Dexamethasone dose reduction for suspected dexamethasone-related delirium during weekly paclitaxel/carboplatin-based concurrent chemoradiotherapy: a two-case report

Abstract Background Dexamethasone (DEX), a type of corticosteroid, is widely used as an essential component of antiemetic prophylaxis in chemotherapy and chemoradiotherapy. However, corticosteroid is associated with adverse events, including delirium. Although dose reduction of the causative agent is generally recommended when adverse events occur, evidence regarding the feasibility of DEX dose reduction in emetogenic regimens, particularly weekly paclitaxel/carboplatin with concurrent radiotherapy (weekly PAC/CBDCA + RT), is limited. Case presentation We present two cases of successful DEX dose reduction in patients undergoing weekly PAC/CBDCA + RT who developed delirium suspected to be associated with DEX. In both cases, DEX was initially administered at 6.6 mg for antiemetic prophylaxis. Following the development of delirium, the DEX dose was gradually decreased; the absence of nausea and vomiting was considered in assessing the feasibility of dose reduction. After dose reduction, the symptoms of delirium improved, with no apparent deterioration in antiemetic control based on objective clinical assessment, including CTCAE assessment and the absence of rescue antiemetic use. One patient discontinued chemotherapy because of persistent hematologic toxicity. Conclusions These two cases suggest that a gradual reduction of DEX dosage may be considered as a potential management strategy for selected patients undergoing weekly PAC/CBDCA + RT when steroid-related adverse events, such as delirium, occur. Careful monitoring and personalized adjustment of antiemetic regimens may facilitate the treatment continuation while maintaining antiemetic control of treatment, even in moderate emetogenic chemoradiotherapy settings.