Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.
Department of Breast Surgery, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.
Support Care Cancer. 2023 Jun 3;31(6):372. doi: 10.1007/s00520-023-07852-x.
Taxane-associated acute pain syndrome (T-APS) is one of the most bothersome adverse effects caused by taxanes. We have previously reported the attenuating effect of dexamethasone (DEX) on T-APS and its risk factors under DEX prophylaxis. However, the appropriate DEX dosage administration remains unclear. Therefore, this study aimed to investigate whether DEX dose-dependently prevents T-APS in breast cancer patients.
We retrospectively evaluated patients with breast cancer who received docetaxel (75 mg/m)-containing chemotherapy without pegfilgrastim and regular non-steroidal anti-inflammatory drugs. The patients were divided into 4 mg/day and 8 mg/day DEX groups, with each DEX dosage on days 2-4 (n = 68 for each group). Primary endpoint was the comparison of all-grade T-APS incidence between the groups. Propensity score-matching was performed to adjust the baseline factors between the groups, and outcomes in the matched-population were also assessed.
The incidence of all-grade T-APS was 72.1% in 4 mg/day group and 48.5% in 8 mg/day group, which was significantly lowered by higher DEX dosage (P = 0.008). The severity of T-APS was also significantly reduced in 8 mg/day group (P = 0.02). These results were confirmed in the propensity score matching. Multivariate logistic analysis showed that higher DEX dosage was an independent T-APS preventive factor, whereas age < 55 years was a risk factor. Moreover, DEX-dosage-associated adverse effects similarly appeared in both groups.
Our study suggested that DEX dose-dependently prevents T-APS in breast cancer treatment. As understanding of the nature of T-APS and its appropriate management can significantly contribute to less onerous chemotherapy provision, further studies are required.
紫杉烷类相关急性疼痛综合征（T-APS）是紫杉烷类药物引起的最麻烦的不良反应之一。我们之前报告了地塞米松（DEX）在 DEX 预防下对 T-APS 及其危险因素的缓解作用。然而，DEX 的适当剂量管理仍不清楚。因此，本研究旨在探讨 DEX 是否剂量依赖性地预防乳腺癌患者的 T-APS。
我们回顾性评估了接受多西他赛（75mg/m）含化疗而未接受培非格司亭和常规非甾体抗炎药的乳腺癌患者。患者分为 4mg/天和 8mg/天 DEX 组，每组 DEX 剂量为 2-4 天（每组 68 例）。主要终点是比较两组之间所有级别 T-APS 的发生率。进行倾向评分匹配以调整组间基线因素，并评估匹配人群的结果。
4mg/天组 T-APS 的总发生率为 72.1%，8mg/天组为 48.5%，DEX 剂量较高时显著降低（P=0.008）。8mg/天组 T-APS 的严重程度也显著降低（P=0.02）。这些结果在倾向评分匹配中得到了证实。多变量逻辑分析表明，DEX 剂量较高是 T-APS 的独立预防因素，而年龄<55 岁是危险因素。此外，DEX 剂量相关的不良反应在两组中也相似。
本研究表明，DEX 剂量依赖性地预防乳腺癌治疗中的 T-APS。由于对 T-APS 的性质及其适当管理的理解可以显著有助于减轻化疗负担，因此需要进一步研究。
