{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:25:25Z","timestamp":1787869525808,"version":"build-2784847793"},"reference-count":28,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"25","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Guideline-recommended 4-day dexamethasone (DEX) for highly emetogenic chemotherapy (HEC) raises toxicity and immunotherapy interference concerns. We tested whether DEX reduction or omission with netupitant\/palonosetron (NEPA) plus olanzapine (OLZ) is noninferior to standard DEX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS<\/jats:title>\n                    <jats:p>In this open-label, randomized phase III noninferiority trial across 28 Chinese centers, adults receiving HEC received NEPA (day 1) plus OLZ (days 1-4) and were randomly assigned to standard DEX (12 mg day 1, 8 mg days 2-4), DEX-sparing (6 mg day 1 only), or DEX-free (no DEX). The primary end point was complete response (CR; no emesis\/no rescue medication) from 0 to 120 h. Noninferiority margin was \u201312% (one-sided \u03b1 = .025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of 644 randomly assigned patients (median age 54.9 years; 66.0% female), stratified analysis showed overall CR rates of 72.4% for standard, 72.2% for DEX-sparing (stratified risk difference [RD], \u20130.2% [95% CI, \u20138.7 to 8.5];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>noninferiority<\/jats:sub>\n                      = .005), and 70.1% for DEX-free (stratified RD, \u20132.2% [95% CI, \u201310.7 to 6.4];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>noninferiority<\/jats:sub>\n                      = .014). Both met noninferiority, confirmed in per-protocol analysis. Steroid-related toxicities were significantly lower with DEX-sparing and DEX-free regimens versus standard.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>NEPA plus OLZ with reduced (6 mg day 1 only) or no DEX is noninferior to standard 4-day DEX for chemotherapy-induced nausea and vomiting prevention in HEC, supporting steroid-sparing strategies particularly relevant in the chemo-immunotherapy era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-26-01029","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T19:59:20Z","timestamp":1780603160000},"page":"2390-2399","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Reduced\/No Dexamethasone With Netupitant\/Palonosetron and Olanzapine for Chemotherapy\u2011Induced Nausea\/Vomiting in Highly Emetogenic Chemotherapy: Phase III Noninferiority Trial"],"prefix":"10.1200","volume":"44","clinical-trial-number":[{"clinical-trial-number":"nct06331520","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yanchun","family":"Meng","sequence":"first","affiliation":[{"name":"Phase I Unit, Fudan University Shanghai Cancer Center, Shanghai, China"},{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0578-2123","authenticated-orcid":false,"given":"Yingying","family":"Liu","sequence":"additional","affiliation":[{"name":"Phase I Unit, Fudan University Shanghai Cancer Center, Shanghai, China"},{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingxi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8465-6933","authenticated-orcid":false,"given":"Yuxin","family":"Mu","sequence":"additional","affiliation":[{"name":"Phase I Unit, Fudan University Shanghai Cancer Center, Shanghai, China"},{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Oncology, XinYu People's Hospital, XinYu City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqun","family":"Du","sequence":"additional","affiliation":[{"name":"Phase I Unit, Fudan University Shanghai Cancer Center, Shanghai, China"},{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Liu","sequence":"additional","affiliation":[{"name":"Phase I Unit, Fudan University Shanghai Cancer Center, Shanghai, China"},{"name":"Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, XINSTEEL Center Hospital, Xinyu City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaodong","family":"Tian","sequence":"additional","affiliation":[{"name":"Cancer Center, HuNan University of Medicine General Hospital, HuaiHua City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Thyroid and Breast Surgery Department, The First People's Hospital of KunShan, SuZhou City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojie","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, YiChun People's Hospital, YiChun City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zikang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology, YaAn People's Hospital, YaAn City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinsong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Tumor Surgery, XianTao First People's Hospital, XianTao City, 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