Incidence of Fatigue Following Dexamethasone Administration for Supportive Therapy and Efficacy of Tapering in Perioperative Chemotherapy for Breast Cancer: A Retrospective Observational Study
In perioperative chemotherapy for breast cancer, dexamethasone (DEX) is administered at high dose to prevent adverse effects. Abrupt cessation of high-dose DEX treatment induces fatigue, but the incidence of the fatigue is uncertain. In this study, we retrospectively evaluated the incidence of fatig...
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| Published in | Biological & pharmaceutical bulletin Vol. 47; no. 7; pp. 1326 - 1330 |
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| Main Authors | , , , , , , |
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| Language | English |
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The Pharmaceutical Society of Japan
23.07.2024
Japan Science and Technology Agency |
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| Abstract | In perioperative chemotherapy for breast cancer, dexamethasone (DEX) is administered at high dose to prevent adverse effects. Abrupt cessation of high-dose DEX treatment induces fatigue, but the incidence of the fatigue is uncertain. In this study, we retrospectively evaluated the incidence of fatigue following DEX administration for supportive therapy and the improvement of fatigue with DEX tapering, a gradual reduction of the daily dose, in breast cancer patients. The subjects were 124 patients with breast cancer receiving epirubicin- or docetaxel-based regimens as perioperative chemotherapy. Of all patients, 16.1% of patients experienced fatigue after cessation of DEX administration. The severity of fatigue was grade 1 in 6.5% of patients, grade 2 in 8.1% of patients, and grade 3 in 1.6% of patients. There were no significant differences in dose and duration of DEX administration between the group with fatigue and the group without fatigue. In almost all patients with fatigue, DEX tapering was performed from the next cycle. The efficacy of DEX tapering was evaluated by comparing the grade and subjective symptoms. Following DEX tapering, the severity of fatigue was significantly reduced (p < 0.05), and the subjective symptom was improved in 94.7% of patients. Therefore, fatigue is occasionally induced after the cessation of DEX administration for supportive therapy in breast cancer patients. The tapering of DEX may be effective for fatigue. |
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| AbstractList | In perioperative chemotherapy for breast cancer, dexamethasone (DEX) is administered at high dose to prevent adverse effects. Abrupt cessation of high-dose DEX treatment induces fatigue, but the incidence of the fatigue is uncertain. In this study, we retrospectively evaluated the incidence of fatigue following DEX administration for supportive therapy and the improvement of fatigue with DEX tapering, a gradual reduction of the daily dose, in breast cancer patients. The subjects were 124 patients with breast cancer receiving epirubicin- or docetaxel-based regimens as perioperative chemotherapy. Of all patients, 16.1% of patients experienced fatigue after cessation of DEX administration. The severity of fatigue was grade 1 in 6.5% of patients, grade 2 in 8.1% of patients, and grade 3 in 1.6% of patients. There were no significant differences in dose and duration of DEX administration between the group with fatigue and the group without fatigue. In almost all patients with fatigue, DEX tapering was performed from the next cycle. The efficacy of DEX tapering was evaluated by comparing the grade and subjective symptoms. Following DEX tapering, the severity of fatigue was significantly reduced (p < 0.05), and the subjective symptom was improved in 94.7% of patients. Therefore, fatigue