aimed to assess the usefulness of steroid-sparing antiemetic therapy for the second and subsequent courses of chemotherapy.
Methods:
Eligible patients who received a moderate emetic risk oxaliplatin-based chemotherapy regimen at Komaki City Hospital between January 2019 and March 2022 were switched to steroid-sparing antiemetic therapy after the second course. Steroid-sparing antiemetic therapy consisted of switching from granisetron to palonosetron on day 1 and discontinuing steroids on days 2-3. Complete response (CR; no emesis and no rescue medication), nausea and vomiting incidence, rescue use, and food intake were recorded by a pharmacist before the next chemotherapy session and compared before and after steroid-sparing antiemetic therapy.
Results:
In total, 10 patients were included with a median age of 74 years; six were male. CR rate was 70.0% before and 80.0% after steroid-sparing antiemetic therapy, with no significant difference between the two groups. None of the patients experienced worsening nausea or vomiting after steroid-sparing antiemetic therapy. The nausea was transient in all patients with nausea and was managed via abortive rescue treatment with oral administration of metoclopramide. There was no increase in side effects after steroid sparing.
Conclusion:
Based on the proven efficacy and safety in this patient population, we recommend the implementation of steroid-sparing therapy after the second course.
