Dexamethasone-associated hyperglycemia during chemotherapy in endometrial and ovarian cancer: A retrospective study.

Abstract

e17583 Background: Dexamethasone is frequently administered during chemotherapy to prevent hypersensitivity reactions, nausea, and emesis. However, corticosteroid-induced glycemic disturbance remains underrecognized in gynecologic oncology. We aim to characterize how dexamethasone exposure during chemotherapy is associated with random glucose variability across the treatment cycles in ovarian and endometrial cancer patients. Methods: A retrospective study of ovarian and endometrial cancer patients treated with dexamethasone during their chemotherapy regimens at the McGill University Health Centre between November 2012 and November 2025 was performed. Random glucose measurements for each chemotherapy cycle were extracted from medical records, along with the total cumulative dexamethasone dose across the six cycles of chemotherapy. ROC analysis identified a BMI value predictive of hyperglycemic event (>11.1mmol/L). A linear regression analysis was used to assess the association between BMI and the mean change in random glucose levels, adjusting for total dexamethasone dose. All analyses were stratified by cancer type to examine metabolic responses across patient subgroups. Results: Overall, 300 patients were included (150 ovarian, 150 endometrial); ovarian patients had a median BMI of 25.1 (IQR: 22.5-29.1) and a median age of 63.0 years (54.5-70.0), while endometrial patients had a median BMI of 28.1 (IQR: 24.1-35.4) and a median age of 65.0 years (IQR: 56.7-73.0). Median cumulative dexamethasone dose was 186mg (range: 16-500mg). ROC analysis identified BMI of 23.55 and 25.45 as a predictor of hyperglycemic events in ovarian and endometrial patients, respectively. Hyperglycemic episodes had a rate of 22.0% and 35.0% in ovarian and endometrial cancer patients, respectively (p=0.627). In the endometrial cancer cohort, a greater proportion of patients with BMI>25.0 experienced ≥1 hyperglycemic event compared to those with BMI<25.0 (20.2% vs. 0.0%; 16 vs. 0 events; p=.006), whereas no significant difference was observed in the ovarian cancer cohort (18.6% vs. 9.3%; 8 vs. 5 events; p=.180). In ovarian cancer patients, neither BMI (p=.171) nor dexamethasone dose (p=.250) was associated with random glucose level. In contrast, for endometrial cancer patients, both BMI (p=.045) and dexamethasone dose (p=.032) were independently associated with increased random glucose levels. Conclusions: Dexamethasone exposure during chemotherapy is associated with clinically meaningful increases in random glucose in select gynecological cancer subgroups, particularly in overweight patients. These findings highlight the importance of BMI-informed risk stratification and proactive glucose monitoring to mitigate dexamethasone-related hyperglycemia in gynecologic oncology care.