Dexamethasone treatment increases survival in some cancers

Patients with certain types of cancer appear to have better survival rates if they are treated during surgery with the anti-nausea drug dexamethasone.

The finding was reported on Oct. 8, 2001 at the American Society of Anesthesiologists annual meeting (ANESTHESIOLOGY 2021).

“Dexamethasone has positive and negative effects — it inhibits cancer growth, but also suppresses the immune system,” said Maximilian Schaefer, M.D., Ph.D., senior author and director of the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. “Previous research has reported that in cancers in which the immune system controls cancer growth, the positive and negative effects of dexamethasone balance each other, so there is no benefit. Ours is the first large study to show that for a wide variety of cancers where the immune system does not play a major role, the positive effects seem to predominate,” he added.

In this retrospective study, the investigators analyzed data on 74,058 subjects who had undergone surgeries to remove non-immunogenic cancerous tumors at two medical centers in Boston.

They noted that 25,178 (34%) subjects had been treated with dexamethasone during surgery.

By 90 days after surgery 209 (0.83%) of the subjects who had been treated with dexamethasone had died compared with 1,543 (3.2%) of the subjects who had not been treated with dexamethasone.

After adjusting for a variety of factors, the investigators reported a 21% reduced risk of death within a year post-surgery for the dexamethasone-treated subjects..

Subgroup analyses indicated significant beneficial effects among subjects undergoing surgery for breast cancer (p<0.001) and gynecological malignancies of the reproductive organs (ovary, uterus, cervix, p=0.002).

The authors concluded, “Administration of dexamethasone during surgery used for prophylaxis of PONV [prevention of nausea and vomiting] is associated with lower 90-day mortality in patients undergoing cancer surgery. These data support the use of dexamethasone for antiemetic prophylaxis of patients undergoing cancer surgery”

Schaefer added, “Based on our data, physician anesthesiologists should feel more confident in administering dexamethasone to patients undergoing surgery for non-immunogenic cancers. It not only helps with nausea, but it also may result in improved survival.”