Reconsidering Dexamethasone for Antiemesis when Combining Chemotherapy and Immunotherapy

Janowitz, Tobias, Kleeman, Sam, Vonderheide, Robert H (April 2021) Reconsidering Dexamethasone for Antiemesis when Combining Chemotherapy and Immunotherapy. The Oncologist, 26 (4). pp. 269-273. ISSN 1083-7159

URL: https://www.ncbi.nlm.nih.gov/pubmed/33465258
DOI: 10.1002/onco.13680

Abstract

Whether the immune suppressive action of glucocorticoid steroids, such as dexamethasone, might reduce the benefits of cancer immunotherapy has long been a concern. Observations that established tumor regressions in response to immune checkpoint inhibitors (ICIs) often persist, despite the use of steroids to mitigate ICI-related autoimmune breakthrough, are not sufficiently reassuring, because these observations do not address the potential blunting of immune priming at the initiation of ICI therapy. With increasing indications for ICI in combination with chemotherapy, this issue merits reconsideration. Professional society guidance advises that dexamethasone should be used as first-line prophylaxis for nausea and vomiting in patients receiving ICI and highly emetogenic chemotherapy combination regimens. Here, we review the availability of data on this subject and propose an alternative approach focused on the adoption of steroid minimization or sparing for prophylaxis of nausea until the underlying immune biology is better understood.

Item Type: Paper
Subjects: diseases & disorders > cancer
diseases & disorders > cancer > drugs and therapies > chemotherapy
diseases & disorders > cancer > drugs and therapies > Immunotherapy
diseases & disorders > nausea
CSHL Authors:
Communities: CSHL labs > Janowitz lab
SWORD Depositor: CSHL Elements
Depositing User: CSHL Elements
Date: April 2021
Date Deposited: 28 Apr 2021 19:35
Last Modified: 28 Apr 2021 19:35
PMCID: PMC8018330
URI: https://repository.cshl.edu/id/eprint/39947

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