Risk factors for chemotherapy-induced dysgeusia in patients receiving dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin therapy: a retrospective observational study

PURPOSE: Chemotherapy-induced (CI) dysgeusia is a common adverse event that impairs nutritional status and quality of life; however, its risk factors remain poorly understood. This study aimed to identify risk factors for CI dysgeusia in patients receiving dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) therapy. METHODS: We conducted a single-center retrospective observational study including patients with urothelial carcinoma who received dd-MVAC therapy between August 2018 and March 2023. CI dysgeusia was defined as grade ≥ 2 dysgeusia according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Univariable logistic regression was performed to screen candidate predictors (p < 0.20), followed by multivariable logistic regression with backward stepwise selection. Cutoff values were determined using receiver operating characteristic (ROC) analysis. Predictive performance was evaluated using positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Among 103 patients, 32 (31.1%) developed CI dysgeusia. Multivariable analysis identified depression (adjusted odds ratio [aOR] 23.3, 95% CI 3.01-529; p = 0.010) and HbA1c ≤ 5.8% (aOR 2.86, 95% CI 1.16-7.30; p = 0.024) as independent risk factors. Depression alone showed good predictive performance (PPV 83.3%; NPV 72.2%) and combining it with HbA1c ≤ 5.8% increased PPV to 100%. CONCLUSIONS: Depression and HbA1c ≤ 5.8% were independent risk factors for CI dysgeusia in patients undergoing dd-MVAC therapy. These findings suggest that readily available clinical information may enable early identification of high-risk patients and support individualized supportive care strategies.