Dexamethasone used as an antiemetic in chemotherapy protocols inhibits natural cytotoxic (NC) cell activity
Article Abstract:
Nausea and vomiting are common side effects of chemotherapy and may be so severe that they prevent the patient from continuing chemotherapeutic treatment. As a result, antiemetics are often given along with chemotherapy drugs. This is especially true in the case of cisplatin, which seems to cause the highest incidence of nausea and vomiting. One of the antiemetics in use is dexamethasone. Research in mice has demonstrated that dexamethasone can reduce the activity of natural cytotoxic (NC) cells, which are part of the body's natural defense against tumors. For this reason, the NC cell activity was examined in patients undergoing chemotherapy and receiving dexamethasone as an antiemetic. Blood was collected from patients and the mononuclear cells, which contain the NC cells as a subset, were separated. Mouse fibroblast cells were used as target cells; healthy NC cells should kill the fibroblasts efficiently. The killing was monitored by measuring radioactive chromium, which normal fibroblasts keep inside but punctured and dying fibroblasts release. NC activity was unaffected by different chemotherapeutic regimens, although chemotherapy may affect NC activity after 1 to 2 weeks. NC activity is not affected by antiemetics such as prochlorperazine or diphenhydramine. Dexamethasone, on the other hand, reduced the activity of the natural cytotoxic cells. Experiments in tissue culture have shown that cisplatin actually enhances the ability of NC cells to bind to and destroy their targets. It is not known, however, if any of the effectiveness of cisplatin is due to the enhancement of NC activity. Since NC activity does play a role in tumor rejection in laboratory animals, however, the advisability of using dexamethasone with cisplatin in cancer patients should be researched further. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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Antiemetic superiority of lorazepam over oxazepam and methylprednisolone as premedicants for patients receiving cisplatin-containing chemotherapy
Article Abstract:
Nausea and vomiting are among the most distressing side effects of chemotherapy, and many physicians are dissatisfied with currently used antiemetics. The chemotherapeutic drug cisplatin is particularly unpleasant in its frequency of emesis (vomiting) as a side effect, and has served as a useful testing ground for antiemetic therapies using lorazepam, oxazepam, or methylprednisolone. In this study, 100 patients received three courses of cisplatin-containing chemotherapy, and each patient served as his own control. Of the 100, 85 received at least two of the three antiemetic agents during their three chemotherapy cycles. The results demonstrated that lorazepam significantly reduced the number of severe vomiting episodes over oxazepam and methylprednisolone. However, there were no significant differences between the drugs in the overall number of vomiting episodes or their duration. Lorazepam and oxazepam both produced more drowsiness and lack of recall than methylprednisolone, which had the fewest side effects overall. The majority of patients found the use of lorazepam and oxazepam desirable, though 10 to 15 percent found the sedation and amnesia to be undesirable or even distressing. It is interesting to note that although methylprednisolone has been reported to be an effective antiemetic for cancer chemotherapy, it performed relatively poorly in this study. In addition to its relative lack of effectiveness, it is significantly more expensive than either lorazepam or oxazepam. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1989
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A randomized, double-blind comparison of the antiemetic effect of metoclopramide and lorazepam with or without dexamethasone in patients receiving high-dose cisplatin
Article Abstract:
The effectiveness of high doses of dexamethasone added to lorazepam and metoclopramide in preventing vomiting (emesis) was assessed in 37 patients with advanced incurable cancer receiving treatment with the anticancer agent cisplatin. Cisplatin is an effective agent against several tumor types, but the nausea and vomiting this drug also produces can be severe. Nineteen patients received dexamethasone added to lorazepam and metoclopramide; 18 patients received only lorazepam and metoclopramide. Vomiting was relieved in 14 of 19 patients treated with dexamethasone, and in 6 of 18 patients who were not treated with this drug. Relief of vomiting or nausea was reported in 13 of the 19 dexamethasone-treated patients, and in 4 of the 18 patients not receiving dexamethasone. The anti-emetic regimen of dexamethasone, lorazepam, and metoclopramide caused sleepiness in all patients, confusion in 8 percent of the patients, and diarrhea in 46 percent of the patients. The results show that dexamethasone improved the anti-emetic effect of lorazepam and metoclopramide without causing additional adverse effects. Thus, combined treatment with dexamethasone, lorazepam, and metoclopramide is effective in controlling emesis resulting from treatment with the anticancer agent cisplatin. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
User Contributions:
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