Co-administration of dexamethasone increases severity and accelerates onset day of neutropenia in bladder cancer patients on methotrexate, vinblastine, adriamycin and cisplatin chemotherapy: a retrospective cohort study

Shingo Itai,Junko Ishizaki,Tsutomu Shimada,Yuji Maeda,Yasuhide Kitagawa,Yoshimichi Sai,Yusuke Hara,Yukio Suga,Atsushi Mizokami,Kouji Izumi

doi:10.1186/s40780-016-0072-5

Abstract

BackgroundBladder cancer patients receiving methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy are co-administered with dexamethasone as an anti-emetic. We examined whether or not dexamethasone affects the severity and onset day of MVAC-induced severe neutropenia.MethodsThis was a retrospective study of bladder cancer patients treated with MVAC chemotherapy with or without dexamethasone as an antiemetic at Kanazawa University Hospital during January 2005 - December 2009. Patients were categorized into three groups; no dexamethasone use (Dex (−)), dexamethasone on day 2 (Dex 1 day), and dexamethasone on days 2, 3 and 4 (Dex multiday). We evaluated the incidence of grade 3/4 neutropenia and the day of onset of first severe neutropenic episode during the first course of MVAC chemotherapy. Logistic regression was used to investigate whether co-administration of dexamethasone was a risk factor for severe neutropenia.ResultsEpisodes of grade 3/4 neutropenia occurred in 3 out of 6 (50.0%), 11 out of 12 (91.7%) and 6 out of 6 (100%) patients in the Dex (−), Dex 1 day, and Dex multiday groups, respectively. The appearance day of first severe neutropenia in the Dex multiday group (13.2 ± 1.0) was significantly accelerated compared to the Dex (−) group (17.7 ± 2.1). Univariate logistic regression analysis revealed that dexamethasone is a risk factor for severe neutropenia (OR 17.0; 95%CI: 1.3–223.1).ConclusionsCo-administration of dexamethasone for anti-emesis brings forward the first appearance of neutropenia, and increases the severity of neutropenia, in bladder cancer patients receiving MVAC chemotherapy.

Highlights

Bladder cancer patients receiving methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy are co-administered with dexamethasone as an anti-emetic
We found that relatively little is known about the side effects of dexamethasone in patients receiving emetogenic cancer chemotherapy [14], and in particular, it is not known whether co-administration of dexamethasone with cancer chemotherapy influences the severity or onset day of neutropenia
There were no significant differences in age, sex, performance status, body surface area, BMI, creatinine clearance, total bilirubin, Aspartate aminotransferase (AST) and concomitant medications among the Dex (−), Dex 1 day and Dex multiday groups (Table 1)

Summary

Introduction

Bladder cancer patients receiving methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy are co-administered with dexamethasone as an anti-emetic. Vinblastine, adriamycin and cisplatin (MVAC) is considered a standard therapy for urothelial cancer throughout the United States, Europe, Canada and Japan [1]. Dexamethasone is effective for the prevention of emetogenic chemotherapy-induced nausea and vomiting (CINV) [4]. Anti-emetic guidelines such as those of the Multinational Association of Supportive Care in Cancer, the European Society of Medical Oncology, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network recommend dexamethasone for prevention of CINV in patients given anti-tumor agents with low, moderate or high emetic risk [5, 6]. It was reported that dexamethasone enhances the anti-emetic effects of 5-HT3 receptor antagonists on vomiting induced by anti-tumor agents in ferrets [7,8,9]. The safety of corticosteroid co-administration in this context has not been established

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