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01-10-2020 | Nausea | Original Article

Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada

Authors: Robert C. Grant, Coleman Rotstein, Geoffrey Liu, Leta Forbes, Kathy Vu, Roy Lee, Pamela Ng, Monika Krzyzanowska, David Warr, Jennifer Knox

Published in: Supportive Care in Cancer | Issue 10/2020

Abstract

Purpose

People with cancer face an elevated risk of infection and severe sequelae from COVID-19. Dexamethasone is commonly used for antiemetic prophylaxis with systemic therapy for cancer. However, dexamethasone is associated with increased risk of viral and respiratory infections, and causes lymphopenia, which is associated with worse outcomes during COVID-19 infections. Our purpose was to minimize dexamethasone exposure during antiemetic prophylaxis for systemic therapy for solid tumors during the COVID-19 pandemic, while maintaining control of nausea and emesis.

Methods

We convened an expert panel to systematically review the literature and formulate consensus recommendations.

Results

No studies considered the impact of dexamethasone-based antiemetic regimens on the risk and severity of COVID-19 infection. Expert consensus recommended modifications to the 2019 Cancer Care Ontario Antiemetic Recommendations.

Conclusion

Clinicians should prescribe the minimally effective dose of dexamethasone for antiemetic prophylaxis. Single-day dexamethasone dosing is recommended over multi-day dosing for regimens with high emetogenic risk excluding high-dose cisplatin, preferably in combination with palonosetron, netupitant, and olanzapine. For regimens with low emetogenic risk, 5-HT₃ antagonists are recommended over dexamethasone.

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Title: Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada
Authors: Robert C. Grant
Coleman Rotstein
Geoffrey Liu
Leta Forbes
Kathy Vu
Roy Lee
Pamela Ng
Monika Krzyzanowska
David Warr
Jennifer Knox
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Nausea
Systemic Therapy
Glucocorticoid
Vomiting
Care
COVID-19
Olanzapine
Dexamethasone
Cytostatic Therapy
Published in: Supportive Care in Cancer / Issue 10/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05588-6

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