Antiemetic Efficacy of Dexamethasone Randomized, Double-Blind, Crossover Study with Prochlorperazine in Patients Receiving Cancer Chemotherapy

• Published in: The New England journal of medicine Vol. 311; no. 9; pp. 549 - 552
• Main Authors: Markman, Maurie, Sheidler, Vivian, Ettinger, David S, Quaskey, Shirley A, Mellits, E. David
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 30.08.1984
• Subjects: Adult; Aged; Antiemetics; Antiemetics - therapeutic use; Antineoplastic Agents - adverse effects; Biological and medical sciences; Cancer; Cancer therapies; Chemotherapy; Cisplatin; Clinical Trials as Topic; Dexamethasone; Dexamethasone - adverse effects; Dexamethasone - therapeutic use; Double-Blind Method; Double-blind studies; Drug dosages; Drug toxicity and drugs side effects treatment; Female; Humans; Male; Medical sciences; Middle Aged; Nausea; Nausea - chemically induced; Nausea - prevention & control; Oncology; Patients; Pharmacology. Drug treatments; Prochlorperazine - adverse effects; Prochlorperazine - therapeutic use; Random Allocation; Statistical analysis; Steroids; Toxicity: digestive system; Vomiting; Vomiting - chemically induced; Vomiting - prevention & control; Antineoplastic agent; Human; Dexamethasone; Toxicity; Nausea; Chemotherapy; Polychemotherapy; Randomization; Treatment; Vomiting; Double blind study; Tumor; Antiemetic; Comparative study
• DOI: 10.1056/NEJM198408303110901
• ISSN: 0028-4793

We conducted a randomized, double-blind, crossover study comparing the antiemetic efficacy of dexamethasone and prochlorperazine in 42 patients with cancer who were receiving outpatient chemotherapy, mainly without cisplatin. Patients experienced significantly less nausea and vomiting with dexamethasone than with prochlorperazine (P<0.02 and <0.03, respectively). Twenty-five patients experienced no nausea with dexamethasone, as compared with 14 patients taking prochlorperazine (P<0.001). Similarly, 29 patients receiving dexamethasone did not vomit, as compared with 18 receiving prochlorperazine (P<0.001). Somnolence was the most frequent side effect, occurring in 60 per cent of patients receiving prochlorperazine and in 12 per cent of those receiving dexamethasone (P<0.001). Patients also experienced less suppression of appetite while receiving dexamethasone (P<0.02). We conclude that dexamethasone is an effective and safe antiemetic in patients receiving cancer chemotherapy without cisplatin. (N Engl J Med 1984; 311:549–52.) NAUSEA and vomiting are frequent and serious complications of cancer chemotherapy. The management of such side effects continues to be a major problem in cytotoxic drug therapy. 1 The commonly used "standard" antiemetics, such as prochlorperazine (Compazine), have been demonstrated to be only moderately effective in controlling these symptoms. 2 Because of the limited effectiveness of the standard antiemetics in controlling nausea and vomiting induced by cancer chemotherapy, newer agents, such as cannabinoid drugs, 3 metoclopramide, 4 and more recently, glucocorticoids, 5 6 7 8 9 10 have been employed with some success. Although the mechanism of steroid activity as an antiemetic is unknown, it has been suggested, though not . . .