Dexamethasone to Prevent Chemotherapy-Induced Nausea and Vomiting: Is Less More?

For patients receiving highly emetogenic chemotherapy (HEC), current guidelines recommend a four-drug antiemetic regimen that includes dexamethasone. But this drug has well-known side effects, and even a short course can blunt antitumor immune responses. Now that more-potent antiemetics are available, do patients still need 4 days of dexamethasone?

In this phase 3, multicenter, open-label, noninferiority trial, 644 adults receiving HEC in China were randomized to receive standard dexamethasone (12 mg on day 1; 8 mg on days 2–4), limited dexamethasone (6 mg on day 1 only), or no dexamethasone. All three groups received netupitant–palonosetron on day 1 and olanzapine 5 mg daily on days 1–4.