Fractionated chemotherapy--granisetron or conventional antiemetics? The Granisetron Study Group

Two randomised single-blind comparative studies were carried out in patients receiving 5-day fractionated chemotherapy. The first which has been reported previously [1] compared granisetron (40 micrograms/kg) (n = 103) with alizapride (12 mg/kg) plus dexamethasone (8 mg) (n = 94) while the second compared granisetron (40 micrograms/kg) (n = 143) with metoclopramide (7 mg/kg) plus dexamethasone (12 mg) (n = 141). Granisetron, unlike alizapride or metoclopramide is a specific 5-HT3 antagonist. The percentage of complete responders (patients with no vomiting and no worse than mild nausea) over the 5-day treatment period was higher for granisetron than for alizapride/dexamethasone (54% vs. 42.7%) (P = 0.121) or for metoclopramide/dexamethasone (46.8% vs. 43.9%). The percentage of complete responders in the first 24 h was significantly higher for granisetron (90.3%) than for alizapride/dexamethasone (65.9%) (P less than 0.001) or for metoclopramide/dexamethasone (87.4% vs. 67.9% P less than 0.0001). Granisetron was also superior to both comparators in terms of the time to the first episode of moderate/severe nausea and to less than a complete response. Significantly fewer granisetron patients were withdrawn than in the alizapride/dexamethasone group (P = 0.017) or the metoclopramide/dexamethasone group (P less than 0.0001). In both studies more comparator patients were withdrawn due to lack of efficacy and adverse events. Significantly fewer granisetron patients experienced adverse events than in either the alizapride/dexamethasone group (47.6% vs. 61.7%, P = 0.047) or the metoclopramide/dexamethasone group (60.8% vs. 77.3% P = 0.003). Granisetron patients experienced a significantly higher occurrence of constipation in both studies (10.7% vs. 3.2% and 12.6% vs. 2.8%). Headache and fever were also more frequent in the granisetron group, while extrapyramidal effects, reported by 5.3% of the alizapride/dexamethsone group and 20.6% of the metoclopramide/dexamethasone group, were not reported in any granisetron patients.