Corticosteroids are powerful anti-inflammatory drugs that play a multifaceted role in cancer treatment. Far from being the performance-enhancing steroids sometimes abused by athletes, these therapeutic medications are vital for managing chemotherapy side effects and can even directly combat certain cancers. Patients undergoing treatment often receive these medications via intravenous (IV) injection during a chemotherapy session or as oral tablets to take at home. The specific type, dose, and duration of steroid therapy are carefully determined by an oncologist based on the patient's individual needs, the type of cancer, and the chemotherapy regimen being used.
Common Steroids Used in Chemotherapy
Several corticosteroids are frequently prescribed alongside chemotherapy, each with slightly different properties regarding potency, duration of action, and anti-inflammatory versus mineralocorticoid effects.
Dexamethasone
Perhaps the most common steroid used during chemotherapy, dexamethasone is known for its high anti-inflammatory potency and long-lasting effects. It is a cornerstone medication for preventing both acute and delayed chemotherapy-induced nausea and vomiting (CINV). Dexamethasone is also crucial for managing swelling, particularly in cases involving brain metastases where it helps reduce intracranial pressure. Given its strength, doses may need to be carefully tapered to avoid adverse effects.
Prednisone and Prednisolone
Prednisone is an intermediate-acting steroid often used in treating hematological cancers like lymphomas and multiple myeloma, sometimes directly targeting and killing cancer cells. It is converted into its active form, prednisolone, by the liver. Prednisone can be used to improve appetite and manage fatigue. The dosage can vary widely depending on the indication.
Methylprednisolone
Similar to prednisone, methylprednisolone is an intermediate-acting corticosteroid. It is a potent anti-inflammatory agent used for various supportive care needs during cancer treatment. It is sometimes preferred over other options based on specific patient factors or drug interactions.
Hydrocortisone
This is a short-acting steroid, with both glucocorticoid and mineralocorticoid activity. While less potent than dexamethasone, it is sometimes used for steroid replacement therapy if the body's natural production is affected or for specific anti-inflammatory purposes.
Why are Steroids Given with Chemo?
Steroids are an essential component of many chemotherapy protocols, serving multiple critical functions to help patients tolerate treatment and improve outcomes.
- Controlling Nausea and Vomiting: A primary use of steroids, especially dexamethasone, is to prevent and treat chemotherapy-induced nausea and vomiting (CINV). They are highly effective when combined with other antiemetic drugs.
- Reducing Inflammation and Swelling: Steroids decrease inflammation throughout the body, which is particularly beneficial for reducing swelling associated with brain tumors or conditions like spinal cord compression.
- Managing Allergic Reactions: Some chemotherapy drugs can trigger hypersensitivity reactions. Steroids are often given as premedication to prevent these allergic responses during infusion.
- Improving Appetite and Energy: Many patients experience a loss of appetite and fatigue during treatment. Steroids can help boost appetite and increase energy levels, contributing to a better quality of life.
- Direct Anti-Cancer Effects: In certain hematologic malignancies, such as acute lymphoblastic leukemia (ALL) and some lymphomas, steroids are not just supportive but are a core component of the treatment regimen, directly killing cancer cells.
Managing Common Steroid Side Effects
While steroids offer significant benefits, they also come with a range of potential side effects. Many are temporary and subside after the medication is stopped, but some may require management.
- Insomnia and Mood Changes: Steroids can cause restlessness, anxiety, or mood swings. Taking doses in the morning or early afternoon can help minimize sleep disruption.
- Increased Appetite and Weight Gain: A heightened appetite is a common effect. Focusing on a healthy, balanced diet can help manage weight gain.
- High Blood Sugar: Steroids can cause blood sugar levels to rise, which is especially important for patients with diabetes. Blood sugar will be monitored, and medication may be adjusted.
- Stomach Irritation: To reduce the risk of stomach upset or ulcers, steroids should be taken with food. A doctor may also prescribe a stomach-protective medication.
- Increased Infection Risk: High-dose or long-term steroid use can weaken the immune system, increasing susceptibility to infections. Patients should report any signs of infection immediately.
- Fluid Retention: Swelling in the face, hands, ankles, or legs can occur. This typically improves after treatment.
- Bone Thinning (Osteoporosis): Prolonged use of high-dose steroids can impact bone density. A doctor might prescribe bone-strengthening medication and recommend calcium and vitamin D supplements.
Comparing Common Chemo Steroids
| Feature | Dexamethasone | Prednisone | Methylprednisolone | Hydrocortisone |
|---|---|---|---|---|
| Potency (relative to hydrocortisone) | ~30x | ~4x | ~5x | 1x |
| Duration of Action | Long-acting (36–54h) | Intermediate-acting (12–36h) | Intermediate-acting (12–36h) | Short-acting (8–12h) |
| Primary Uses | CINV prophylaxis, cerebral edema, inflammation | Lymphomas, appetite stimulation, fatigue | Anti-inflammatory effects, supportive care | Steroid replacement, specific anti-inflammatory uses |
| Administration | Oral or IV | Oral | Oral or IV | Oral or IV |
Conclusion
Corticosteroids are a crucial part of many chemotherapy regimens, not for muscle-building but for their potent anti-inflammatory, antiemetic, and, in some cases, anti-cancer properties. They are given to manage side effects like nausea, swelling, and fatigue, significantly improving a patient's comfort and ability to complete their treatment plan. The specific steroid and dosage are tailored to the individual, balancing the benefits of controlling symptoms with potential side effects. Patients should always take these medications exactly as prescribed and should never stop them abruptly without consulting their healthcare team due to the risk of serious withdrawal symptoms. Working closely with your medical team is key to navigating steroid therapy successfully while undergoing chemotherapy. More information on cancer treatment can be found at the MD Anderson Cancer Center.