is occasionally induced after the cessation of DEX administration for supportive therapy in breast cancer patients. The tapering of DEX may be effective for fatigue. In perioperative chemotherapy for breast cancer, dexamethasone (DEX) is administered at high dose to prevent adverse effects. Abrupt cessation of high-dose DEX treatment induces fatigue, but the incidence of the fatigue is uncertain. In this study, we retrospectively evaluated the incidence of fatigue following DEX administration for supportive therapy and the improvement of fatigue with DEX tapering, a gradual reduction of the daily dose, in breast cancer patients. The subjects were 124 patients with breast cancer receiving epirubicin- or docetaxel-based regimens as perioperative chemotherapy. Of all patients, 16.1% of patients experienced fatigue after cessation of DEX administration. The severity of fatigue was grade 1 in 6.5% of patients, grade 2 in 8.1% of patients, and grade 3 in 1.6% of patients. There were no significant differences in dose and duration of DEX administration between the group with fatigue and the group without fatigue. In almost all patients with fatigue, DEX tapering was performed from the next cycle. The efficacy of DEX tapering was evaluated by comparing the grade and subjective symptoms. Following DEX tapering, the severity of fatigue was significantly reduced (p < 0.05), and the subjective symptom was improved in 94.7% of patients. Therefore, fatigue is occasionally induced after the cessation of DEX administration for supportive therapy in breast cancer patients. The tapering of DEX may be effective for fatigue.In perioperative chemotherapy for breast cancer, dexamethasone (DEX) is administered at high dose to prevent adverse effects. Abrupt cessation of high-dose DEX treatment induces fatigue, but the incidence of the fatigue is uncertain. In this study, we retrospectively evaluated the incidence of fatigue following DEX administration for supportive therapy and the improvement of fatigue with DEX tapering, a gradual reduction of the daily dose, in breast cancer patients. The subjects were 124 patients with breast cancer receiving epirubicin- or docetaxel-based regimens as perioperative chemotherapy. Of all patients, 16.1% of patients experienced fatigue after cessation of DEX administration. The severity of fatigue was grade 1 in 6.5% of patients, grade 2 in 8.1% of patients, and grade 3 in 1.6% of patients. There were no significant differences in dose and duration of DEX administration between the group with fatigue and the group without fatigue. In almost all patients with fatigue, DEX tapering was performed from the next cycle. The efficacy of DEX tapering was evaluated by comparing the grade and subjective symptoms. Following DEX tapering, the severity of fatigue was significantly reduced (p < 0.05), and the subjective symptom was improved in 94.7% of patients. Therefore, fatigue is occasionally induced after the cessation of DEX administration for supportive therapy in breast cancer patients. The tapering of DEX may be effective for fatigue. |
| ArticleNumber | b24-00207 |
| Author | Wakasugi, Yoshinori Morii, Hiroaki Tomida, Kaori Morita, Shin-ya Sudo, Masatomo Yabuta, Naoki Noda, Satoshi |
| Author_xml | – sequence: 1 fullname: Morita, Shin-ya organization: Department of Pharmacy, Shiga University of Medical Science Hospital – sequence: 1 fullname: Noda, Satoshi organization: College of Pharmaceutical Sciences, Ritsumeikan University – sequence: 1 fullname: Morii, Hiroaki organization: Department of Pharmacy, Shiga University of Medical Science Hospital – sequence: 1 fullname: Sudo, Masatomo organization: Department of Pharmacy, Shiga University of Medical Science Hospital – sequence: 1 fullname: Wakasugi, Yoshinori organization: Department of Pharmacy, Shiga University of Medical Science Hospital – sequence: 1 fullname: Tomida, Kaori organization: Department of Surgery, Shiga University of Medical Science – sequence: 1 fullname: Yabuta, Naoki organization: Department of Pharmacy, Shiga University of Medical Science Hospital |
