Efficacy Of Single Low-Dose Dexamethasone With NEPA For The 168h Prevention Of Highly Or Moderately Emetogenic Chemotherapy

Li Xiao^1,2*Yuting He²Fanzhuoran Lou²XinTian Huang²Yiqin Zhang²Qunbo Lin²Tan Weijuan²Quan Chen²Xiurong Ren²huibo shi³

• ¹Zhongshan Hospital, Xiamen University, Xiamen, China
• ²Department of Oncology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University,, xiamen, China
• ³Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, wuhan, China

Background: Dexamethasone (DEX) can cause various side effects, particularly when used over several consecutive days to prevent chemotherapy-induced nausea and vomiting (CINV). Efforts to minimize the dose and frequency of DEX present challenges in managing CINV Methods: This single-center, retrospective study included 100 patients with solid tumors undergoing moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC). Each patient received a single low-dose DEX (8 mg) and NEPA prior to each chemotherapy cycle. The primary efficacy endpoint was the complete response (CR: no emesis, no rescue medication) within 0-168 hours post-chemotherapy initiation in cycle 1. The main secondary endpoints were CR during the acute (0-24 hours), delayed (24-120 hours), and long-delayed (120-168 hours) phases. Results: Between August 2023 and April 2024, a total of 100 patients received 230 chemotherapy cycles, consisting of 67.4% MEC and 32.6% HEC. CR rates rose from 85% in cycle 1 to 93.1% in cycle 4, with a slight decline during the delayed phase compared to the acute phase. Better outcomes appeared to be associated with fewer risk factors. Treatment was well-tolerated, with only Grade 1 or 2 adverse events reported; constipation and hyperglycemia were the most common. Regression analysis indicated a significant association between diabetes and CR rates (OR 0.09, 95% CI 0.02-0.40, p=0.002). Conclusions: Single low-dose DEX (8 mg) with NEPA safely prevents CINV in high-risk patients during MEC/HEC cycles, offering an alternative to minimize the dose and frequency of DEX.