another long-held assumption/practice of oncologist is ?d--is dexamethasone good?

[Lani]

It was assumed it must be given with chemo--here is evidence (not yet in people) that dexamethasone and other glucocorticoids may induce resistance to chemotherapy rather than help it work better!

Int J Oncol. 2006 Nov;29(5):1295-301. Links
Corticosteroids induce chemotherapy resistance in the majority of tumour cells from bone, brain, breast, cervix, melanoma and neuroblastoma.

Zhang C,
Beckermann B,
Kallifatidis G,
Liu Z,
Rittgen W,
Edler L,
Buchler P,
Debatin KM,
Buchler MW,
Friess H,
Herr I.
Research Group Molecular OncoSurgery, University of Heidelberg, Heidelberg, Germany.
Glucocorticoids (GCs) such as dexamethasone (DEX) have been widely used as co-medication in cancer therapy because they have potent proapoptotic properties in lymphoid cells, can reduce nausea, and alleviate acute toxic effects in healthy tissue. However, GCs are used in a supportive-care role, even though no prospective clinical studies have assessed the effect of these steroids on the growth of solid tumours. Data from preclinical and, to some extent, clinical studies, suggest that GCs induce treatment resistance in some solid tumours. Since it is unknown whether GC-induced resistance occurs only occasionally or is a more common phenomenon, we performed a screening study using several established cell lines from bone, brain, breast and cervix carcinoma as well as melanoma and neuroblastoma together with fresh surgical resections from patients with breast cancer. We found that DEX inhibits cisplatin and 5-fluorouracil-induced apoptosis and promotes the growth of the majority of examined malignant cells. In contrast, and as expected, DEX acted pro-apoptotically and promoted the cytotoxic effect of chemotherapy in established and primary lymphoid cells. Thus, these data demonstrate the need for detailed molecular studies to clarify the mechanism of differential glucocorticoid signaling as well as controlled, prospective clinical studies.
PMID: 17016664 [PubMed - in process]