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Dexamethasone is typically included in the anti-emetic regimens during the administration of anticancer drugs. However, the incidence and severity of nausea and vomiting in patients receiving anticancer therapy, for whom dexamethasone must be avoided to prevent the recurrence of diabetes mellitus or hepatitis, remain unknown.

This retrospective, observational study evaluated nausea and vomiting in patients with breast cancer who underwent highly emetogenic chemotherapy, including anthracycline and cyclophosphamide, for breast cancer. In all patients, dexamethasone was completely omitted from the standard antiemetic regimen for reasons such as hepatitis, and only palonosetron and aprepitant were administered.

For the 82 evaluated cases, the incidence of nausea was 84.1%, vomiting was 14.6%, and the complete response (CR) rate was 8.5%. In addition, the incidence rate of grade 2 or higher nausea (CTCAE ver. 4) was 47.6%, and the proportion of cases in which anticancer drug doses were reduced in the subsequent course due to nausea and vomiting was 2.4%. Factor analysis showed that treatment regimens, age, drinking history, history of prior chemotherapy, and reasons for omitting dexamethasone had no significant effects on the incidence of chemotherapy-induced nausea and vomiting.

This study confirmed that the antiemetic effect of only administering palonosetron and aprepitant is insufficient for patients receiving highly emetogenic chemotherapy in whom dexamethasone cannot be administered. Prophylactic administration of other antiemetic drugs is necessary to effectively manage nausea and vomiting in patients receiving anticancer therapy who cannot receive dexamethasone.