Pemetrexed-Induced Rash May Be Prevented by Supplementary Corticosteroids

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Author(s)

    • Kakiuchi Soji Kawazoe Kazuyoshi
    • Department of Pharmacy, Tokushima University Hospital|Department of Clinical Pharmacy, Institute of Biomedical Sciences, The University of Tokushima Graduate School
    • Nishioka Yasuhiko
    • Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, The University of Tokushima Graduate School
    • Ishizawa Keisuke
    • Department of Pharmacy, Tokushima University Hospital|Department of Clinical Pharmacy, Institute of Biomedical Sciences, The University of Tokushima Graduate School
    • Kakiuchi Soji
    • Department of Medical Oncology, Institute of Biomedical Sciences, The University of Tokushima Graduate School|Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, The University of Tokushima Graduate School
    • Konaka Ken
    • Department of Pharmacy, Tokushima University Hospital
    • Okada Naoto
    • Department of Pharmacy, Tokushima University Hospital

Abstract

Pemetrexed, a chemotherapeutic drug, is highly active in non-small cell lung cancer and malignant pleural mesothelioma. Unfortunately, rashes are more commonly associated with pemetrexed than other chemotherapies, and it is recommended that patients receive corticosteroids (8 mg/d of dexamethasone) for 3 d, including the day of pemetrexed administration (day 1). However, the efficacy of corticosteroids in this context has not been fully verified. In this retrospective study, we evaluated the medical records of 78 patients who received pemetrexed between April 2009 and March 2014, to confirm whether supplementary corticosteroids prevented rash development. The incidence of rash was lower in the 47 patients who received supplementary corticosteroids (after day 1) compared with the incidence among the 31 patients who did not receive supplementary corticosteroids (19.1% <i>vs.</i> 38.7%). The average cutoff dosage of supplementary corticosteroids on day 2 and day 3 was 1.5 mg/d of dexamethasone, as calculated using the receiver operating characteristic curve, and the odds ratio was 0.33 (95% confidence interval: 0.12–0.94). Administration of ≥1.5 mg of corticosteroids on day 2 and day 3 significantly reduced the severity of the rash compared to no supplementary treatment (grades 2/3, 13.3% <i>vs.</i> 33.3%, <i>p</i><0.05). However, increasing the dose of corticosteroids had no additional effect on rash development. These results suggest that ≥1.5 mg of supplementary dexamethasone on day 2 and day 3 (in addition to day 1) may be necessary for preventing pemetrexed-induced rash, but high doses of dexamethasone (<i>e.g.</i>, 8 mg/d) are unnecessary.

Journal

  • Biological and Pharmaceutical Bulletin

    Biological and Pharmaceutical Bulletin 38(11), 1752-1756, 2015

    The Pharmaceutical Society of Japan

Codes

  • NII Article ID (NAID)
    130005106388
  • NII NACSIS-CAT ID (NCID)
    AA10885497
  • Text Lang
    ENG
  • ISSN
    0918-6158
  • NDL Article ID
    026830167
  • NDL Call No.
    Z53-V41
  • Data Source
    NDL  J-STAGE 
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