Role of dexamethasone dosage in combination with 5-HT3 antagonists for prophylaxis of acute chemotherapy-induced nausea and vomiting

Dexamethasone (20 mg) or its equivalent in combination with 5-HT3 antagonis ts appears to be the gold-standard dose for antiemetic prophylaxis. Additio nal to concerns about the use of corticosteroids with respect to enhanced t umour growth or impaired killing of the tumour cells, there is evidence tha t high-dosage dexamethasone impairs the control of delayed nausea and emesi s, whereas lower doses appear more beneficial. To come closer to the most a dequate dose, we started a prospective, single-blind, randomized trial inve stigating additional dosage of 8 or 20 mg dexamethasone to tropisetron (Nav oban), a 5-HT3 receptor antagonist, in cis-platinum-containing chemotherapy . After an interim analysis of 121 courses of chemotherapy in 69 patients, we have been unable to detect major differences between both treatment alte rnatives. High-dose dexamethasone (20 mg) had no advantage over medium-dose dexamethasone with respect to objective and subjective parameters of acute and delayed nausea and vomiting. In relation to concerns about the use of corticosteroids in non-haematological cancer chemotherapy, we suggest that 8 mg or its equivalent should be used in combination with 5-HT3 antagonists until further research proves otherwise.