内容紹介
Effect of Oral Dexamethasone Given 24 Hours Previously on Docetaxel-Induced Edema: A Retrospective Study
Summary
In Europe and the United States, beginning steroid treatment on the day before docetaxel(DTX)administration is recommended to reduce edema and/or hypersensitivity symptoms. In this study, we investigated the usefulness of starting steroid treatment on the day before DTX administration. Patients with breast cancer who received 4 or more cycles of DTX with or without trastuzumab or DTX and cyclophosphamide(TC)with or without trastuzumab as pre- or post-operative chemotherapy in our hospital between January 2010 and May 2012 were analyzed in this retrospective study. Patients were classified as those who started taking steroids on the day of DTX administration(Group A: 62 patients)and those who started taking steroids on the day before DTX administration(Group B: 47 patients). The incidence of edema and/or hypersensitivity was retrospectively compared between these groups after the completion of 4 cycles of chemotherapy. The incidence of edema was significantly lower in Group B(n=12, 25.5%)than in Group A(n=28, 45.2%; p=0.04). The onset of edema also tended to be later in Group B. The incidence of hypersensitivity tended to be lower in Group B(n=3, 6.4%)than in Group A(n=8, 12.9%), although this difference was not statistically significant. These results suggest the benefit of steroid treatment started on the day before DTX administration in preventing the development of edema. Results also suggest that the onset of edema could be delayed by this administration method. We recommend that steroid premedication, which can lead to a reduction in adverse drug reactions to DTX, be used to help maintain patients' quality of life(QOL)and to support treatment continuation.
要旨
欧米ではドセタキセル(DTX)投与時に浮腫や過敏症状の軽減を目的に前日からのステロイドの使用が推奨されている。今回われわれは,前日からのステロイド服用の有用性について検討した。2010年1月～2012年5月に当院で術前または術後化学療法としてDTX単剤±trastuzumabまたはTC(DTX+サイクロフォスファミド)±trastuzumab療法を開始し,4サイクル以上施行した乳癌患者を対象とし,ステロイドをDTX投与日より内服した症例(A群62例)と前日より内服した症例(B群47例)において,4サイクル終了時での浮腫や過敏症の出現頻度をレトロスペクティブに比較検討した。浮腫はA群28例(45.2%),B群12例(25.5%)に出現し,有意にB群が低かった(p=0.04)。また,浮腫の発現時期についてもB群で遅くなる傾向が認められた。過敏症はA群8例(12.9%),B群3例(6.4%)でB群が低い傾向であったが,有意な差はなかった。浮腫の発現予防に対して,ステロイドの前日投与の有用性が示唆された。また,浮腫の発現時期を遅らせることができると考えられた。DTXの副作用軽減につながる前投薬は,患者のQOL維持や治療継続の上で使用が望まれる。
目次
Summary
In Europe and the United States, beginning steroid treatment on the day before docetaxel(DTX)administration is recommended to reduce edema and/or hypersensitivity symptoms. In this study, we investigated the usefulness of starting steroid treatment on the day before DTX administration. Patients with breast cancer who received 4 or more cycles of DTX with or without trastuzumab or DTX and cyclophosphamide(TC)with or without trastuzumab as pre- or post-operative chemotherapy in our hospital between January 2010 and May 2012 were analyzed in this retrospective study. Patients were classified as those who started taking steroids on the day of DTX administration(Group A: 62 patients)and those who started taking steroids on the day before DTX administration(Group B: 47 patients). The incidence of edema and/or hypersensitivity was retrospectively compared between these groups after the completion of 4 cycles of chemotherapy. The incidence of edema was significantly lower in Group B(n=12, 25.5%)than in Group A(n=28, 45.2%; p=0.04). The onset of edema also tended to be later in Group B. The incidence of hypersensitivity tended to be lower in Group B(n=3, 6.4%)than in Group A(n=8, 12.9%), although this difference was not statistically significant. These results suggest the benefit of steroid treatment started on the day before DTX administration in preventing the development of edema. Results also suggest that the onset of edema could be delayed by this administration method. We recommend that steroid premedication, which can lead to a reduction in adverse drug reactions to DTX, be used to help maintain patients' quality of life(QOL)and to support treatment continuation.
要旨
欧米ではドセタキセル(DTX)投与時に浮腫や過敏症状の軽減を目的に前日からのステロイドの使用が推奨されている。今回われわれは,前日からのステロイド服用の有用性について検討した。2010年1月～2012年5月に当院で術前または術後化学療法としてDTX単剤±trastuzumabまたはTC(DTX+サイクロフォスファミド)±trastuzumab療法を開始し,4サイクル以上施行した乳癌患者を対象とし,ステロイドをDTX投与日より内服した症例(A群62例)と前日より内服した症例(B群47例)において,4サイクル終了時での浮腫や過敏症の出現頻度をレトロスペクティブに比較検討した。浮腫はA群28例(45.2%),B群12例(25.5%)に出現し,有意にB群が低かった(p=0.04)。また,浮腫の発現時期についてもB群で遅くなる傾向が認められた。過敏症はA群8例(12.9%),B群3例(6.4%)でB群が低い傾向であったが,有意な差はなかった。浮腫の発現予防に対して,ステロイドの前日投与の有用性が示唆された。また,浮腫の発現時期を遅らせることができると考えられた。DTXの副作用軽減につながる前投薬は,患者のQOL維持や治療継続の上で使用が望まれる。