Efficacy of Steroid-Omitting Antiemetic Therapy in Patients with Advanced Pancreatic Cancer receiving Nano-liposomal Irinotecan plus Fluorouracil and Leucovorin

Background : Nano-liposomal irinotecan plus 5-fluorouracil and leucovorin (Nal-IRI/FL) is an established second-line chemotherapy for advanced pancreatic cancer (APC). Standard antiemetic prophylaxis for this moderately emetogenic regimen includes a 5-hydroxytryptamine (5-HT₃) receptor antagonist and dexamethasone (Dex). However, steroid use may exacerbate glucose intolerance in patients with diabetes mellitus (DM), and an evidence supporting Dex-omitting antiemetic strategy remains limited. Methods : We retrospectively compared efficacy of prophylactic antiemetic therapy between Dex-omitting (no steroid use) and Dex-sparing (on day1) in combination with a 5-hydroxytryptamine (5-HT3) receptor antagonist and neurokinin-1 (NK1) in patients with APC who received Nal-IRI/FL from October 2020 to August 2024. The primary outcome was a total control (TC) rate of nausea and vomiting without rescue medication within 120 hours. Results : Patients were categorized into Dex-sparing (n=61) and Dex-omitting (n=13) groups according to use of Dex in antiemetic prophylaxis. Baseline characteristics were comparable except for a higher prevalence of DM in the Dex-omitting group (31% vs. 100%, P < 0.01). The TC rate did not differ between the two groups (80% vs. 69%, P = 0.46). The relative dose intensity of Nal-IRI and 5-FU was slightly higher in the Dex-omitting group (Nal-IRI: 55% vs. 62%; 5-FU: 59% vs. 68%). Progression-free survival (median: 5.2 vs. 5.0 months, P = 0.84) and overall survival (median: 10.1 vs. 9.4 months, P = 0.56) were also similar. Conclusions : Steroid-omitting antiemetic therapy with a 5-HT₃ receptor antagonist and an NK₁ receptor antagonist is a feasible option without compromising safety and efficacy of Nal-IRI/FL.