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| Cites_doi | 10.1210/clinem/dgac151 10.1634/theoncologist.2015-0211 10.1016/S0889-8529(02)00008-7 10.5649/jjphcs.38.282 10.1016/S0140-6736(79)91077-8 10.1056/NEJM199201233260403 10.1097/MED.0000000000000804 10.1007/s12282-011-0297-y 10.1016/j.semarthrit.2016.03.001 10.1016/j.eprac.2021.09.011 10.1016/S0140-6736(99)06290-X 10.1200/JCO.2005.02.027 10.1200/JCO.2005.05.0294 10.1007/s10147-020-01818-3 10.1007/s00280-008-0713-y 10.1136/bmj.n1380 10.1056/NEJMoa0707056 10.1016/S0140-6736(96)91723-7 |
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| References | 17) Nakade S, Ohno T, Kitagawa J, Hashimoto Y, Katayama M, Awata H, Kodama Y, Miyata Y. Population pharmacokinetics of aprepitant and dexamethasone in the prevention of chemotherapy-induced nausea and vomiting. Cancer Chemother. Pharmacol., 63, 75–83 (2008). 15) Sparano JA, Wang M, Martino S, Jones V, Perez EA, Saphner T, Wolff AC, Sledge GW Jr, Wood WC, Davidson NE. Weekly paclitaxel in the adjuvant treatment of breast cancer. N. Engl. J. Med., 358, 1663–1671 (2008). 4) Chan S, Winterbottom L, Gardner S. Response to dexamethasone in patients with fluid retention after docetaxel. Lancet, 347, 1486–1487 (1996). 5) Hosonaga M, Ito Y, Tokudome N, Takahashi S, Iwase T, Hatake K. A lower dose of docetaxel at 60 mg/m2 could be continued longer for controlling peripheral edema in patients with metastatic breast cancer. Breast Cancer, 19, 329–334 (2012). 19) Theiler-Schwetz V, Prete A. Glucocorticoid withdrawal syndrome: what to expect and how to manage. Curr. Opin. Endocrinol. Diabetes Obes., 30, 167–174 (2023). 3) Harvey V, Mouridsen H, Semiglazov V, Jakobsen E, Voznyi E, Robinson BA, Groult V, Murawsky M, Cold S. Phase III trial comparing three doses of docetaxel for second-line treatment of advanced breast cancer. J. Clin. Oncol., 24, 4963–4970 (2006). 9) Usami E, Kimura M, Yoshimura T, Yasuda T, Teramachi H, Sugiyama T, Tsuchiya T. Steroid withdrawal syndrome after normal dose chemotherapy in Non-Hodgkin’s lymphoma: a study of the frequency of symptoms and the efficacy of steroid tapering. Iryo Yakugaku (Jpn. J. Pharm. Health Care Sci.), 38, 282–287 (2012). 2) Jones SE, Erban J, Overmoyer B, Budd GT, Hutchins L, Lower E, Laufman L, Sundaram S, Urba WJ, Pritchard KI, Mennel R, Richards D, Olsen S, Meyers ML, Ravdin PM. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J. Clin. Oncol., 23, 5542–5551 (2005). 11) Han HS, Park JC, Park SY, Lee KT, Bae SB, Kim HJ, Kim S, Yun HJ, Bae WK, Shim HJ, Hwang JE, Cho SH, Park MR, Shim H, Kwon J, Choi MK, Kim ST, Lee KH. A prospective multicenter study evaluating secondary adrenal suppression after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy: a Korean South West Oncology Group study. Oncologist, 20, 1432–1439 (2015). 10) Richter B, Neises G, Clar C. Glucocorticoid withdrawal schemes in chronic medical disorders: a systematic review. Endocrinol. Metab. Clin. North Am., 31, 751–778 (2002). 7) Gruber LM, Bancos I. Secondary adrenal insufficiency: recent updates and new directions for diagnosis and management. Endocr. Pract., 28, 110–117 (2022). 12) Borresen SW, Klose M, Glintborg D, Watt T, Andersen MS, Feldt-Rasmussen U. Approach to the patient with glucocorticoid-induced adrenal insufficiency. J. Clin. Endocrinol. Metab., 107, 2065–2076 (2022). 16) Joseph RM, Hunter AL, Ray DW, Dixon WG. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin. Arthritis Rheum., 46, 133–141 (2016). 13) Schlaghecke R, Kornely E, Santen RT, Ridderskamp P. