A Randomized Placebo-Controlled Trial of Prophylactic Dexamethasone for Transcatheter Arterial Chemoembolization

Abstract

This randomized, double-blind, placebo-controlled trial evaluated dexamethasone efficacy in preventing fever, anorexia, and nausea/vomiting, the most frequent adverse events of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Child-Pugh class A/B patients with HCC and no macrovascular invasion/extrahepatic metastases were randomly assigned to either a dexamethasone (day 1, intravenous dexamethasone [20 mg] and granisetron [3 mg] before TACE; days 2 and 3, intravenous dexamethasone [8 mg]) or a control regimen (day 1, intravenous placebo [saline] and granisetron [3 mg]; days 2 and 3, intravenous placebo). The primary endpoint was complete response (CR) defined as the absence of grade ≥1 fever, anorexia, or nausea/vomiting according to the Common Terminology Criteria for Adverse Events (version 4.0) and no use of rescue therapy for 120 h after TACE. A total of 120 patients between October 2010 and June 2013 were randomly assigned to treatment groups. Overall CR rate was greater with the dexamethasone regimen than with the control regimen (47.5% [95% CI: 34.3-60.9%] vs. 10.2% [95% CI: 3.8-20.8%]; P < 0.001). Cumulative incidences of fever, anorexia, nausea/vomiting were higher in the control regimen group compared with the dexamethasone group (P < 0.001, P < 0.001, and P = 0.095, respectively). The dexamethasone regimen was generally well tolerated by HCC patients including those with well-controlled diabetes mellitus and those with hepatitis B virus infection.

Conclusion: The dexamethasone regimen was more effective than the control regimen in preventing TACE-induced fever, anorexia, and nausea/vomiting in patients with HCC. This article is protected by copyright. All rights reserved.

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