Roscoe JA, Heckler CE, Morrow GR, Mohile SG, Dakhil SR, Wade JL, Kuebler JPPrevention of delayed nausea: a university of Rochester cancer center community clinical oncology program study of patients receiving chemotherapy. J Clin Oncol 30: 3389-3395

James P. Wilmot Cancer Center, University of Rochester, 601 Elmwood Ave, Box 704, Rochester, NY 14642
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2012; 30(27):3389-95. DOI: 10.1200/JCO.2011.39.8123
Source: PubMed


We conducted a double-blind randomized clinical trial of the following four regimens for controlling delayed nausea (DN): group 1: palonosetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 2: granisetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 3: aprepitant + palonosetron + dexamethasone on day 1 with aprepitant + dexamethasone on days 2 and 3; and group 4: palonosetron + dexamethasone on day 1 with prochlorperazine + dexamethasone on days 2 and 3.

Patients and methods:
Chemotherapy-naive patients received doxorubicin, epirubicin, cisplatin, carboplatin, or oxaliplatin. The primary end point was average nausea assessed four times daily on days 2 and 3. Primary analyses were whether nausea control would be improved by using palonosetron versus granisetron on day 1 (group 1 v group 2); by adding dexamethasone on days 2 and 3 (group 1 v group 4); and by using aprepitant versus prochlorperazine (group 3 v group 4). Statistical significance was set at P = .017.

Two hundred thirty-four, 234, 241, and 235 evaluable patients were accrued to groups 1, 2, 3, and 4, respectively. Adjusted mean differences for the three planned analyses were as follows: palonosetron versus granisetron: -0.01 (95% CI, -0.23 to 0.20; P = .72); adding dexamethasone on days 2 and 3: 0.20 (95% CI, -0.02 to 0.41; P = .01); and using aprepitant versus prochlorperazine: -0.03 (95% CI, -0.24 to 0.19; P = .56).

The addition of dexamethasone on days 2 and 3 reduced DN. Palonosetron and granisetron have similar effects on DN. The beneficial effect of adding aprepitant for control of DN was the same as adding prochlorperazine.

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    • "In the trial conducted by Hesketh et al. [19], 48% of patients had no nausea in the overall phase, and 9% and 25% of patients were reported to have significant nausea in the acute and delayed phases, respectively. In a recent study, Roscoe et al. [24] reported that delayed nausea could be improved by addition of dexamethasone on days 2 and 3, but not by the 5-HT3 receptor antagonist. "
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    ABSTRACT: Combination therapy with aprepitant, serotonin receptor antagonist, and steroids improves the complete response rate of both acute and delayed chemotherapy-induced nausea and vomiting (CINV). However, it is not known whether ramosetron is suitable for administration in combination with aprepitant. Therefore, we conducted a multicenter, open-label, prospective, phase II study in order to assess the efficacy and tolerability of combination therapy with ramosetron, aprepitant, and dexamethasone (RAD) for prevention of cisplatin-based CINV in chemotherapy-naïve patients with solid cancers. Forty-one patients with various solid cancers (31 male and 10 female; median age, 59 years) who received treatment with highly emetogenic chemotherapy (median cisplatin dose, 70 mg/m(2); range 50 to 75 mg/m(2)) were enrolled in this study. Oral aprepitant (125 mg on day 1; 80 mg on days 2 and 3), intravenous ramosetron (0.6 mg on day 1), and oral dexamethasone (12 mg on day 1; 8 mg on days 2-4) were administered for prevention of CINV. The complete response (no emesisand retching and no rescue medication) rate was 94.9% in the acute period (24 hours post-chemotherapy), 92.3% in the delayed period (24-120 hours post-chemotherapy), and 92.3% in the overall period (0-120 hours). The absolute complete response (complete response plus no nausea) rate was 74.4% in the acute period, 51.3% in the delayed period, and 46.2% in the overall period. There were no grade 3 or 4 toxicities related to these antiemetic combinations. RAD regimen is a safe and effective antiemetic treatment for prevention of CINV in patients receiving highly emetogenic chemotherapy.
    Full-text · Article · Sep 2013 · Cancer Research and Treatment
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    ABSTRACT: Nausea and vomiting in the cancer patient may have different causes. However, these frequently occur in relation to chemo- and radiotherapy treatments. Their types are: acute emesis, which occurs in the first 24 hours of treatment; delayed, which appears after and may last for several days; and anticipatory, which occurs prior to chemotherapy treatment. The following are used for their treatment: serotonin receptor inhibitors (ondansetron, granisetron and palonosetron), which are frequently used in combination with steroids (dexamethasone); neurokinin receptor inhibitors (aprepitant and fosaprepitant); other drugs (phenothiazines, haloperidol, metoclopramide, domperidone, benzodiazepines, antacids, anticholinergic, cannabinoids, etc.). Cytostatics are classified as highly emetogenic (they are treated with neurokinin inhibitors, antiserotoninergics and dexamethasone), moderately emetogenic (antiserotoninergics, dexamethasone and occasional neurokinin inhibitors are recommended), low risk (treatment with dexamethasone) and minimum risk (they do not require prophylactic antiemetics). Their efficacy should be reevaluated in each cycle to adapt the treatment to each individual need.
    No preview · Article · Feb 2013 · Medicine - Programa de Formación Médica Continuada Acreditado
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    ABSTRACT: Introduction: Nausea and vomiting are well recognized in different clinical situations, suggesting that no single mechanism is likely to be responsible for their production. Chemotherapy-induced nausea and vomiting (CINV) can have a negative impact on quality of life and this may lead to a refusal of curative therapy or to a decline in palliative benefits offered by cytotoxic treatment. Palonosetron is a new agent in the class of 5-HT3 receptor antagonists (5-HT3RAs), and differs from the other agents by its higher receptor-binding affinity and longer half-life. These pharmacological properties have resulted in improved antiemetic activity in clinical trials, particularly in the treatment of delayed CINV following moderate emetogenic chemotherapy (MEC). Area covered: A systematic review of the medical literature was completed to inform this update. MEDLINE, the Cochrane Collaboration Library and meeting materials from ASCO and MASCC were all searched. Expert opinion: Palonosetron was the only serotonin receptor antagonist approved for prevention of delayed CINV caused by MEC and its use was incorporated in guideline recommendations. To date, several treatment settings such as multiple day chemotherapy require further studies to improve emesis related to therapy.
    No preview · Article · Feb 2013 · Expert Opinion on Pharmacotherapy
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