From mechanism to resistance – changes in the use of dexamethasone in the treatment of multiple myeloma

Figures & data

Table 1. Approved agents for treatment of Multiple Myeloma that include dexamethasone in product label.

Multiple myeloma agent	Dexamethasone noted on label
Bortezomib	Administered either as a single agent or in combination with dexamethasone.
Selinexor	In combination with bortezomib and dexamethasone. Dexamethasone 20 mg taken orally twice weekly on Days 1 and 2 of each week.
Carfilzomib	Dexamethasone 40 mg once per week for 4 weeks in combination with lenalidomide
Daratumumab	Dexamethasone 20 mg (or equivalent) orally or intravenously 1–3 h prior to every daratumumab infusion
Ixazomib Citrate	Dexamethasone is 40 mg administered on Days 1, 8, 15, and 22 of a 28-day treatment cycle.
Lenalidomide	Dexamethasone dosing, 40 mg once daily on Days 1, 8, 15, and 22 of each 28-day cycle. For patients over >75 years old, the starting dose of 20 mg dexamethasone, orally, once daily on days 1,8,15, and 22 of repeated 28-day cycles.
Pomalidomide	Dexamethasone (40 mg/day given only on Days 1, 8, 15, and 22 of each 28-day cycle for patients aged 75 years or younger, or 20 mg/day given only on Days 1, 8, 15, and 22 of each 28-day cycle for patients aged greater than 75 years).
Elotuzumab	On days that elotuzumab is administered, dexamethasone 28 mg orally 3-24 h before elotuzumab plus 8 mg intravenously 45–90 min before elotuzumab. On days elotuzumab is not administered but dexamethasone is scheduled (Days 8 and 22 of cycle 3 and all subsequent cycles), give 40 mg orally.
Thalidomide	Dexamethasone 40 mg/day on days 1–4, 9–12, and 17–20 every 28 days.
Isatuximab-irfc	In combination with pomalidomide and dexamethasone. Premedication - Dexamethasone 40 mg orally or intravenously (or 20 mg orally or intravenously for patients ≥75 years of age). Cycle 1, Days 1, 8, 15, and 22 (weekly). Cycle 2 and beyond, Days 1, 15 (every 2 weeks).
Belantamab mafodotin-blmf	Only agent that does not include dexamethasone in indication.

Figure 1. Mechanism of action of dexamethasone in multiple myeloma.

Table 2. Toxicities associated with dexamethasone.

Musculoskeletal	Gastrointestinal
Osteoporosis Myopathy Osteonecrosis	Gastritis Gastric ulcer formation Gastrointestinal  bleeding Intestinal perforation
Neuropsychiatric Hypomanic reactions Activated states Depression Psychosis Sleep disturbances Behavioral symptoms Euphoria Aggression Mood fluctuations Manic behavior	Dermatologic Ecchymosis Skin thinning and atrophy Acne Mild hirsutism Facial erythema Stria Impaired wound healing Hair thinning Perioral dermatitis
Metabolic and Endocrine New-onset hyperglycemia Cushingoid feature development Weight gain Adrenal gland atrophy/insufficiency	Ophthalmic Cataract formation Increased intraocular pressure/glaucoma Central serous chorioretinopathy
Cardiovascular Fluid retention Edema Weight gain Hypertension Arrhythmias	Immune system Infection Leukocystosis