Are you dose reducing/omitting IV dexamethasone as a pre-medication for anti-emesis in patients with MIBC when using durvalumab/gemcitabine/cisplatin?

In my practice, we routinely give IV dexamethasone on the day of treatment. The question is whether or not to give extended dex on days 2-4 to prevent delayed nausea.

The NIAGARA protocol did permit dex on the day of the treatment but did state "investigators should attempt to limit the use of steroi...

Not routinely, however, assessment of comorbid conditions such as uncontrolled diabetes remains standard. In the recent approval with continuation in the adjuvant space, it may be considered.