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N. Engl. J. Med., 326, 226–230 (1992). 8) Spiegel RJ, Vigersky RA, Oliff AI, Echelberger CK, Bruton J, Poplack DG. Adrenal suppression after short-term corticosteroid therapy. Lancet, 313, 630–633 (1979). 14) Henzen C, Suter A, Lerch E, Urbinelli R, Schorno XH, Briner VA. Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment. Lancet, 355, 542–545 (2000). 6) Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ, 374, n1380 (2021). 18) McCrea JB, Majumdar AK, Goldberg MR, Iwamoto M, Gargano C, Panebianco DL, Hesney M, Lines CR, Petty KJ, Deutsch PJ, Murphy MG, Gottesdiener KM, Goldwater DR, Blum RA. Effects of the neurokinin1 receptor antagonist aprepitant on the pharmacokinetics of dexamethasone and methylprednisolone. Clin. Pharmacol. Ther., 74, 17–24 (2003). 1) Aogi K, Takeuchi H, Saeki T, et al. Optimizing antiemetic treatment for chemotherapy-induced nausea and vomiting in Japan: update summary of the 2015 Japan Society of Clinical Oncology Clinical Practice Guidelines for Antiemesis. Int. J. Clin. Oncol., 26, 1–17 (2021). 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 |
| References_xml | – reference: 3) Harvey V, Mouridsen H, Semiglazov V, Jakobsen E, Voznyi E, Robinson BA, Groult V, Murawsky M, Cold S. Phase III trial comparing three doses of docetaxel for second-line treatment of advanced breast cancer. J. Clin. Oncol., 24, 4963–4970 (2006). – reference: 14) Henzen C, Suter A, Lerch E, Urbinelli R, Schorno XH, Briner VA. Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment. Lancet, 355, 542–545 (2000). – reference: 16) Joseph RM, Hunter AL, Ray DW, Dixon WG. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin. Arthritis Rheum., 46, 133–141 (2016). – reference: 17) Nakade S, Ohno T, Kitagawa J, Hashimoto Y, Katayama M, Awata H, Kodama Y, Miyata Y. Population pharmacokinetics of aprepitant and dexamethasone in the prevention of chemotherapy-induced nausea and vomiting. Cancer Chemother. Pharmacol., 63, 75–83 (2008). – reference: 1) Aogi K, Takeuchi H, Saeki T, et al. Optimizing antiemetic treatment for chemotherapy-induced nausea and vomiting in Japan: update summary of the 2015 Japan Society of Clinical Oncology Clinical Practice Guidelines for Antiemesis. Int. J. Clin. Oncol., 26, 1–17 (2021). – reference: 5) Hosonaga M, Ito Y, Tokudome N, Takahashi S, Iwase T, Hatake K. A lower dose of docetaxel at 60 mg/m2 could be continued longer for controlling peripheral edema in patients with metastatic breast cancer. Breast Cancer, 19, 329–334 (2012). – reference: 15) Sparano JA, Wang M, Martino S, Jones V, Perez EA, Saphner T, Wolff AC, Sledge GW Jr, Wood WC, Davidson NE. Weekly paclitaxel in the adjuvant treatment of breast cancer. N. Engl. J. Med., 358, 1663–1671 (2008). – reference: 2) Jones SE, Erban J, Overmoyer B, Budd GT, Hutchins L, Lower E, Laufman L, Sundaram S, Urba WJ, Pritchard KI, Mennel R, Richards D, Olsen S, Meyers ML, Ravdin PM. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J. Clin. Oncol., 23, 5542–5551 (2005). – reference: 13) Schlaghecke R, Kornely E, Santen RT, Ridderskamp P. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N. Engl. J. Med., 326, 226–230 (1992). – reference: 9) Usami E, Kimura M, Yoshimura T, Yasuda T, Teramachi H, Sugiyama T, Tsuchiya T. Steroid withdrawal syndrome after normal dose chemotherapy in Non-Hodgkin’s lymphoma: a study of the frequency of symptoms and the efficacy of steroid tapering. Iryo Yakugaku (Jpn. J. Pharm. Health Care Sci.), 38, 282–287 (2012). – reference: 7) Gruber LM, Bancos I. Secondary adrenal insufficiency: recent updates and new directions for diagnosis and management. Endocr. Pract., 28, 110–117 (2022). – reference: 19) Theiler-Schwetz V, Prete A. Glucocorticoid withdrawal syndrome: what to expect and how to manage. Curr. Opin. Endocrinol. Diabetes