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A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Authors
Han, Hye SookPark, Ji ChanPark, Suk YoungLee, Kyu TaekBae, Sang ByungKim, Han JoKim, SamyoungYun, Hwan JungBae, Woo KyunShim, Hyun-JeongHwang, Jun-EulCho, Sang-HeePark, Moo-RimShim, HyeokKwon, JihyunChoi, Moon KiKim, Seung TaikLee, Ki Hyeong
Issue Date
Dec-2015
Publisher
AlphaMed Press Inc
Keywords
Adrenal; Antiemetic; Cancer; Dexamethasone; Suppression
Citation
Oncologist, v.20, no.12, pp 1432 - 1439
Pages
8
Journal Title
Oncologist
Volume
20
Number
12
Start Page
1432
End Page
1439
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/10099
DOI
10.1634/theoncologist.2015-0211
ISSN
1083-7159
1549-490X
Abstract
Background. In a previous pilot study, adrenal suppression was found to be common after antiemetic dexamethasone therapy in cancer patients. The objective of this large prospective multicenter study was to confirm the incidence and factors associated with secondary adrenal suppression related to antiemetic dexamethasone therapy in cancer patients receiving chemotherapy. Methods. Chemotherapy-naive patients who were scheduled to receive at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Patients with a suppressed adrenal response before chemotherapy or those administered corticosteroids within 6 months of enrollment in the study were excluded. Results. Between October 2010 and August 2014, 481 patients receiving chemotherapy underwent the rapid adrenocorticotropic hormone (ACTH) stimulation test to assess eligibility; 350 of these patients were included in the final analysis. Fifty-six patients (16.0%) showed a suppressed adrenal response in the rapid ACTH stimulation test at 3 or 6 months after the start of the first chemotherapy. The incidence of adrenal suppression was affected by age, performance status, stage, and use of megestrol acetate in univariate analysis. Multivariate analysis revealed that secondary adrenal suppression associated with antiemetic dexamethasone therapy was significantly associated with megestrol acetate treatment (odds ratio: 3.06; 95% confidence interval: 1.60 to 5.86; p<.001). Conclusion. This large prospective study indicates that approximately 15% of cancer patients receiving chemotherapy with a normal adrenal response show suppressed adrenal responses after antiemetic dexamethasone therapy. This result was particularly significant for patients cotreated with megestrol acetate.
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