A randomised, double-blind, placebo-controlled trial evaluating the efficacy of prophylactic dexamethasone in preventing the most frequent adverse events of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma found it to be more effective than a placebo regimen.
Corticosteroids such as dexamethasone can be used to reduce inflammation; lower the immune response and help reduce sickness when having chemotherapy.
The trial was published in Hepatology in late July. Study authors Sadahisa Ogasawara, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan and colleagues randomly assigned Child-Pugh class A/B patients with HCC and no macrovascular invasion/extrahepatic metastases to either receive a treatment regimen that used intravenous dexamethasone or a placebo regimen with intravenous saline.
As summarised in Hepatology, the primary endpoint was complete response defined as the absence of grade ≥1 fever, anorexia, or nausea/vomiting according to the Common Terminology Criteria for Adverse Events (version 4) and no use of rescue therapy for 120 hours after TACE. A total of 120 patients between October 2010 and June 2013 were randomly assigned to treatment groups. The overall complete response rate was greater with the dexamethasone regimen than with the control regimen (p< 0.001). The cumulative incidences of fever, anorexia and nausea/vomiting were higher in the control regimen group. The authors report that the dexamethasone regimen was generally well tolerated by hepatocellular carcinoma patients including those with well-controlled diabetes mellitus and those with hepatitis B virus infection.
Conclusion
Ogasawara and colleagues concluded that the dexamethasone regimen was more effective than the control regimen in preventing TACE-induced fever, anorexia, and nausea/vomiting in patients with hepatocellular carcinoma.
