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SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Breast Cancer
Volume 14 - 2024 |
doi: 10.3389/fonc.2024.1414037
Dexamethasone-sparing Strategies in Anthracycline and Cyclophosphamide-based ChemotherapyBreast Cancer Chemotherapy with a Focus on 5-HT3 Receptor Antagonists: a Network Meta-analysis. Running head: Dexamethasone-sparing strategy against AC therapy
Provisionally accepted- Gifu University Hospital, Gifu, Japan
The effectiveness of a dexamethasone-sparing strategy in the treatment of breast cancer with anthracycline-cyclophosphamide therapy when combined with firstgeneration 5-HT3 receptor antagonists (RAs) and neurokinin-1 RAs is unclear. This is attributable to a lack of evidence from direct comparison of multiple doses of DEX to a single dose of DEX in combination with first-generation 5-HT3 RAs in anthracyclinecyclophosphamide therapy. Our goal was to clarify the impact of dexamethasonesparing strategies that involve both first-generation 5-HT3 RAs and palonosetron when combined with neurokinin-1 RAs, using a network meta-analysis.A literature search was conducted on PubMed/Medline for articles published up to July 4, 2023. We included randomized controlled trials which assessed the efficacy of antiemetic regimens which combined 5-HT3 RAs and dexamethasone, with or without neurokinin-1 RAs, for the initial dose in anthracycline-cyclophosphamide therapy for patients with breast cancer. The primary outcome was the proportion of patients achieving a complete response during the delayed phase (CR-DP).The difference in the proportion of patients achieving CR-DP between multiple and single doses of dexamethasone was 0.1% (95%CI: -12.4 to 12.5) with palonosetron and neurokinin-1 RAs, compared to 5.3% (95%CI: -13.4 to 23.0) with a single dose of a first-generation 5-HT3 receptor antagonist. Additionally, the difference was 12.7% (95% CI: -2.8 to 28.2) when comparing palonosetron against first-generation 5-HT3 RAs in combination with a single dose of dexamethasone and neurokinin-1 RAs.Palonosetron is recommended rather than a single dose of first-generation 5-HT3 RAs in dexamethasone-sparing strategies for anthracycline-cyclophosphamide therapy.
Keywords: Antiemetics, Neurokinin-1 receptor antagonists, Serotonin 5-HT3 Receptor Antagonists, Dexamethasone, Nausea, Vomiting, Anthracyclines, Cyclophosphamide
Received: 08 Apr 2024; Accepted: 08 Jul 2024.
Copyright: © 2024 Watanabe, Iihara, Kobayashi, Fujii, Mori, Kumada, Shimizu, Futamura and Suzuki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hirotoshi Iihara, Gifu University Hospital, Gifu, Japan
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Ryo Kobayashi