Снижение или исключение дексаметазона не уступает стандартной терапии при профилактике тошноты у пациентов с высокоэметогенной химиотерапией

Reducing or omitting dexamethasone (DEX) was found to be noninferior to treatment including standard DEX for patients being treated with highly emetogenic chemotherapy (HEC) and receiving netupitant/palonosetron (NEPA) and olanzapine (OLZ) for prevention of chemotherapy-induced nausea and vomiting (CINV). These results from a recent study were reported in the Journal of Clinical Oncology. The phase 3, randomized, open-label, noninferiority DESCEND trial (NCT06331520) was conducted across 28 centers in China and included adults with malignant solid tumors scheduled to receive highly emetogenic chemotherapy and receiving NEPA (day 1) plus olanzapine (days 1 to 4). Patients were stratified by sex (male vs female) and by age (≥55 years vs <55 years) and randomly assigned 1:1:1 to receive standard DEX (12 mg on day 1 and 8 mg on days 2 to 4), DEX-sparing (6 mg on day 1 only) therapy, or DEX-free (no DEX) therapy. The study’s primary endpoint was the proportion of patients reaching a complete response (CR), which was characterized by no emesis and no rescue medication, during the overall phase after initiating chemotherapy, from 0 to 120 hours. The study included 644 patients, median age 54.9 years and 66.0% were female. Overall CR rates in stratified analysis were 72.4% for the group receiving standard DEX, 72.2% for the group receiving DEX-sparing therapy, and 70.1% for the group receiving DEX-free therapy. Stratified risk differences (RDs) for CR were calculated to be −0.2% (95% CI, −8.7% to 8.5%; noninferiority P =.005) for DEX-sparing therapy vs standard DEX therapy and −2.2% (95% CI, −10.7% to 6.4%; noninferiority P =.014) for DEX-free therapy vs standard DEX therapy. Both the DEX-sparing and DEX-free approaches met requirements for noninferiority in comparison with standard DEX therapy. In the full analysis set of patients, there were no significant differences identified between DEX-sparing and DEX-free approaches, compared with standard DEX therapy, for secondary endpoints of CR, complete protection, and total control rates across acute, delayed, and overall time periods (P >.05 for each comparison). Rates of no impact on daily life regarding vomiting appeared similar across the study arms. There were no serious drug-related adverse events reported in this study. Additionally, the patient-reported severities of prespecified DEX-related toxicities appeared to be significantly reduced for the DEX-free regimen across these toxicities and for the DEX-sparing regimen for all but facial rash/acne, compared with the standard DEX regimen. “This [phase 3] trial demonstrates that, in HEC, NEPA plus OLZ with reduced or omitted DEX provides noninferior CINV prophylaxis versus standard 4-day DEX,” the study investigators wrote in their report. They also considered the study findings to support the use of steroid-sparing antiemetic approaches. References: Meng Y, Liu Y, Lin M, et al. Reduced/No dexamethasone with netupitant/palonosetron and olanzapine for chemotherapy-induced nausea/vomiting in highly emetogenic chemotherapy: phase III noninferiority trial. J Clin Oncol. 2026;JCO2601029. doi:10.1200/JCO-26-01029