Obes., 30, 167–174 (2023). – reference: 12) Borresen SW, Klose M, Glintborg D, Watt T, Andersen MS, Feldt-Rasmussen U. Approach to the patient with glucocorticoid-induced adrenal insufficiency. J. Clin. Endocrinol. Metab., 107, 2065–2076 (2022). – reference: 8) Spiegel RJ, Vigersky RA, Oliff AI, Echelberger CK, Bruton J, Poplack DG. Adrenal suppression after short-term corticosteroid therapy. Lancet, 313, 630–633 (1979). – reference: 18) McCrea JB, Majumdar AK, Goldberg MR, Iwamoto M, Gargano C, Panebianco DL, Hesney M, Lines CR, Petty KJ, Deutsch PJ, Murphy MG, Gottesdiener KM, Goldwater DR, Blum RA. Effects of the neurokinin1 receptor antagonist aprepitant on the pharmacokinetics of dexamethasone and methylprednisolone. Clin. Pharmacol. Ther., 74, 17–24 (2003). – reference: 10) Richter B, Neises G, Clar C. Glucocorticoid withdrawal schemes in chronic medical disorders: a systematic review. Endocrinol. Metab. Clin. North Am., 31, 751–778 (2002). – reference: 11) Han HS, Park JC, Park SY, Lee KT, Bae SB, Kim HJ, Kim S, Yun HJ, Bae WK, Shim HJ, Hwang JE, Cho SH, Park MR, Shim H, Kwon J, Choi MK, Kim ST, Lee KH. A prospective multicenter study evaluating secondary adrenal suppression after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy: a Korean South West Oncology Group study. Oncologist, 20, 1432–1439 (2015). – reference: 4) Chan S, Winterbottom L, Gardner S. Response to dexamethasone in patients with fluid retention after docetaxel. Lancet, 347, 1486–1487 (1996). – reference: 6) Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ, 374, n1380 (2021). – ident: 18 – ident: 12 doi: 10.1210/clinem/dgac151 – ident: 11 doi: 10.1634/theoncologist.2015-0211 – ident: 10 doi: 10.1016/S0889-8529(02)00008-7 – ident: 9 doi: 10.5649/jjphcs.38.282 – ident: 8 doi: 10.1016/S0140-6736(79)91077-8 – ident: 13 doi: 10.1056/NEJM199201233260403 – ident: 19 doi: 10.1097/MED.0000000000000804 – ident: 5 doi: 10.1007/s12282-011-0297-y – ident: 16 doi: 10.1016/j.semarthrit.2016.03.001 – ident: 7 doi: 10.1016/j.eprac.2021.09.011 – ident: 14 doi: 10.1016/S0140-6736(99)06290-X – ident: 2 doi: 10.1200/JCO.2005.02.027 – ident: 3 doi: 10.1200/JCO.2005.05.0294 – ident: 1 doi: 10.1007/s10147-020-01818-3 – ident: 17 doi: 10.1007/s00280-008-0713-y – ident: 6 doi: 10.1136/bmj.n1380 – ident: 15 doi: 10.1056/NEJMoa0707056 – ident: 4 doi: 10.1016/S0140-6736(96)91723-7 |
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| SubjectTerms | adrenal insufficiency Adult Aged Antineoplastic Agents - administration & dosage Antineoplastic Agents - adverse effects Antineoplastic Agents - therapeutic use Antineoplastic Combined Chemotherapy Protocols - administration & dosage Antineoplastic Combined Chemotherapy Protocols - adverse effects Antineoplastic Combined Chemotherapy Protocols - therapeutic use Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - surgery Cancer therapies Chemotherapy Dexamethasone Dexamethasone - administration & dosage Dexamethasone - adverse effects Dexamethasone - therapeutic use Docetaxel - administration & dosage Docetaxel - adverse effects Docetaxel - therapeutic use Drug Tapering Epirubicin Epirubicin - administration & dosage Epirubicin - adverse effects Epirubicin - therapeutic use Fatigue Fatigue - drug therapy Fatigue - etiology Female Humans Incidence Middle Aged Observational studies Perioperative Care - methods Retrospective Studies supportive therapy tapering |
| Title | Incidence of Fatigue Following Dexamethasone Administration for Supportive Therapy and Efficacy of Tapering in Perioperative Chemotherapy for Breast Cancer: A Retrospective Observational Study |
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| ispartofPNX | Biological and Pharmaceutical Bulletin, 2024/07/23, Vol.47(7), pp.1326-1330 |
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