Dexamethasone was associated with higher incidence of life-threatening events(primarily infections), resulting in a significantly higher induction death rate(2.5% for dexamethasone vs. 0.9% for prednisone; P= .00013).
In two trials of 53 and 45 patients with newly diagnosed disease, carfilzomib combined with lenalidomide and dexamethasone achieved an nCR or stringent complete response in 62% of the patients in both trials and an 18- to 24-month PFS of 92%, also in both trials.
The 5-year cumulative incidence of relapse was significantly lower with dexamethasone(11% vs. 16%; P< .0001), resulting in superior 5-year EFS(84% for dexamethasone vs. 81% for prednisone, P= .024) despite the increased induction death rate.
Low(10%- 30%) risk Single dose of 5-HT3 receptor antagonist or dexamethasone(8 mg) recommended Single dose of 5-HT3 receptor antagonist or dexamethasone or dopamine antagonist recommended Single dose of 5-HT3 receptor antagonist or dexamethasone(8 mg) or metoclopramide(10- 20 mg) or prochlorperazine(10 mg) recommended.
A trial of hepatic arterial floxuridine and dexamethasone plus systemic 5-FU/LV compared with systemic 5-FU/LV alone showed improved 2-year PFS(57% vs. 42%, P= .07) and OS(86% vs. 72%, P= .03) for patients in the combined therapy arm but did not show a significant statistical difference in median survival compared with systemic 5-FU therapy alone.
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